pharm 144 test 3

An adolescent has recently been experiencing pimples. The nurse notes several closed comedones across the patient's forehead and on the nose. The nurse will expect to teach this patient about the use of which medication? a. Benzoyl peroxide b. Topical clindamycin c. Topical erythromycin d. Topical retinoids

ANS: A Benzoyl peroxide is a first-line drug for mild to moderate acne. Other topical antibiotics and retinoids are used when first-line therapy fails.

A patient with hepatitis B begins treatment with adefovir [Hepsera] and asks the nurse how long the drug therapy will last. The nurse will tell the patient that the medication will need to be taken for: a. a lifetime. b. an indefinite, prolonged period of time. c. 48 weeks. d. until nephrotoxicity occurs.

ANS: B Current guidelines recommend treatment only for patients at highest risk; it is unknown whether treatment should continue lifelong. Treatment is usually prolonged, without a specific period of time. Nephrotoxicity is common but is not the deciding factor when determining length of effective treatment.

A group of people has been exposed to ricin by inhalation of ricin mist. When preparing to receive these victims in the emergency department, nurses will prepare to: a. administer antidotes. b. give chelating agents. c. provide respiratory support. d. start hemodialysis.

ANS: C Within a few hours of inhaling ricin mist, victims experience coughing, tightness in the chest, difficulty breathing, nausea, and muscle aches. The airway may become severely inflamed and edematous and breathing can become extremely difficult. Management of poisoning with ricin is purely supportive. There is no antidote or chelating agent. Hemodialysis is not indicated.

A nurse is attending a conference about terrorism and emergency response. During a discussion of radiation emergencies, the use of potassium iodide is reviewed. When should potassium iodide be administered to be most effective after exposure to radiation? a. Immediately after exposure b. Within 48 hours after exposure c. Within 72 hours after exposure d. The time frame is not important

ANS: A To be the most effective, potassium iodide must be taken immediately after exposure. If taken 48 hours after exposure, the drug is useless.

A nurse at an immunization clinic is providing vaccines to children. The parent of a child waiting to receive vaccines tells the nurse that the child has an immune deficiency disorder. The nurse understands that which vaccine should not be administered to this child? a. Diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine b. Haemophilus influenzae type b (Hib) vaccine c. Polio injection d. Varicella virus vaccine

ANS: D The varicella vaccine should be avoided by individuals who are immunocompromised, which includes those infected with the human immunodeficiency virus (HIV) and those who have a congenital immunodeficiency. The DTaP vaccine, Hib vaccine, and polio injection may be administered to immunocompromised individuals, because these are not live vaccines.

A 50-year-old patient asks about using tretinoin [Renova] to minimize wrinkles. What will the nurse tell the patient? a. The drug may be discontinued once results are obtained. b. Results may be visible within a few weeks of starting therapy. c. Systemic toxicity is a common effect in patients with sensitive skin. d. The drug is not effective on coarse wrinkles or sun-damaged skin.

ANS: D Tretinoin is used to treat fine wrinkles, not coarse wrinkles, and does not repair sun-damaged skin. Treatment with Renova must continue to maintain the response to the drug. Results are not visible for up to 6 months after beginning therapy. Systemic toxicity is not common.

A 1-year-old child is scheduled to receive the MMR vaccine, pneumococcal vaccine (PCV), Varivax, and hepatitis A vaccine. The child's parents request that the MMR vaccine not be given, saying that, even though there is no demonstrated link with autism, they are still concerned about toxic levels of mercury in the vaccine. Which response by the nurse is correct? a. "Most U.S.-made vaccines have zero to low amounts of mercury." b. "Other vaccine preparations contain mercury as well." c. "Thimerosal is a nontoxic form of mercury." d. "You can get more mercury from breast milk and many foods on the market."

ANS: A Because of concerns about mercury levels, most U.S.-made vaccines contain either zero or very low amounts of mercury. Some multidose vials of flu vaccine still contain thimerosal, but even that is a very low amount. Telling parents that other vaccines contain mercury will increase their suspicion about vaccines and further reduce their trust. Thimerosal is a mercury-based preservative and thus has the same toxicity as mercury. Although it is true that mercury is found in breast milk and other foods, telling parents this belittles their concerns about the vaccines.

An otherwise healthy child receives a varicella virus vaccine. Three weeks later the parent calls to report that the child has a mild case of chickenpox and wonders how this could happen after the vaccination. What will the nurse tell the parent? a. "A varicella-like rash can occur after the vaccine is given." b. "The vaccine was probably ineffective." c. "This represents a serious vaccine side effect." d. "Give the child aspirin to treat any fever that may occur."

ANS: A Children who receive the varicella vaccine may sometimes develop a mild, local varicella-like rash within a month of receiving the vaccine. This rash does not indicate that the vaccine was ineffective, and it is not a serious side effect. Because of the association with Reye's syndrome, children should not take aspirin or other salicylates for 6 weeks after receiving the vaccine.

Before giving methenamine [Hiprex] to a patient, it is important for the nurse to review the patient's history for evidence of which problem? a. Elevated blood urea nitrogen and creatinine b. History of reactions to antibiotic agents c. Possibility of pregnancy d. Previous resistance to antiseptic agents

ANS: A Methenamine should not be given to patients with renal impairment, because crystalluria can occur. There is no cross-reactivity between methenamine and antibiotic agents. Methenamine is safe for use during pregnancy. There is no organism drug resistance to methenamine.

The parent of a 2-month-old infant who has just received the first dose of DTaP asks the nurse about expected reactions to the vaccine. The nurse will respond by saying that: a. "Mild reactions, including a low-grade fever, are common." b. "Most children do not experience any reaction." c. "Seizures are common and may require anticonvulsant medication." d. "The most common reaction is a rash that develops into itchy vesicles."

ANS: A Mild reactions to the first dose of the DTaP vaccine are common and most often are manifested by a low-grade fever, fretfulness, drowsiness, and local reactions of swelling and redness. At least 50% of children experience reactions. Seizures are not common. Itchy vesicles do not appear with the DTaP vaccine.

To provide protection against the full range of ultraviolet (UV) radiation, an organic sunscreen must contain which agent? a. Avobenzone b. Para-aminobenzoic acid (PABA) c. Titanium dioxide d. Zinc oxide

ANS: A Only one organic sunscreen, avobenzone, absorbs the full range of UV radiation. The other agents do not protect against the full range of UV radiation. Titanium dioxide and zinc oxide are inorganic screens.

A patient has a positive urine culture 1 week after completion of a 3-day course of antibiotics. The nurse anticipates that the prescriber will: a. begin a 2-week course of antibiotics. b. evaluate for a structural abnormality of the urinary tract. c. initiate long-term prophylaxis with low-dose antibiotics. d. treat the patient with intravenous antibiotics.

ANS: A Patients who develop a subsequent urinary tract infection after treatment are treated in a stepwise fashion, beginning with a longer course of antibiotics. The next steps would be to begin a 4- to 6-week course of therapy, followed by a 6-month course of therapy if that is unsuccessful. If urinary tract infections are thought to be caused by other complicating factors, an evaluation for structural abnormalities may be warranted. Unless the infections are severe or are complicated, intravenous antibiotics are not indicated.

A patient has lamivudine-resistant hepatitis B and has been taking entecavir [Baraclude] for 2 years. The patient asks the nurse why the provider has recommended taking the drug for another year. What will the nurse tell the patient? a. "Entecavir can reverse fibrosis and cirrhosis of the liver when taken long term." b. "It is necessary to continue taking entecavir to avoid withdrawal symptoms." c. "The drug will be given until the infection is completely eradicated." d. "You will need to continue taking entecavir to prevent lactic acidosis and hepatotoxicity."

ANS: A Recent evidence indicates that, with long-term use (3 years), entecavir can reverse fibrosis and cirrhosis. The drug is not continued to avoid withdrawal symptoms. Patients who stop taking entecavir may experience acute exacerbations of hepatitis B; the disease is not eradicated. Entecavir can cause lactic acidosis and hepatotoxicity; it does not prevent these adverse effects.

A nurse is teaching a course in bioterrorism to a group of military nurses. Which statement by a military nurse indicates understanding of the teaching? a. "Although smallpox has been eradicated, it remains a threat." b. "Anthrax is spread rapidly from person to person." c. "Pneumonic plague is not transmitted from person to person." d. "Terrorists spreading tularemia would most likely put it in the water supply."

ANS: A Smallpox has been eradicated as an endemic disease but it remains a threat because so many people are un-immunized. The virus is still available in laboratories throughout the world. Anthrax is not spread from person to person. Pneumonic plague is spread from person to person. Tularemia would be spread by terrorists as an aerosol.

