Pharmacology Exam 5 old questions

A pregnant client who has human immunodeficiency virus (HIV) infection is being seen in the antenatal clinic. The nurse expects the primary health care provider (PHCP) to initiate zidovudine at how many weeks of gestation? 1. 4 2. 14 3. 24 4. 34

2. 14 Rationale: The pregnant woman with HIV infection will be prescribed oral zidovudine in the 14th week of gestation. Before this time, the fetus is at risk because of the teratogenic effects of the medication. In addition, a bolus of zidovudine is given intravenously during labor, and the neonate is treated for 6 weeks after birth.

A primary health care provider has just prescribed foscarnet to be given intravenously. The nurse should obtain which piece of equipment to administer this medication? 1. A glass bottle 2. An infusion pump 3. A microdrip tubing set 4. Special manufacturer's tubing

2. An infusion pump Rationale: Foscarnet, an antiviral medication used to treat cytomegalovirus retinitis in clients with acquired immunodeficiency syndrome, should be administered with a controlled infusion device because of its potential toxicity. The items described in the other options are unnecessary.

The nurse is preparing to administer piperacillin/tazobactam. An abnormal elevation in which laboratory value should prompt the nurse to withhold the medication and notify the primary health care provider (PHCP) before administering the medication? 1. Hematocrit and hemoglobin 2. Blood urea nitrogen and creatinine 3. Prothrombin time and partial thromboplastin time 4. Aspartate aminotransferase and alanine transaminase

2. Blood urea nitrogen and creatinine Rationale: Piperacillin/tazobactam is a penicillin-type antibiotic normally eliminated rapidly by the kidney but that can accumulate to harmful levels if renal function is severely impaired. Dosages must be reduced in clients with renal impairment. Therefore, an elevation in blood urea nitrogen and creatinine should be reported to the PHCP for dosage adjustment.

A client with a urinary tract infection (UTI) has been prescribed ciprofloxacin. The nurse notes that the client also has a prescription for theophylline written by a pulmonologist. Based on this information, the nurse should take which action? 1. Encourage intake of antacids. 2. Clarify the medication prescriptions. 3. Schedule the doses to be given together. 4. Schedule the doses to be given at the same time.

2. Clarify the medication prescriptions. Rationale: Quinolones, such as ciprofloxacin, prolong the half-life of caffeine and theophylline. This would make the theophylline stay in the client's system longer and could cause toxic effects. The nurse should clarify the medication prescriptions. The remaining options are incorrect actions.

The client with human immunodeficiency virus (HIV) infection has been started on therapy with zidovudine. The nurse reviews the laboratory results and determines that the client is experiencing an adverse effect of the medication if which is noted? 1. Phosphorus 4.5 mg/dL (1.45 mmol/L) 2. Hemoglobin of 10 g/dL (100 mmol/L) 3. Blood glucose level 70 mg/dL (3.9 mmol/L) 4. Blood urea nitrogen (BUN) 10 mg/dL (3.6 mmol/L)

2. Hemoglobin of 10 g/dL (100 mmol/L) Rationale: An adverse effect of this medication therapy is agranulocytopenia and anemia. The nurse carefully monitors the CBC count for these changes. With early HIV infection or in the client who is asymptomatic, CBC counts are monitored monthly for 3 months and then every 3 months thereafter. In clients with advanced disease, these counts are monitored every 2 weeks for the first 2 months and then once a month if the medication is tolerated well. The normal hemoglobin level is 14 to 18 g/dL (140 to180 mmol/L); thus, this client is experiencing anemia. The remaining options identify normal values. The normal phosphorus is 3.0 to 4.5 mg/dL (0.97 to 1.45 mmol/L). The normal blood glucose level is 99 mg/dL (3.9 to 5.5 mmol/L). The normal BUN is 10 to 20 mg/dL (3.6 to 7.1 mmol/L).

Ribavirin is prescribed for a hospitalized child with severe respiratory syncytial virus (RSV). The nurse prepares to administer this medication via which route? 1. Oral 2. Oxygen tent 3. Intramuscular 4. Subcutaneous

2. Oxygen tent Rationale: Ribavirin is an antiviral respiratory medication used mainly for hospitalized children with severe RSV. Administration is via hood, face mask, or oxygen tent. Ribavirin is not administered orally, intramuscularly, or subcutaneously.