The nurse is discussing upper and lower UTIs. Which of these conditions can be treated at home? (Select all that apply.) a. Acute cystitis b. Acute urethritis c. Recurrent UTI d. Severe pyelonephritis e. Acute bacterial prostatitis

ANS: A, B, C Acute cystitis, urethritis, and recurrent UTIs can be treated on an outpatient basis. Severe pyelonephritis and acute bacterial prostatitis require hospitalization and IV antibiotics.`

An adolescent has begun using benzoyl peroxide lotion twice daily to treat acne. The patient reports experiencing drying and burning of the skin. What will the nurse suggest? a. Applying lotion to the skin after applying the drug b. Reducing the frequency to one application a day c. Discontinuing the medication, because this is likely an allergic reaction d. Requesting a prescription for a gel formulation of the drug

ANS: B Benzoyl peroxide may cause drying and peeling of the skin. If signs of severe local irritation occur, such as burning or blistering, the frequency of application should be reduced. Applying lotion is not indicated. These symptoms are not consistent with an allergic reaction. There is no difference in skin reactions between the gel and the lotion formulations.

Bethanechol [Urecholine] is used to treat urinary retention but is being investigated for use in which other condition? a. Gastric ulcers b. Gastroesophageal reflux c. Hypotension d. Intestinal obstruction

ANS: B Bethanechol is being investigated for treatment for gastroesophageal reflux disease (GERD) because of its effects on esophageal motility and the lower esophageal sphincter. Bethanechol stimulates acid secretion and could intensify ulcer formation. Bethanechol can cause hypotension. Because bethanechol increases the motility and tone of intestinal smooth muscle, the presence of an obstruction could lead to bowel rupture.

A -year-old child who has been receiving high-dose systemic glucocorticoids for several months comes to a clinic for school immunizations, which usually include the DTaP vaccine; varicella virus vaccine [Varivax]; the measles, mumps, and rubella virus (MMR) vaccine; and the inactivated poliovirus vaccine (IPV). The clinic nurse will expect to administer which vaccines to this child? a. All four school immunizations b. DTaP and IPV only c. DTaP, OPV, and Varivax only d. DTaP and IPV, along with immunoglobulins

ANS: B Children who are immunocompromised should not receive live virus vaccines, including the MMR vaccine and Varivax. Children taking high-dose systemic glucocorticoids are immunocompromised and should not receive the vaccine until therapy is stopped and normal glucocorticoid production returns. The oral polio vaccine (OPV) contains live virus and is contraindicated. Immunoglobulins are not indicated unless children are exposed to the diseases themselves.

A 14-year-old patient has moderate acne that has not responded to topical drugs. The nurse will suggest that the patient and her parents discuss which treatment with the provider? a. Combination oral contraceptive medication b. Doxycycline [Vibramycin] c. Isotretinoin [Accutane] d. Spironolactone

ANS: B For moderate to severe acne, oral antibiotics are indicated. Doxycycline is a drug of first choice. Hormonal agents, such as oral contraceptive pills (OCPs), are used in female patients who are at least 15 years old. Isotretinoin is used when other treatments fail and acne is severe. Spironolactone is used when OCPs fail.

A patient with HIV contracts herpes simplex virus (HSV), and the prescriber orders acyclovir [Zovirax] 400 mg PO twice daily for 10 days. After 7 days of therapy, the patient reports having an increased number of lesions. The nurse will expect the provider to: a. extend this patient's drug therapy to twice daily for 12 months. b. give intravenous foscarnet every 8 hours for 2 to 3 weeks. c. increase the acyclovir dose to 800 mg PO 5 times daily. d. order intravenous valacyclovir [Valtrex] 1 gm PO twice daily for 10 days.

ANS: B Foscarnet is active against all known herpesviruses and is used in immunocompromised patients with acyclovir-resistant HSV or VZV. This patient is demonstrating resistance to acyclovir, so extending acyclovir therapy or increasing the acyclovir dose will not be effective. Valacyclovir is not approved for use in immunocompromised patients because of the risk for thrombotic thrombocytopenic purpura/hemolytic uremic syndrome.

A teenaged female patient has begun to develop acne and asks a nurse how to minimize pimple formation. What will the nurse recommend? a. Asking the provider about oral contraceptives b. Cleansing the face gently 2 to 3 times daily c. Eliminating greasy foods from the diet d. Using an abrasive agent to scrub the face

ANS: B Gentle cleansing 2 to 3 times a day can reduce surface oiliness and help minimize acne lesions. Oral contraceptives are not first-line treatment for acne. Eliminating greasy foods from the diet does not affect pimple formation. An abrasive agent is not indicated for mild acne.

A patient will begin initial treatment for severe acne. Which regimen will the nurse expect the provider to order? a. Clindamycin/benzoyl peroxide [BenzaClin] and tretinoin [Retin-A] b. Doxycycline [Vibramycin] and tretinoin [Retin-A] c. Erythromycin [Ery-Tab) and benzoyl peroxide d. Topical clindamycin and isotretinoin [Accutane]

ANS: B Oral antibiotics are used for moderate to severe acne and are usually combined with a topical retinoid. Combination clindamycin/benzoyl peroxide and tretinoin are used for mild to moderate acne. Erythromycin can be used as an oral antibiotic but would need to be combined with a topical retinoid. Isotretinoin is used for severe acne that has not responded to other treatments.

A patient has a positive test for influenza type A and tells the nurse that symptoms began 5 days before being tested. The prescriber has ordered oseltamivir [Tamiflu]. The nurse will tell the patient that oseltamivir: a. may decrease symptom duration by 2 or 3 days. b. may not be effective because of the delay in starting treatment. c. may reduce the severity but not the duration of symptoms. d. will alleviate symptoms within 24 hours of the start of therapy.

ANS: B Oseltamivir is most effective when begun within 2 days after symptom onset. When started within 12 hours of symptom onset, it may decrease duration of symptoms by 2 to 3 days. The drug reduces both symptom severity and symptom duration when used in a timely fashion. It does not rapidly alleviate symptoms.

A patient has developed muscarinic antagonist toxicity from ingestion of an unknown chemical. The nurse should prepare to administer which medication? a. Atropine [Sal-Tropine] IV b. Physostigmine [Antilirium] c. An acetylcholinesterase activator d. Pseudoephedrine [Ephedrine]

ANS: B Physostigmine is indicated for muscarinic antagonist toxicity. Atropine is a drying agent and would only complicate the drying action that arises from the muscarinic antagonist. An acetylcholinesterase activator would only contribute to dryness that arises from the muscarinic antagonist. Ephedrine is not indicated for muscarinic antagonist toxicity.

A prescriber has ordered pilocarpine [Pilocar]. A nurse understands that the drug stimulates muscarinic receptors and would expect the drug to have which action? a. Reduction of excessive secretions in a postoperative patient b. Lowering of intraocular pressure in patients with glaucoma c. Inhibition of muscular activity in the bladder d. Prevention of hypertensive crisis

ANS: B Pilocarpine is a muscarinic agonist used mainly for topical therapy of glaucoma to reduce intraocular pressure. Pilocarpine is not indicated for the treatment of excessive secretions and mucus; in fact, pilocarpine is used to treat dry mouth. Pilocarpine does not inhibit muscular activity in the bladder. Pilocarpine is not used to prevent hypertensive crisis.

The nurse is preparing to discharge a patient with HIV who will continue to take enfuvirtide [Fuzeon] at home. The nurse is providing patient education about the medication. What information about the administration of enfuvirtide is most appropriate for the patient? a. The importance of injecting the drug into two alternating sites daily b. How to reconstitute and self-administer a subcutaneous injection c. The importance of taking the drug with high doses of vitamin E d. Likely drug interactions between enfuvirtide and other antiretroviral drugs

ANS: B The most appropriate information about the administration of enfuvirtide is how to reconstitute and self-administer a subcutaneous injection. The medication should never be injected into the same site or just between two sites. Vitamin E is not indicated for this medication. Enfuvirtide does not appear to cause significant drug interactions.

A member of a community disaster response team received the smallpox vaccine 3 weeks ago and sees a nurse for a follow-up appointment. The nurse examines the area and should expect to see a: a. necrotic vesicle. b. small area of scarification. c. small, fluid-filled blister. d. red bump.

ANS: B With smallpox vaccination, the scab falls off in the third week, leaving a small scar; the nurse should expect to see a scar. A necrotic vesicle would be a symptom of progressive vaccinia (vaccinia necrosum), which develops almost exclusively in those who are immunodeficient. There is progressive necrosis at the inoculation site. During the first week after inoculation, the bump becomes a blister, which begins to dry and develop a scab. Within 3 to 4 days of administration of the vaccine, a red, itchy bump appears.

The nurse asks a graduate nurse, "When a patient in the initial phase of HIV infection is assessed, which findings would you expect to see?" The graduate nurse would be correct to respond with which conditions? (Select all that apply.) a. Respiratory distress b. Fever c. Myalgia d. Lymphadenopathy e. Insomnia

ANS: B, C, D Fever, myalgia, and lymphadenopathy are early signs associated with HIV infection. Respiratory distress and insomnia are not consistent findings in the initial phase of HIV infection.

A patient asks a nurse about who is eligible to receive anthrax vaccine [BioThrax]. The nurse will respond by saying that which groups of people would be candidates for this vaccine? (Select all that apply.) a. Hospital personnel b. Laboratory workers c. Military personnel d. Nursing home residents e. Veterinarians

ANS: B, C, E Immunization for anthrax currently is limited to people considered at risk. BioThrax is approved for people at high risk of exposure to anthrax spores, such as veterinarians and laboratory workers. Also, military personnel are approved to receive this vaccine. Hospital personnel and nursing home residents are not groups at risk of contact with anthrax spores.

The nurse is caring for a patient who is taking a protease inhibitor (PI). Upon review of the laboratory test results, the nurse notes that the patient has newly elevated plasma triglycerides and cholesterol. The nurse expects that the prescriber will manage these levels with: a. lovastatin [Mevacor]. b. simvastatin [Zocor]. c. modified diet and exercise. d. Pancrease.

ANS: C All PIs can elevate plasma levels of cholesterol and triglycerides. Potential interventions for hyperlipidemia include modified diet, exercise, and lipid-lowering agents. Lovastatin and simvastatin should be avoided, because they can accumulate to dangerous levels. Pancrease is not indicated to lower triglycerides and cholesterol.

An 11-year-old boy received all childhood immunizations before attending school as a kindergartner. Which vaccines are recommended for this child at his current age? a. DTaP, MCV4, Varivax b. PCV-23, Td, MMR c. Tdap, MCV4, HPV d. Tdap, Varivax, hepatitis B

ANS: C At age 11, both males and females should receive a booster of diphtheria, tetanus, and pertussis (Tdap); the Menactra vaccine against meningitis (MCV4); and the human papilloma virus (HPV) vaccine. A Varivax booster is not recommended at this age. The PCV-23 vaccine is indicated only in high-risk patients. The Td can be given, but a vaccine with a pertussis component is preferred. The MMR is not given at this age. The hepatitis B vaccine is not given at this age.

A nurse provides teaching for a patient with cytomegalovirus (CMV) retinitis who will receive the ganciclovir ocular implant [Vitrasert]. Which statement by the patient indicates a need for further teaching? a. "My vision may be blurred for 2 to 4 weeks after receiving the implant." b. "Surgical placement of the implant is an outpatient procedure." c. "The implant will remain in place permanently." d. "The implant will slow progression of CMV retinitis."

ANS: C Ganciclovir ocular implants must be replaced every 5 to 8 months and do not remain in place permanently. It is correct that vision may be blurred for 2 to 4 weeks after placement of the implant, that placement is an outpatient procedure, and that the implant will slow progression of CMV retinitis.

A child with eczema has been treated unsuccessfully with a topical glucocorticoid for a year and has skin atrophy and hypopigmentation. The nurse will suggest discussing which drugs with the provider? a. Higher potency topical glucocorticoids b. Topical keratolytic agents c. Topical immunosuppressants d. Topical nonsteroidal anti-inflammatory drugs (NSAIDs)

ANS: C If topical glucocorticoids fail to treat eczema without causing skin atrophy and hypopigmentation, topical immunosuppressants may be used. Higher potency glucocorticoids will only compound the adverse effects. Topical keratolytic agents are not indicated. Topical NSAIDs are not indicated.

A patient is admitted to the hospital with fever, cough, malaise, and weakness. Forty-eight hours later, the symptoms have become progressively worse, and they progress to severe respiratory distress, septicemia, and hemorrhagic meningitis. The nurse recognizes these signs and symptoms as: a. tularemia. b. smallpox. c. inhalation anthrax. d. pneumonic plague.

ANS: C Inhalation anthrax is characterized by fever, cough, malaise, and weakness, which progress 2 to 3 days later to severe respiratory distress, septicemia, and hemorrhagic meningitis. Tularemia is characterized by fever, headache, chills, rigors, body aches, sneezing, and sore throat. Pneumonia and pleuritis may develop. Smallpox is manifested by a vesicular rash, which this patient does not have. Fever is a characteristic of both inhalational anthrax and smallpox. Pneumonic plague is manifested by high fever, cough, dyspnea, and hemoptysis, as well as gastrointestinal symptoms.

A pregnant female patient with bacteriuria, suprapubic pain, urinary urgency and frequency, and a low-grade fever is allergic to sulfa, ciprofloxacin, and amoxicillin. The nurse knows that the best alternative for treating this urinary tract infection is with: a. cephalexin [Keflex]. b. fosfomycin [Monurol]. c. methenamine [Hiprex]. d. nitrofurantoin [Macrodantin].

ANS: C Methenamine is an excellent second-line drug for this patient and is indicated because of the patient's multiple drug sensitivities. It is safe in pregnancy, and there is no drug resistance. Nitrofurantoin has potential harmful effects on the fetus and should not be used during pregnancy. Single-dose regimens are not recommended in pregnant women. Cephalexin can have cross-reactivity with amoxicillin.

A patient who is pregnant has a history of recurrent genital herpesvirus (HSV). The patient asks the nurse what will be done to suppress an outbreak when she is near term. The nurse will tell the patient that: a. antiviral medications are not safe during pregnancy. b. intravenous antiviral agents will be used if an outbreak occurs. c. oral acyclovir [Zovirax] may be used during pregnancy. d. topical acyclovir [Zovirax] must be used to control outbreaks.

ANS: C Oral acyclovir is devoid of serious adverse effects and may be used safely during pregnancy. It is incorrect to tell this patient that antiviral medications are not safe during pregnancy. Oral acyclovir is used to suppress recurrent genital herpes near term; intravenous antiviral medications are not indicated. It is not necessary to rely on topical medications because oral acyclovir is safe.

A nurse is teaching a group of lifeguards about safe sunning. Which statement by a lifeguard indicates understanding of the teaching? a. "Sunscreen should be applied 30 minutes before going outside." b. "I do not need sunscreen when it is cloudy outside." c. "I should reapply sunscreen after swimming." d. "UV radiation does not penetrate through water."

ANS: C Sunscreens should be reapplied after swimming and with profuse sweating. Most sunscreens should be applied at least 30 minutes before going outdoors, but some require application 2 hours before exposure. Clouds do not protect from all UV rays. UV radiation can penetrate at least several centimeters of clear water.

A 1-year-old child receives the MMR vaccine. The next day the child's parent calls the nurse to report that the child has a temperature of 103°F. What will the nurse do? a. File an adverse event report with the Vaccine Adverse Event Reporting System (VAERS). b. Notify the child's provider that thrombocytopenia is likely to occur. c. Reassure the parent that fever can occur with the MMR vaccine. d. Tell the parent to take the child to the emergency department.

ANS: C The MMR vaccine can have several adverse effects, including fever up to 103°F; this is not considered a serious effect and does not warrant filing an adverse event report with VAERS. Thrombocytopenia is a rare but serious side effect of the MMR vaccine but is not associated with fever. There is no need to have the parent take the child to the emergency department.

A patient presents to the emergency department with complaints of chills, severe flank pain, dysuria, and urinary frequency. The patient has a temperature of 102.9°F, a pulse of 92 beats per minute, respirations of 24 breaths per minute, and a blood pressure of 119/58 mm Hg. The nurse would be correct to suspect that the patient shows signs and symptoms of: a. acute cystitis. b. urinary tract infection. c. pyelonephritis. d. prostatitis.

ANS: C The nurse should suspect pyelonephritis. Pyelonephritis is characterized by fever, chills, severe flank pain, dysuria, urinary urgency and frequency, and pyuria and bacteriuria. Clinical manifestations of acute cystitis include dysuria, urinary urgency and frequency, suprapubic discomfort, pyuria, and bacteriuria. Urinary tract infections (UTIs) are very general and are classified by their location. These symptoms are specific to pyelonephritis. Prostatitis is manifested by high fever, chills, malaise, myalgia, localized pain, and various UTI symptoms but not by severe flank pain.