Tetracycline is prescribed for a client with severe acne. The nurse instructs the client regarding the importance of reporting which finding if it occurs? 1. Sunburn 2. Persistent diarrhea 3. Epigastric burning 4. Abdominal cramping

2. Persistent diarrhea Rationale: Tetracycline can be used to treat severe acne. Adverse effects include gastrointestinal irritation manifested as epigastric burning, cramps, nausea, vomiting, and diarrhea. These effects do not need to be reported unless the diarrhea becomes persistent and severe. If this does occur, this could indicate another adverse effect, superinfection. Clostridium difficile infection is another potential adverse effect associated with tetracycline use. In addition, photosensitivity is another potential effect, which can more easily result in sunburn. Clients should be instructed to wear sunscreen. A sunburn does not need to be reported necessarily, as this is an expected and self-limiting effect. Other adverse effects include yellowing of the teeth (which can occur in the unborn fetus), hepatotoxicity, and renal toxicity.

A client who is seropositive for human immunodeficiency virus (HIV) has been taking stavudine. The nurse assesses which most closely while the client is taking this medication? 1. Appetite 2. Presence of paresthesia 3. Gastrointestinal function 4. Level of consciousness (LOC)

2. Presence of paresthesia Rationale: Stavudine is an antiretroviral (protease inhibitor) used in the management of HIV infection in clients who do not respond to or cannot tolerate conventional therapy. The medication can cause peripheral neuropathy; the nurse should closely monitor the client's gait and ask the client about paresthesia. The remaining options are not a concern.

A home health nurse is visiting a client who has been started on therapy with clotrimazole. The nurse determines the effectiveness of the medication by noting a decrease in which problem? 1. Pain 2. Rash 3. Fever 4. Sneezing

2. Rash Rationale: Clotrimazole is a topical antifungal agent used in the treatment of cutaneous fungal infections. It is not used for pain, fever, or sneezing.

The client who is seropositive for human immunodeficiency virus (HIV) has been taking ritonavir. The nurse tells the client that which follow-up laboratory study will be necessary while taking this medication? 1. Platelet count 2. Triglyceride level 3. Prothrombin time (PT) 4. International normalized ratio (INR)

2. Triglyceride level Rationale: Ritonavir is an antiretroviral (protease inhibitor) used in combination with other antiretroviral medications in the management of HIV infection. It can increase triglyceride levels; therefore, the client's triglyceride levels should be monitored. The platelet count, PT, and INR are not laboratory tests that would be monitored specifically in the client on this medication.

A 2-year-old with Pneumocystis jiroveci pneumonia is to begin treatment with highly active antiretroviral therapy (HAART). The nurse anticipates that the primary health care provider will prescribe which combination? 1. One immunoglobulin and one nucleoside analogue 2. Two nucleoside analogues and one protease inhibitor 3. Two protease inhibitors and one broad-spectrum antibiotic 4. One nucleoside reverse transcriptase inhibitor and one non-nucleoside reverse transcriptase inhibitor

2. Two nucleoside analogues and one protease inhibitor Rationale: Pneumocystis jiroveci pneumonia (PCP) is a fungal infection and is a common opportunistic infection in the client with acquired immunodeficiency syndrome. HAART consists of the combination of 2 nucleoside analogues, which target viral replication during the reverse transcription phase of the cell cycle, and a protease inhibitor, which targets viral replication at a different phase. The remaining options are incorrect descriptions of combination therapies.

Phenazopyridine is prescribed for a client with a urinary tract infection. The nurse evaluates that the medication is effective based on which observation? 1. Urine is clear amber. 2. Urination is not painful. 3. Urge incontinence is not present. 4. A reddish-orange discoloration of the urine is present.

2. Urination is not painful.

Phenazopyridine is prescribed for a client with a urinary tract infection. The nurse evaluates that the medication is effective based on which observation? 1. Urine is clear amber. 2. Urination is not painful. 3. Urge incontinence is not present. 4. A reddish-orange discoloration of the urine is present.

2. Urination is not painful. Rationale: Phenazopyridine is a urinary analgesic. It is effective when it eliminates pain and burning with urination. It does not eliminate the bacteria causing the infection, so it would not make the urine clear amber. It does not treat urge incontinence. It will cause the client to have reddish-orange discoloration of urine, but this is a side effect of the medication, not the desired effect.