The parents of an infant who will be attending day care tell the nurse that they do not want their child vaccinated against rotavirus because an older cousin developed intussusception after receiving this vaccine. Which response by the nurse is correct? a. "Intussusception is much less serious than getting the disease." b. "It was probably just a coincidental reaction to the vaccine." c. "The newer vaccines for rotavirus are not associated with intussusception." d. "Your child will have herd immunity and won't need the vaccine."

ANS: C The rotavirus vaccine product RotaShield was withdrawn because of the high rate of intussusception associated with it. The two products currently on the market—RotaTeq and Rotarix—do not carry a risk for intussusception. Intussusception can be life threatening, so telling parents it is less serious than the disease is incorrect. Intussusception was not merely a coincidental reaction. Herd immunity is not guaranteed.

A nurse responds when a patient asks why the smallpox vaccine is no longer given. Which statement by the patient indicates a need for further teaching? a. "The smallpox vaccine can cause serious side effects." b. "The smallpox vaccine can confer protection when given after exposure." c. "The smallpox vaccine is too expensive to give routinely." d. "The smallpox vaccine may cause live virus to spread to others."

ANS: C The smallpox vaccine can cause serious side effects and the live virus in the vaccine may be transmitted to others. Because it can confer protection even after exposure to the illness, it may be given when needed. It is not true that it is withheld because it is too expensive.

A patient who is taking didanosine [Videx] reports nausea, vomiting, and abdominal pain. What will the nurse recommend to this patient? a. "Take the drug with food to minimize these side effects." b. "Stop taking the drug immediately and resume taking it once your symptoms subside." c. "Take the medication in the evening to avoid experiencing these kinds of symptoms." d. "You will need laboratory tests to determine if these are serious effects of the drug."

ANS: D As with all NRTIs, pancreatitis may occur and may manifest as nausea, vomiting, and abdominal pain. The patient will need evaluation of serum amylase, triglycerides, and calcium. Taking the drug with food or at a different time of day are not indicated. It is not correct to discontinue the drug and to resume it when symptoms subside, since pancreatitis may be fatal.

A patient will begin using a transdermal preparation of a muscarinic antagonist for overactive bladder (OAB). The nurse teaches the patient what to do if side effects occur. Which statement by the patient indicates the need for further teaching? a. "I can use sugar-free gum for dry mouth." b. "I may need laxatives for constipation." c. "I should keep the site covered to prevent other people from getting the medicine." d. "I will take Benadryl for any itching caused by a local reaction to the patch."

ANS: D Benadryl is an antihistamine, and even though it is not classified as a muscarinic antagonist, it has anticholinergic effects. Giving it with a muscarinic antagonist greatly enhances these effects, so it should not be used. Muscarinic antagonists cause dry mouth, and patients should be taught to use sugar-free gum or candies to help with this. Muscarinic antagonists can cause constipation, and laxatives may be used. Medication applied topically can be transferred to others who come in contact with the skin, so the site should be covered.

A patient with psoriasis has been using a high-potency glucocorticoid. Because of skin atrophy, the provider has ordered a switch to calcitriol [Vectical], a vitamin D3 analog. What will the nurse teach this patient? a. "Calcitriol causes severe photosensitivity." b. "Itching, erythema, and irritation are indications of an allergic reaction." c. "Systemic effects do not occur with this topical agent." d. "You may apply calcitriol to all areas of the skin except the face."

ANS: D Calcitriol may be applied twice daily to all areas except the face. It does not cause severe photosensitivity. Skin irritation does not occur. Systemic effects may occur.

A patient with actinic keratoses has received a prescription for fluorouracil [Carac]. Which statement by the patient indicates understanding of this medication? a. "Healing should occur 6 weeks after beginning treatment." b. "I will apply this drug twice daily." c. "Severe inflammation is an indication for stopping treatment." d. "Tissue ulceration and necrosis are desired effects."

ANS: D Fluorouracil causes tissue disintegration, erosion, ulceration, and necrosis as part of the normal course of desired effects. Complete healing may take several months, although treatment lasts 2 to 6 weeks. Carac is applied once daily. Severe inflammation is part of the course of treatment and not an indication for discontinuing the medication.

After starting an antiviral protease inhibitor, a patient with HIV telephones the nurse, complaining, "I'm so hungry and thirsty all the time! I'm urinating 10 or 12 times a day." The nurse recognizes these findings to be consistent with: a. pancreatic infiltration by HIV. b. allergic reaction. c. nonadherence to the antiviral regimen. d. hyperglycemia.

ANS: D Protease inhibitors have been associated with hyperglycemia, new-onset diabetes, abrupt exacerbation of existing diabetes, and diabetic ketoacidosis. These symptoms are not consistent with pancreatic infiltration or an allergic reaction. No evidence indicates that the patient is noncompliant.

A female patient who has hepatitis C is being treated with pegylated interferon alfa and ribavirin [Ribasphere]. It will be important for the nurse to teach this patient that: a. if she gets pregnant, she should use the inhaled form of ribavirin [Virazole]. b. if she is taking oral contraceptives, she should also take a protease inhibitor. c. she should use a hormonal contraceptive to avoid pregnancy. d. she will need a monthly pregnancy test during her treatment.

ANS: D Ribavirin causes severe fetal injury and is contraindicated during pregnancy. Women taking ribavirin must rule out pregnancy before starting the drug, monthly during treatment, and monthly for 6 months after stopping treatment. Inhaled ribavirin is also embryo lethal and teratogenic. Adding a protease inhibitor will reduce the efficacy of oral contraceptives. Women using ribavirin should use two reliable forms of birth control.

An immigrant child is in the clinic for MMR vaccination. The nurse learns that the child has recently received an immune globulin injection for a viral infection, currently has an upper respiratory infection with a temperature of 100°F, and has a recent history of thrombocytopenia, which has resolved. What does the nurse tell the child's parents? a. "The vaccine is contraindicated in this child because of the history of thrombocytopenia." b. "The child should be brought back for the vaccine when the temperature is back to normal." c. "The child is at increased risk of developing autism from this vaccine." d. "The vaccine must be postponed for 3 months after administration of the immune globulin."

ANS: D The MMR vaccine should be postponed in children who have received immunoglobulins, because the immunoglobulin contains antibodies against the viruses in the vaccine. Thrombocytopenia is not a contraindication to the MMR vaccine. A low-grade temperature is not a contraindication. There is no link between receiving the MMR vaccine and the development of autism.

A patient who has esophageal cancer is experiencing dry mouth and the provider orders oral pilocarpine to treat this symptom. What will the nurse expect to teach this patient about this medication? a. "This medication may cause rapid heart rate and elevated blood pressure." b. "This medication may cause constipation and gastric discomfort in large doses." c. "You should experience sweating with this medication and should not have other side effects." d. "You will begin taking 5 mg three times daily and may increase the dose to 10 mg."

ANS: D The dosing for pilocarpine, when used for dry mouth associated with head and neck cancers, is 5 mg three times daily, which may be titrated up to 10 mg three times daily. Tachycardia and constipation are side effects of atropine. Sweating occurs with low doses of pilocarpine. Higher doses, such as this, are associated with the full range of muscarinic effects.

The nurse is caring for a patient who is HIV positive and is taking zidovudine [Retrovir]. Before administering the medication, the nurse should monitor which laboratory values? a. Ketones in the urine and blood b. Serum immunoglobulin levels c. Serum lactate dehydrogenase d. Complete blood count (CBC)

ANS: D The nurse should monitor the patient's CBC to determine whether the patient has anemia and neutropenia. Ketones are not an adverse effect of zidovudine. Nothing indicates a need to monitor the immunoglobulin levels or serum lactate dehydrogenase.

An older male patient comes to the clinic with complaints of chills, malaise, myalgia, localized pain, dysuria, nocturia, and urinary retention. The nurse would most likely suspect that the patient has: a. acute cystitis. b. urinary tract infection. c. pyelonephritis. d. prostatitis.

ANS: D The nurse should suspect prostatitis, which is manifested by high fever, chills, malaise, myalgia, and localized pain and may also be manifested by dysuria, nocturia, and urinary urgency, frequency, and retention. Clinical manifestations of acute cystitis include dysuria, urinary urgency and frequency, suprapubic discomfort, pyuria, and bacteriuria. Urinary tract infections are very general and are classified by their location. Pyelonephritis is characterized by fever, chills, severe flank pain, dysuria, and urinary frequency and urgency, as well as by pyuria and bacteriuria.