Which is the nurse's priority assessment for monitoring for adverse effects for the client taking isoniazid? 1. Skin color 2. Urine color 3. Hydration status 4. Respiratory effort

2. Urine color Rationale: Isoniazid is an antituberculosis medication. The most serious adverse effect associated with isoniazid is hepatic injury, which on rare occasions has been fatal; therefore, monitoring of liver function tests and for signs and symptoms of liver injury is the priority. Dark urine is a sign of liver injury and the client should be taught to report this, and the nurse should assess for this. Skin color, hydration status, and respiratory effort are not directly related to adverse effects of this medication.

The nurse is providing discharge instructions to the mother of a child who has been prescribed tetracycline hydrochloride. The nurse stresses to the mother the importance of which measure in giving this medication to the child? 1. Give the medication with milk. 2. Use a straw when giving the medication. 3. Give the medication with chocolate milk. 4. Dilute the medication with water in a Styrofoam cup.

2. Use a straw when giving the medication. Rationale: Tetracycline is an antibiotic. Because tetracycline can cause permanent staining of the teeth, a straw should be used, and the mouth should be rinsed after administration. The medication should be administered 1 hour before or 2 hours after the consumption of milk. Diluting the medication with water is unnecessary.

A client with a respiratory tract infection is receiving intravenous tobramycin sulfate. The nurse should assess for which adverse effect of this medication? 1. Nausea 2. Vertigo 3. Vomiting 4. Hypotension

2. Vertigo Rationale: Tobramycin sulfate is an aminoglycoside. Ringing in the ears and vertigo are symptoms of ototoxicity that may indicate dysfunction of the eighth cranial nerve. This is a frequent adverse effect of therapy with the use of aminoglycosides and could result in permanent hearing loss. In clients with these symptoms, the nurse should withhold the dose of the medication and notify the primary health care provider. Nausea, vomiting, and hypotension are rare side effects of the medication.

The nurse is caring for a client with a diagnosis of influenza who first began to experience symptoms yesterday. Antiviral therapy is prescribed, and the nurse provides instructions to the client about the therapy. Which statement by the client indicates an understanding of the instructions? 1. "I must take the medication exactly as prescribed." 2. "Once I start the medication, I will no longer be contagious." 3. "I will not get any colds or infections while taking this medication." 4. "This medication has minimal side effects, and I can return to normal activities."

1. "I must take the medication exactly as prescribed." Rationale: Antiviral medications for influenza must be taken exactly as prescribed. These medications do not prevent the spread of influenza, and clients are usually contagious for up to 2 days after the initiation of antiviral medications. Secondary bacterial infections may occur despite antiviral treatment. Side effects occur with these medications and may necessitate a change in activities, especially when driving or operating machinery if dizziness occurs.

The nurse is caring for a client with a diagnosis of Chlamydia. Because the client has a history of noncompliance with medication administration, the primary health care provider prescribes azithromycin. When educating the client about azithromycin, the nurse should make which statement? 1. "One dose of this medication will be needed." 2. "This medication is given only every 72 hours." 3. "You will need to take this medication every 6 hours." 4. "You will need to return tomorrow for your second dose."

1. "One dose of this medication will be needed." Rationale: Azithromycin is a macrolide antibiotic. The usual pharmacological treatment for urethral, cervical, or rectal chlamydial infections is doxycycline or azithromycin. Azithromycin is often prescribed when compliance may be a problem because only one dose is needed; however, expense is a concern with this medication. The responses in the remaining options are incorrect.

Which supplies should the nurse obtain for the administration of ribavirin to a hospitalized child with respiratory syncytial virus (RSV)? 1. A mask and pair of goggles 2. Isolation gown and sterile gloves 3. An intravenous (IV) pole and hood 4. Intramuscular (IM) syringe and needle

1. A mask and pair of goggles Rationale: Ribavirin is administered via hood, face mask, or oxygen tent and is not administered by the IV or IM route. Some caregivers experience headaches, burning nasal passages and eyes, and crystallization of soft contact lenses as a result of administration of ribavirin. Specific to this medication is the use of goggles. A mask may be worn. A gown is not necessary. The medication used for the prevention of RSV is palivizumab, a monoclonal antibody, which is given monthly in an IM injection to prevent hospitalization associated with RSV.