Which patient with a urinary tract infection will require hospitalization and intravenous antibiotics? a. A 5-year-old child with a fever of 100.5°F, dysuria, and bacteriuria b. A pregnant woman with bacteriuria, suprapubic pain, and fever c. A young man with dysuria, flank pain, and a previous urinary tract infection d. An older adult man with a low-grade fever, flank pain, and an indwelling catheter

ANS: D The patient with an indwelling catheter and signs of pyelonephritis shows signs of a complicated UTI, which is best treated with intravenous antibiotics. The other three patients show signs of uncomplicated urinary tract infections that are not severe and can be treated with oral antibiotics.

Terrorists have detonated a "dirty bomb" in a shopping center. Nurses are called to the site to assist with triage of victims. Besides treating injuries incurred from the blast itself, the priorities for treatment for most of the victims will include: a. administering potassium iodide as soon as possible. b. giving Prussian blue and monitoring electrolytes. c. monitoring urine and stool samples for radioactivity. d. removing clothing and bathing victims.

ANS: D The primary danger from a dirty bomb is the blast itself, and not the radiation, since dispersal of the radiation is limited to a relatively small area. Persons exposed should remove clothing as soon as possible and then decontaminate the skin by showering or bathing. Since dirty bombs do not release iodine-131, taking potassium iodide is of no benefit. Prussian blue is used to hasten excretion of radioactive cesium and radioactive and non-radioactive thallium. Patients treated with Prussian blue should have close monitoring of stools and urine.

A patient who is taking nitrofurantoin calls the nurse to report several side effects. Which side effect of this drug causes the most concern and would require discontinuation of the medication? a. Anorexia, nausea, and vomiting b. Brown-colored urine c. Drowsiness d. Tingling of the fingers

ANS: D Tingling of the fingers can indicate peripheral neuropathy, which can be an irreversible side effect of nitrofurantoin. The other side effects are not serious and can be reversed.

The nurse is providing smallpox vaccinations after determining that an individual who works for a local military laboratory was exposed. After administering the vaccine, how should the nurse instruct the individual to care for the site? a. Cover the site with a bandage. b. Leave the site open to the air. c. Cover the site with a nonpermeable, occlusive dressing. d. Cover the site with sterile gauze and tape the edges.

ANS: D To prevent the spread of live viruses, which the vaccine contains, the site should be covered with a secure, sterile gauze or a semipermeable membrane. If a vaccination site is not securely covered, the vaccine, which contains live viruses, can be transferred to other areas of the body and to other people. A bandage is not a secure device. A semipermeable dressing, not a nonpermeable dressing, can be used to cover the inoculation site.

An adolescent patient with moderate acne has begun a regimen consisting of combination clindamycin/benzoyl peroxide [BenzaClin] and tretinoin [Retin-A]. Which statement by the patient indicates understanding of this medication regimen? a. "I should apply the Retin-A immediately after bathing." b. "I should apply the Retin-A twice daily." c. "I should augment this therapy with an abrasive soap." d. "I should use sunscreen every day."

ANS: D Tretinoin increases susceptibility to sunburn, so patients should be warned to apply a sunscreen and wear protective clothing. Before applying Retin-A, the skin should be washed, toweled dry, and allowed to dry fully for 15 to 30 minutes. Retin-A is applied once daily. Abrasive soaps intensify localized reactions to Retin-A and should not be used.

An older adult patient who lives alone and is somewhat forgetful has an overactive bladder (OAB) and reports occasional constipation. The patient has tried behavioral therapy to treat the OAB without adequate results. Which treatment will the nurse anticipate for this patient? a. Oxybutynin short-acting syrup b. Oxybutynin [Ditropan XL] extended-release tablets c. Oxybutynin [Oxytrol] transdermal patch d. Percutaneous tibial nerve stimulation (PTNS)

An older adult patient who lives alone and is somewhat forgetful has an overactive bladder (OAB) and reports occasional constipation. The patient has tried behavioral therapy to treat the OAB without adequate results. Which treatment will the nurse anticipate for this patient? a. Oxybutynin short-acting syrup b. Oxybutynin [Ditropan XL] extended-release tablets c. Oxybutynin [Oxytrol] transdermal patch d. Percutaneous tibial nerve stimulation (PTNS)

A patient who is taking nelfinavir [Viracept] calls the nurse to report moderate to severe diarrhea. What will the nurse expect the provider to recommend? a. An over-the-counter antidiarrheal drug b. Immediate discontinuation of the nelfinavir c. Reducing the dose of nelfinavir by half d. Taking the nelfinavir with food to avoid side effects

ANS: A A dose-limiting effect of nelfinavir is moderate to severe diarrhea, which can be managed with OTC antidiarrheal medications. Unless the symptoms become severe, withdrawing the nelfinavir is not indicated. Reducing the dose by half or taking it with food is not indicated.

A patient asks a nurse what a sun protection factor (SPF) of 15 indicates. The nurse will tell the patient that an SPF of 15 indicates: a. a 93% block of UVB radiation. b. half the protection of a sunscreen with an SPF of 30. c. low protection. d. that it takes 15 minutes for the sun to burn.

ANS: A A sun protection factor of 15 indicates a 93% block of UVB. As the SPF increases, the increment in protection gets progressively smaller, so an SPF of 15 is not half that of an SPF of 30. Low protection is indicated by an SPF of 2 to 14. The SPF is calculated by the time required for the development of erythema in the protected region divided by the time required for development of erythema in the unprotected region.

A patient with severe psoriasis will begin taking acitretin [Soriatane]. The nurse obtains a health history and learns that the patient takes a combination oral contraceptive. What will the nurse do? a. Counsel the patient to use another form of birth control along with the OCP. b. Tell the patient she may stop using contraception when the medication is withdrawn. c. Tell the patient that acitretin is safe to take during pregnancy. d. Tell the patient to report spotting to the provider so that another form of contraceptive may be ordered.

ANS: A Acitretin is contraindicated during pregnancy and can reduce the effectiveness of progestin-only oral contraceptives. Patients should be counseled to use two reliable forms of birth control when taking this drug. Patients must continue using birth control for at least 3 months after treatment has stopped. Acitretin is teratogenic. Patients may experience spotting with progestin-only contraceptives, which this woman is not taking.

A prescriber has ordered bethanechol [Urecholine] for a postoperative patient who has urinary retention. The nurse reviews the patient's chart before giving the drug. Which part of the patient's history would be a contraindication to using this drug? a. Asthma as a child b. Gastroesophageal reflux c. Hypertension d. Hypothyroidism

ANS: A Bethanechol is contraindicated in patients with active or latent asthma, because activation of muscarinic receptors in the lungs causes bronchoconstriction. It increases the tone and motility of the gastrointestinal (GI) tract and is not contraindicated in patients with reflux. It causes vasodilation and would actually lower blood pressure in a hypertensive patient. It causes dysrhythmias in hyperthyroid patients.

A patient with HIV and mucocutaneous HSV is being treated with foscarnet after failing treatment with acyclovir. After 2 weeks, the patient's dose is increased to 90 mg/kg over 2 hours from 40 mg/kg over 1 hour. The patient reports numbness in the extremities and perioral tingling. What will the nurse do? a. Notify the provider and request an order for a serum calcium level. b. Notify the provider of potential foscarnet overdose. c. Request an order for a creatinine clearance level. d. Request an order of IV saline to be given before the next dose.

ANS: A Foscarnet frequently causes hypocalcemia and other electrolyte and mineral imbalances. Paresthesias, numbness in the extremities, and perioral tingling can indicate hypocalcemia, so a calcium level should be drawn. These are not signs of foscarnet overdose. Nephrotoxicity may occur, but these are not signs of renal complications, so a creatinine clearance is not indicated. If nephrotoxicity occurs, prehydration with IV saline is indicated to reduce the risk of renal injury.

A pregnant patient with fever, flank pain, and chills has a history of two previous bladder infections before getting pregnant. She is allergic to several antibiotics. She reports having taken methenamine successfully in the past. What will the nurse tell her? a. "This agent is not effective against infections of the upper urinary tract." b. "This antiseptic agent is safe for use during pregnancy and has no drug resistance." c. "This drug is linked to many serious birth defects and is not recommended during pregnancy." d. "You will need to take this medication with meals to avoid gastric upset."

ANS: A Methenamine is safe for use during pregnancy and would be an excellent choice for this patient if she had a lower urinary tract infection. However, it is not an effective agent for upper urinary tract infection, because it is a prodrug that must break down into ammonia and formaldehyde to be effective. There is not enough time for formaldehyde to form in the kidneys, so it is not effective in the upper tract. Nitrofurantoin is linked to serious birth defects and also must be given with food to prevent gastrointestinal problems.