A client is diagnosed with herpes simplex virus type 1 (HSV 1). The primary health care provider prescribes a topical medication for treatment. The nurse anticipates that which medication will be prescribed? 1. Acyclovir 2. Salicylic acid 3. Gentamicin sulfate 4. Mupirocin calcium

1. Acyclovir Rationale: Acyclovir is a topical antiviral agent that inhibits DNA replication in the virus. Acyclovir has activity against herpes simplex virus types 1 and 2, varicella-zoster virus (VZV), Epstein-Barr virus (EBV), and cytomegalovirus (CMV). Salicylic acid is a keratolytic. Gentamicin sulfate is an antibacterial agent and would not be effective in treating herpesvirus. Mupirocin calcium is a topical antibacterial agent that is active against Staphylococcus aureus, beta-hemolytic streptococci, and Streptococcus pyogenes.

A client has a prescription for ketoconazole. Which instruction should the nurse include in the client's teaching plan? 1. Avoid exposure to sunlight. 2. Take the medication with an antacid. 3. Take the medication on an empty stomach. 4. Limit alcohol consumption to 2 oz per day.

1. Avoid exposure to sunlight. Rationale: Ketoconazole is an antifungal medication. The client should avoid exposure to sunlight because the medication increases photosensitivity. Antacids should be avoided for 2 hours after ketoconazole is taken because gastric acid is needed to activate the medication; however, it should be taken with food. The client should avoid concurrent use of alcohol because the medication is hepatotoxic.

A client seen in the health care clinic is diagnosed with syphilis, and the primary health care provider prescribes an intramuscular injection of penicillin G benzathine. After administering the intramuscular injection of medication, the nurse should perform which action? 1. Monitor the client for 30 minutes. 2. Encourage the client to ambulate. 3. Administer subcutaneous epinephrine. 4. Apply a topical anesthetic spray to the injection site.

1. Monitor the client for 30 minutes. Rationale: Penicillin G benzathine is an antibiotic. Anaphylactic shock is a possible reaction to penicillin therapy, and the onset of anaphylaxis nearly always occurs within 10 minutes. The client should be observed for 30 minutes after intramuscular injection so that if anaphylaxis develops, treatment is immediately available. Encouraging ambulation is unnecessary. The remaining 2 options are inaccurate interventions.

A client has been given a prescription for sulfasalazine. Which allergy should the nurse assess for in the client prior to administration? 1. Sulfonamides or salicylates 2. Salicylates or acetaminophen 3. Shellfish or calcium channel blockers 4. Histamine receptor antagonists or beta blockers

1. Sulfonamides or salicylates Rationale: Sulfasalazine is a sulfonamide. The client who has been prescribed sulfasalazine should be checked for history of allergy to either sulfonamides or salicylates because the chemical composition of sulfasalazine and that of these medications are similar. The other options are not associated with an allergy to sulfasalazine.

The nurse is presenting information on treatment of influenza and the use of oseltamivir. The nurse should provide which information on the use of oseltamivir? Select all that apply. 1. The incidence of flu complications is reduced. 2. Oseltamivir is effective for all types of influenza. 3. Dosing must begin within 2 days after symptom onset. 4. No interactions with other medications have been reported. 5. It is best to begin dosing within the first 12 hours after symptom onset. 6. Oseltamivir is highly toxic to the liver, and liver function studies must be performed.

1. The incidence of flu complications is reduced. 2. Oseltamivir is effective for all types of influenza. 3. Dosing must begin within 2 days after symptom onset. 4. No interactions with other medications have been reported. 5. It is best to begin dosing within the first 12 hours after symptom onset. Rationale: Options 1 through 5 are correct. Oseltamivir is an antiviral medication that reduces complications of the flu and is effective for all flu types. Treatment must begin early, no later than 2 days after symptom onset, and preferably much sooner, even during the first 12 hours, because benefits decline greatly when treatment is delayed. It has no reported interactions with other medications. The only major side effects are nausea and vomiting. It is not toxic to the liver.

A client receiving a dose of intravenous vancomycin begins to experience chills, tachycardia, syncope, and flushing of the face and trunk. What is the nurse's best interpretation of these findings? 1. The medication is infusing too rapidly. 2. The client is allergic to the medication. 3. The client is experiencing upper airway obstruction. 4. The medication has interacted with another medication the client is receiving.

1. The medication is infusing too rapidly. Rationale: Vancomycin is an antibiotic. The client is experiencing manifestations of what is called "red neck syndrome." This is a response due to histamine release that occurs with rapid or bolus injection of this medication. The client may experience chills, fever, flushing of the face or trunk, tachycardia, syncope, tingling, and an unpleasant taste in the mouth. The corrective action is to administer the medication more slowly. An antihistamine such as diphenhydramine may be administered as well. Although the client can experience an allergic reaction to the medication, the manifestations in the question best describe "red neck syndrome." There is no indication that the client is experiencing an upper airway obstruction. In addition, there are no data in the question that indicate that the client is taking another medication.