A nurse is preparing to administer medications to a patient recently started on delavirdine [Rescriptor]. Which concurrent prescription should the nurse question before administration? a. Alprazolam [Xanax] b. Diphenhydramine [Benadryl] c. Morphine d. Penicillin

ANS: A To prevent toxicity from excessive drug levels, patients should not take alprazolam while taking delavirdine. Diphenhydramine, morphine, and penicillin are not contraindicated for patients taking delavirdine.

The nurse is caring for a patient who is HIV positive and has a previous history of drug and alcohol abuse. The patient is being treated with combination therapies, including didanosine [Videx]. Which laboratory findings would most concern the nurse? a. Increased serum amylase and triglycerides and decreased serum calcium b. Decreased serum amylase and serum triglycerides and increased serum calcium c. Decreased hemoglobin and hematocrit d. Increased serum amylase, decreased triglycerides, and increased platelets

ANS: A The nurse should be concerned about increased serum amylase triglycerides and a decreased serum calcium, which are symptoms of pancreatitis, the major adverse effect of didanosine. The other laboratory test results and assessment findings are not consistent with pancreatitis and are not a concern for the nurse.

3. The nurse is caring for a patient receiving intravenous acyclovir [Zovirax]. To prevent nephrotoxicity associated with intravenous acyclovir, the nurse will: a. hydrate the patient during the infusion and for 2 hours after the infusion. b. increase the patient's intake of foods rich in vitamin C. c. monitor urinary output every 30 minutes. d. provide a low-protein diet for 1 day before and 2 days after the acyclovir infusion.

ANS: A The nurse should ensure that the patient is hydrated during the acyclovir infusion and for 2 hours after the infusion to prevent nephrotoxicity. Increasing vitamin C would not help prevent nephrotoxicity. Monitoring urine output is important but would not help prevent nephrotoxicity. A low-protein diet is not indicated after an acyclovir infusion.

A patient comes to the clinic and receives valacyclovir [Valtrex] for a herpes-zoster virus. The nurse instructs the patient to take the medication: a. without regard to meals. b. without any dairy products. c. each morning. d. on an empty stomach.

ANS: A The patient may take the medication without regard to meals. The patient does not need to avoid dairy products, take the pill only in the morning, or take it on an empty stomach.

Nitrofurantoin [Macrodantin] is prescribed for an adolescent female patient with acute cystitis. What should the nurse include in the teaching for this patient? (Select all that apply.) a. "Make sure you tell your prescriber if you might be pregnant." b. "If you experience any tingling or numbness, stop taking the drug and call the clinic immediately." c. "Headaches and drowsiness can occur and are mild side effects." d. "You should not take sulfonamides while taking this medication." e. "Your urine may have a brown tinge while you are taking this drug."

ANS: A, B, C, E Nitrofurantoin is linked to serious birth defects and is not recommended during pregnancy. Tingling and numbness indicate neuropathy, which is a serious and often irreversible side effect. Central nervous system (CNS) side effects usually are mild and reversible. Sulfonamides cannot be taken with methenamine, because they can cause crystalluria. Patients' urine may have a brown tinge while they are taking this drug.

The public health nurse is teaching a group of parents about immunizations. The nurse tells the parents that after receiving the varicella virus vaccine, children should temporarily avoid close contact with whom? (Select all that apply.) a. Neonates b. Siblings c. Relatives older than 65 years d. Pregnant women e. Individuals infected with HIV

ANS: A, D, E To reduce the risk of transmission, vaccine recipients should temporarily avoid close contact with susceptible high-risk individuals (e.g., neonates, pregnant women, and immunocompromised people).

A patient has a positive test for hepatitis C and is admitted to the hospital. The admission laboratory tests reveal a normal ALT, and a liver biopsy is negative for hepatic fibrosis and inflammation. The nurse will prepare this patient for: a. dual therapy with pegylated interferon alfa and ribavirin. b. no medication therapy at this time. c. pegylated interferon alfa only until ALT levels are elevated. d. triple drug therapy with pegylated interferon alfa, ribavirin, and boceprevir.

ANS: B Current recommendations are that treatment is used only for patients with HCV viremia, persistent elevation of ALT, and evidence of hepatic fibrosis and inflammation upon liver biopsy. Dual therapy has been the regimen of choice for patients with the above symptoms, but the addition of a protease inhibitor has been shown to improve outcomes. It is not correct to give pegylated interferon alfa until ALT levels are elevated. Triple drug therapy is used for patients with the above symptoms.

A nurse is teaching a group of nursing students about influenza prevention. Which statement by a student indicates understanding of the teaching? a. "I may develop a mild case of influenza if I receive the vaccine by injection." b. "I should receive the vaccine every year in October or November." c. "If I have a cold I should postpone getting the vaccine." d. "The antiviral medications are as effective as the flu vaccine for preventing the flu."

ANS: B Influenza vaccine should be given every year in October or November. The vaccine will not cause influenza. Minor illnesses, such as a cold, are not a contraindication for receiving the vaccine. Antiviral medications are not as effective as the flu vaccine in preventing influenza.

A patient received atropine intravenously before surgery. The recovery room nurse notes that the patient is delirious upon awakening and has a heart rate of 96 beats per minute, a respiratory rate of 22 breaths per minute, and a blood pressure of 110/78 mm Hg. The nurse notifies the anesthesiologist, who will order: a. activated charcoal to minimize intestinal absorption of the antimuscarinic agent. b. an acetylcholinesterase inhibitor to compete with the antimuscarinic agent at receptors. c. an antipsychotic medication to treat the patient's central nervous system symptoms. d. ipratropium bromide [Atrovent] to counter the respiratory effects of the antimuscarinic agent.

ANS: B This patient is showing signs of antimuscarinic toxicity, caused by the atropine given during surgery. The most effective antidote is physostigmine, which inhibits acetylcholinesterase, allowing acetylcholine to build up at cholinergic junctions and compete with the antimuscarinic agent for receptor binding. Activated charcoal is useful only if an antimuscarinic agent has been ingested, because it impedes absorption from the GI tract. Because this patient's psychotic symptoms are caused by an antimuscarinic agent, physostigmine should be given to treat the cause; an antipsychotic medication would only treat the symptom. Ipratropium bromide is an antimuscarinic agent and would only compound the effects. This patient's respiratory rate is only mildly elevated.

Which are recommended measures to help minimize pain associated with vaccine administration? (Select all that apply.) a. Administer acetaminophen or ibuprofen before the vaccine is given. b. Apply a topical anesthetic to the injection site before the vaccine is given. c. Give intramuscular vaccines rapidly without aspiration. d. Have the child lie down while the vaccine is given. e. Provide tactile stimulation as a diversion.

ANS: B, C, E Topical anesthetics and tactile stimulation are helpful for minimizing pain associated with vaccine administration, as is giving IM injections rapidly without aspirating. Acetaminophen and ibuprofen are not recommended, because they can inhibit the immune response to the vaccine. Allowing the child to sit up helps minimize pain.

The nurse is caring for a patient who is receiving an infusion of botulinum antitoxin after consuming botulinum toxin in contaminated food. The patient has developed double vision, slurred speech, and upper body muscle weakness. The patient's spouse asks the nurse what the antitoxin will do. Which response is correct? a. "The antitoxin is an antidote to the botulinum toxin." b. "This medication helps restore strength in weakened muscles." c. "This infusion will help prevent further nerve damage." d. "The antitoxin will reverse the symptoms within a couple of days."

ANS: C Botulinum antitoxin contains neutralizing antibodies and can minimize further nerve damage, but cannot reverse damage that has already set in. It is not an antidote to the toxin. It does not restore strength in weakened muscles.

The nurse is caring for a patient who is human immunodeficiency virus (HIV) positive and is taking high doses of zidovudine [Retrovir]. The nurse is providing patient education about the adverse effects of the medication. Which statement by the patient demonstrates a need for further teaching? a. "I may experience fatigue from anemia." b. "I may be more susceptible to infection from neutropenia." c. "I may have a deficiency of vitamin B6." d. "I may have a deficiency of folic acid."

ANS: C A deficiency of vitamin B12, not vitamin B6, would be expected; this statement indicates that further teaching is required. With high-dose zidovudine, the patient can expect anemia, neutropenia, and folic acid deficiency.

A patient receives topical atropine to facilitate an eye examination. The nurse will tell the patient to remain in a darkened room or to wear sunglasses for several hours until the effects of the medication wear off. This teaching is based on the nurse's knowledge that muscarinic antagonists cause: a. elevation of intraocular pressure. b. miosis and ciliary muscle contraction. c. paralysis of the iris sphincter. d. relaxation of ciliary muscles.

ANS: C By blocking muscarinic receptors in the eye, atropine causes paralysis of the iris sphincter, which prevents constriction of the pupil; consequently, the eye cannot adapt to bright light. This also causes an elevation in intraocular pressure, which increases the risk of glaucoma. However, it is not an indication for wearing darkened glasses. Muscarinic agonists cause miosis; atropine causes mydriasis. The effect of relaxing ciliary muscles focuses the eye for far vision, causing blurred vision.

The parent of a 5-year-old child who has had four urinary tract infections in the past year asks the nurse why the provider doesn't just order an antibiotic for the child's current symptoms of low-grade fever, flank pain, and dysuria since these are similar symptoms as before. Which is the most important reason given by the nurse? a. "Your child may need to be hospitalized for treatment." b. "Your child may need a urine culture before and after treatment." c. "Your child may need tests to assess for urinary tract abnormalities." d. "Your child may need additional medications, such as urinary tract antiseptics."

ANS: C Children with recurrent urinary tract infections should be assessed for underlying urinary tract abnormalities to help determine a possible cause for recurrence. This child has mild fever and therefore may not require hospitalization. Urine cultures are important when treating patients with recurrent UTI prophylactically, but this is not the most important consideration. Urinary tract antiseptics are used to treat uncomplicated lower urinary tract infections.

A patient reported to have been exposed to mustard gas is brought to the emergency department. The patient's skin is red and swollen with small blisters, and the patient's eyes are red and tearing. The patient has a runny nose and a dry, barking cough. What should the nurse's initial action be? a. Prepare for renal dialysis. b. Provide oxygen and prepare for mechanical ventilation. c. Remove the patient's clothing and clean the skin with soap and water. d. Rush the patient to the intensive care unit for cardiorespiratory monitoring.

ANS: C Patients exposed to sulfur mustard should undress immediately and wash three times with soap and water. Renal dialysis is not indicated. Oxygen may be useful but is not as important as decontamination. Rushing the patient to the ICU should not be the initial action.

A nursing student asks a nurse why pegylated interferon alfa is used instead of regular interferon for a patient with hepatitis C. The nurse will tell the student that pegylated interferon: a. decreases the need for additional medications. b. has fewer adverse effects than interferon. c. is administered less frequently than interferon. d. may be given orally to increase ease of use.

ANS: C Pegylated interferon alfa preparations are preferred because of their convenience and superior efficacy. These preparations may be given once weekly instead of three or more times per week like the regular interferon. Using pegylated interferons does not decrease the need for additional medications. Pegylated interferons have similar adverse effects. Pegylated interferons are not given orally.

A 30-year-old male patient reports having two to four urinary tract infections a year. What will the nurse expect to teach this patient? a. "Make sure you void after intercourse and drink extra fluids to stay well hydrated." b. "We will treat each infection as a separate infection and treat with short-course therapy." c. "You will need to take a low dose of medication for 6 months to prevent infections." d. "You will need to take antibiotics for 4 to 6 weeks each time you have an infection."

ANS: C This patient has reinfection of his urinary tract at a rate of more than three per year, which is an indication for long-term prophylaxis. Voiding after intercourse is a good teaching point for sexually active women to prevent urinary infections, but it is not a sufficient preventive measure for recurrent infections in men. Short-course therapy may be used for each occurrence of infection if the reinfection rate is less than three per year. Long-term treatment for individual infections is recommended if relapse occurs or if infections do not clear with shorter-term therapy.

An immunocompromised child is exposed to chickenpox and the provider orders valacyclovir [Valtrex] to be given orally three times daily. The nurse will contact the provider to change this order for which reason? a. Valacyclovir is not used as varicella prophylaxis. b. The dosage is too high for this indication. c. The drug may cause serious adverse effects in immunocompromised patients. d. Valacyclovir is not approved for use in children.

ANS: C Valacyclovir is approved for use for varicella in immunocompetent children. In immunocompromised patients, it has produced a syndrome known as thrombotic thrombocytopenic purpura/hemolytic uremia syndrome (TTP/HUS). The dosage is fine for immunocompetent children.

A patient starting therapy with efavirenz [Sustiva] asks about the timing of the medication with regard to meals. What patient education about the administration of this medication should the nurse provide? a. The drug must be taken within 30 minutes after a meal. b. The drug is best taken with a high-fat meal. c. The drug can be taken anytime without regard to meals. d. The drug should be taken once daily on an empty stomach.

ANS: D The nurse should advise the patient that the medication should be taken once daily on an empty stomach. Thirty minutes after a meal is too soon to take the medication. The medication is taken on an empty stomach, because high-fat meals increase plasma levels by 39% with capsules and by 79% with tablets. The medication must not be taken with high-fat meals.

A patient with a history of renal calculi has fever, flank pain, and bacteriuria. The nurse caring for this patient understands that it is important for the provider to: a. begin antibiotic therapy after urine culture and sensitivity results are available. b. give prophylactic antibiotics for 6 weeks after the acute infection has cleared. c. initiate immediate treatment with broad-spectrum antibiotics. d. refer the patient for intravenous antibiotics and hospitalization.

ANS: A Patients with renal calculi are more likely to have complicated urinary tract infections that have less predictable microbiologic etiologies. Because the symptoms are mild, it is important first to obtain a culture and sensitivity to assist with antibiotic selection. If symptoms worsen, a broad-spectrum antibiotic may be started until sensitivity information is available. Intravenous antibiotics are indicated for severe pyelonephritis. Long-term prophylaxis is not indicated unless this patient develops frequent reinfection.

A male patient with hepatitis C will begin triple drug therapy with pegylated interferon alfa 2a [Pegasys], ribavirin [Ribasphere], and boceprevir [Victrelis]. The patient tells the nurse that his wife is pregnant. What will the nurse tell him? a. Boceprevir is contraindicated in males whose partners are pregnant. b. He should use a barrier contraceptive when having sex. c. He should use dual drug therapy with pegylated interferon alfa and ribavirin only. d. This combination drug therapy is safe for him to use.

ANS: A The triple combination is dangerous for pregnant women whose partners are using it, so it is contraindicated for any man whose partner is pregnant. Barrier contraceptives should be used by couples to prevent pregnancy when either partner is taking the triple combination therapy. Ribavirin is teratogenic and is not safe when a partner is pregnant. This combination is not safe for pregnant women whose partners are taking these drugs.

A 20-year-old female patient has suprapubic discomfort, pyuria, dysuria, and bacteriuria greater than 100,000/mL of urine. Which are the most likely diagnosis and treatment? a. Uncomplicated lower urinary tract infection treatable with short-course therapy b. Complicated lower urinary tract infection treatable with single-dose therapy c. Uncomplicated upper urinary tract infection requiring 14 days of oral antibiotics d. Complicated upper urinary tract infection requiring parenteral antibiotics

ANS: A These are symptoms of uncomplicated cystitis, which is a lower urinary tract infection that can be treated with a short course of antibiotics. Short-course therapy is more effective than single-dose therapy and is preferred. A complicated lower urinary tract infection would be associated with some predisposing factor, such as renal calculi, an obstruction to the flow of urine, or an indwelling catheter. Upper urinary tract infections often include severe flank pain, fever, and chills.

A clinic nurse receives a phone call from a parent who states that a 2-month-old infant has a severe cough, a low-grade fever, and a runny nose that have lasted over a week. What will the nurse ask the parent? a. Whether the infant has had the first set of vaccines b. Whether the infant received a hepatitis B vaccine as a newborn c. Whether the infant attends day care d. Whether there is a family history of respiratory disorders

ANS: A This infant may have pertussis, for which the primary symptoms are low-grade fever, persistent cough, and runny nose. Infants who have not received the first set of immunizations, including the DTaP vaccine, are especially vulnerable to this disease. The hepatitis B vaccine does not protect against these symptoms. Asking about day care may be important for evaluating exposure, but differentiating between the cough of pertussis and other coughs is best done by determining immunization status. A family history of respiratory disorders may indicate whether the symptoms are related to a chronic lung disease, but these do not usually manifest at 2 months of age.

The nurse is providing education to a group of patients who are HIV positive. The nurse is discussing the various medications used to treat HIV infection. A patient asks about nevirapine [Viramune]. Which statements by the nurse most accurately reflect the facts about nevirapine? (Select all that apply.) a. "Some herbal preparations can reduce the levels of this drug." b. "This agent can damage the liver; therefore, liver function tests are needed periodically." c. "Usually no adverse effects occur when this medication is used alone." d. "The drug must be dosed five times per day at evenly spaced intervals." e. "You should call your healthcare provider immediately if you develop a rash."

ANS: A, B, E Some herbal preparations can reduce the levels of nevirapine, which can damage the liver. The patient should call the healthcare provider immediately if a rash develops. Many adverse effects are associated with the use of nevirapine. In adults, nevirapine is dosed once daily initially, not five times a day.

A patient is using a high-concentration keratolytic agent containing 20% salicylic acid to remove warts. What will the nurse teach this patient? a. Peeling and drying are desired effects of this drug. b. Systemic effects may occur with this medication. c. Tinnitus is a common side effect of little concern. d. Tissue injury is unlikely at this dose.

ANS: B Salicylic acid is readily absorbed through the skin, and systemic toxicity can result. Peeling and drying are not desired effects of salicylic acid. Tinnitus is a symptom of systemic toxicity. Tissue injury is likely in any concentration above 6%.

A nurse is discussing the use of tazarotene [Tazorac] with a patient who has psoriasis. Which statement by the patient indicates a need for further teaching? a. "I should use a sunscreen when using this medication." b. "I understand the gel can cause staining of clothing." c. "I will apply this once daily in the evening." d. "I will apply the medication to dry skin."

ANS: B Tazarotene will not stain clothing. It is true that patients should use sunscreen while using this drug. It should be applied once daily in the evening to dry skin.

The nurse at a public health infant immunization clinic is acting as a preceptor for a nursing student. To assess the student's understanding of vaccinations, the nurse asks the student where the hepatitis B vaccine (HepB) should be administered. The student would be correct to respond that the hepatitis B vaccine should be administered in the: a. dorsogluteal muscle in an adult. b. anterolateral thigh in infants. c. ventrogluteal muscle in adolescents. d. deltoid of toddlers.

ANS: B The HepB vaccine should be administered in the anterolateral thigh in infants and children. The vaccine should be administered in the deltoid of adults and adolescents. The vaccine should not be administered in the deltoid of toddlers, because they have little muscle in that location.

A 3-year-old child who has asthma is in the clinic for a well-child checkup. The nurse notes that the child is up-to-date for the DTaP, Hepatitis A, Hepatitis B, and the MMR vaccines but has only had one each of the Hib, the Rotavirus, and the PCV13 vaccines. Which vaccine(s) will the nurse anticipate administering to this child? a. Hib and Rotavirus vaccines b. PCV13 c. PCV13 and Hib d. Rotavirus

ANS: B The PCV13 should be given to all children under the age of 2 years and to all healthy children between ages 2 and 5 years, especially those who have conditions such as chronic lung disease that put them at high risk of serious pneumococcal disease. The Hib vaccine is only given up to age 15 months. The Rotavirus vaccine is not given after 32 weeks of age.

A patient taking stavudine [Zerit] telephones the clinic and reports numbness and tingling in the hands and feet. What should the nurse tell the patient? a. The numbness is an expected side effect of the medication and will diminish once the drug is withdrawn. b. The medication will probably be stopped, and the patient should come into the clinic for further evaluation. c. The dose may be too high, and the patient should cut the tablet in half. d. The patient should take the medication on a full stomach to reduce absorption of the drug.

ANS: B The patient has early signs and symptoms of neuropathy, which may resolve if the drug is stopped. The patient should be taught early in treatment to report these symptoms immediately. Numbness is not an expected side effect and these symptoms may diminish once the drug is withdrawn. The patient should never be advised to cut the dose in half unless instructed to do so by a prescriber. Taking the medication on a full stomach will not affect the amount of medication absorbed.

The nurse is performing a physical assessment on a patient who is receiving treatment with abacavir, zidovudine, and lamivudine [Trizivir]. The patient complains of fatigue. Upon further assessment, the nurse finds a rash and notes that the patient has a temperature of 101.1°F. What is the nurse's best course of action? a. Tell the patient that this is an expected response to these medications and to continue the agents as prescribed. b. Have the patient hold the medications and arrange for an immediate evaluation by the prescriber. c. Have the patient continue the abacavir but discontinue the other two agents for 3 weeks. d. Instruct the patient to continue all three medications and administer an antihistamine for the symptoms.

ANS: B The patient should discontinue all the medications. Immediate assessment by the provider is required, because the patient is showing early symptoms of a fatal hypersensitivity reaction. This is not an expected response; it indicates a serious reaction, which the patient should report to the prescriber immediately. The patient should not continue the medications for any additional dosages.

An infant has a severe contact diaper dermatitis. The provider orders triamcinolone acetonide [Kenalog] 0.1% cream to be applied 3 times daily. When teaching the infant's parents about this medication, the nurse will instruct them to apply: a. a thick layer and massage the cream into the skin. b. a thin layer and leave the diaper open as much as possible. c. the cream and place an occlusive dressing over the area. d. the cream and put the infant's diaper on tightly.

ANS: B Topical glucocorticoids can be absorbed systemically and cause adverse effects. To minimize systemic and local adverse effects, the medication should be applied sparingly. Parents should be taught to avoid tight-fitting diapers. The cream should be rubbed gently into the skin. Occlusive dressings increase the risk of adverse effects. Putting the diaper on tightly creates an occlusive dressing.

A patient has severe acne that has been refractory to treatment. The patient is taking tetracycline and using topical tretinoin [Retin-A] and has been applying benzoyl peroxide twice daily. The provider asks the nurse to teach this patient about isotretinoin [Accutane], which the patient will begin taking in a few weeks. The nurse will include which statement when teaching this patient about this drug? a. "Alcohol may be consumed in moderation when taking this drug." b. "Skin rash, headache, and hair loss are common with this drug." c. "Tetracycline must be discontinued before beginning the isotretinoin." d. "Two pregnancy tests are required before each monthly refill of your prescription."

ANS: C Adverse effects of isotretinoin can be increased by tetracycline, so tetracycline must be discontinued before therapy is started. Alcohol should be avoided, since it can potentiate hypertriglyceridemia. Skin rash, headache, and hair loss are not common side effects, although they can occur. Two pregnancy tests are required at the beginning of therapy; at each refill, only one pregnancy test is required.

A nurse is preparing to administer vaccines to a 1-year-old child. The parents ask the nurse to give the child acetaminophen before administering the vaccine to reduce the pain. Which response by the nurse is correct? a. "Children don't remember pain, so it isn't necessary to give acetaminophen." b. "The small needles used to inject the vaccines cause hardly any discomfort." c. "You can apply a topical anesthetic when you get home to reduce pain from the injection." d. "Your child's immune response may not be as effective if I give acetaminophen before the vaccine."

ANS: D Giving analgesic/antipyretic medications before or shortly after vaccines can reduce the immune response, so giving them to prevent pain or fever is not recommended. Children do remember pain, and it is important to provide other comfort measures and to give the injections rapidly. Small needles cause less discomfort, and it is important to reassure the parents about this; however, it is more important to explain why acetaminophen is not recommended. Topical anesthetics are useful before giving the injections, not afterwards.

A young, nonpregnant female patient with a history of a previous urinary tract infection is experiencing dysuria, urinary urgency and frequency, and suprapubic pain of 3 days' duration. She is afebrile. A urine culture is positive for more than 100,000/mL of urine. The nurse caring for this patient knows that which treatment is most effective? a. A 14-day course of amoxicillin with clavulanic acid [Augmentin] b. A 7-day course of ciprofloxacin [Cipro] c. A single dose of fosfomycin [Monurol] d. A 3-day course of trimethoprim/sulfamethoxazole [Bactrim]

ANS: D Short-course therapy is recommended for uncomplicated, community-acquired lower urinary tract infections. The short course is more effective than a single dose, and compared with longer-course therapies, it is less costly, has fewer side effects, and is more likely to foster compliance. Amoxicillin with clavulanic acid is a second-line drug used for pyelonephritis. Fosfomycin is a second-line drug and can be useful in patients with drug allergies.

The parent of a child who attends day care questions the need for Varivax. What will the nurse tell the parent? a. "Chickenpox is not as contagious as other communicable diseases." b. "The child will be protected by herd immunity and does not need the vaccine." c. "Varicella is an uncomfortable disease, but it is not that serious." d. "Varicella in adults can have serious consequences."

ANS: D Varicella tends to cause more severe symptoms in adults than in children; adults have a 10-fold greater likelihood of hospitalization and a 20-fold increase in deaths. Chickenpox is highly contagious. Even with herd immunity, because of the degree of contagiousness, spread is likely. Varicella can be serious, even in children.