A client is receiving tobramycin. The nurse evaluates that the medication therapy is effective if which laboratory test result is noted? 1. WBC count of 8000 mm3 (8 × 109/L) and a creatinine level of 0.9 mg/dL (79.5 mcmol/L) 2. Sodium level of 145 mEq/L (145 mmol/L) and chloride level of 106 mEq/L (106 mmol/L) 3. Sodium level of 140 mEq/L (140 mmol/L) and potassium level of 3.9 mEq/L (3.9 mmol/L) 4. White blood cell (WBC) count of 15,000 mm3 (15 × 109/L) and a blood urea nitrogen level of 38 mg/dL (13.7 mmol/L)

1. WBC count of 8000 mm3 (8 × 109/L) and a creatinine level of 0.9 mg/dL (79.5 mcmol/L) Rationale: Tobramycin is an antibiotic (aminoglycoside) that causes nephrotoxicity and ototoxicity. The medication is working if the WBC count drops back into the normal range and kidney function remains normal. A WBC count of 15,000 mm3 (15 × 109/L) is elevated, indicating that infection is still present. The sodium, chloride, and potassium levels are all normal values and are unrelated to the effectiveness of this medication.

Ketoconazole is prescribed for an assigned client. The nurse prepares to administer the medication by which method? 1. With food 2. With an antacid 3. With 8 oz of water 4. On an empty stomach

1. With food Rationale: Ketoconazole is an antifungal medication. It should be administered with food to minimize gastrointestinal irritation. The remaining options are incorrect. The medication requires acidity and should be administered at least 2 hours apart from an antacid.

The primary health care provider (PHCP) writes a prescription for zidovudine for a client who was admitted to the hospital. The nurse should contact the PHCP to verify the prescription if which finding is noted in the assessment data? 1. History of renal calculi 2. Complaints of diarrhea 3. Bone marrow depression 4. Complaints of abdominal discomfort

3. Bone marrow depression Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Zidovudine is a nucleoside reverse transcriptase inhibitor that is used in combination with other antiretroviral agents to treat human immunodeficiency virus (HIV) infection. A contraindication to the medication is a history of hypersensitivity to this medication. Cautions include bone marrow suppression, renal and hepatic dysfunction, and conditions that cause decreased hepatic blood flow. A history of renal calculi, diarrhea, and complaints of abdominal discomfort are not contraindications or cautions related to this medication.

Zidovudine has been prescribed for a client. The nurse should tell the client that which blood test will be done periodically while the client is taking this medication? 1. Urea nitrogen level 2. Magnesium and calcium levels 3. Complete blood cell (CBC) count 4. Sedimentation rate and prothrombin time

3. Complete blood cell (CBC) count Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Zidovudine is a nucleoside reverse transcriptase inhibitor that is used in combination with other antiretroviral agents to treat human immunodeficiency virus (HIV) infection. Because anemia and granulocytopenia can occur with this medication, a CBC count will be done periodically. A urea nitrogen level tests kidney function. A magnesium level and calcium level check electrolyte and mineral balance. A sedimentation rate and prothrombin time are assessed for the presence of inflammation and coagulation ability.

Zidovudine has been prescribed for a client, and the client asks the nurse about the side effects of the medication. The nurse responds that which is a common side effect of this medication? 1. Lethargy 2. Weakness 3. Headache 4. Constipation

3. Headache Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Zidovudine is a nucleoside reverse transcriptase inhibitor that is used in combination with other antiretroviral agents to treat human immunodeficiency virus (HIV) infection. Common side effects include nausea and headache. Lethargy, weakness, and constipation are not side effects of this medication.

The nurse has a prescription to administer foscarnet intravenously to a client with acquired immunodeficiency syndrome (AIDS). What should the nurse plan to do before administering this medication? 1. Obtain a sputum culture. 2. Obtain folic acid as an antidote. 3. Place the solution on a controlled infusion pump. 4. Ensure that liver enzyme levels have been drawn as a baseline.

3. Place the solution on a controlled infusion pump. Rationale: Acquired immunodeficiency syndrome (AIDS) is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Foscarnet is an antiviral agent used to treat cytomegalovirus (CMV) retinitis in clients with AIDS. Because of the potential toxicity of the medication, it is administered with the use of a controlled infusion device. It is highly toxic to the kidneys, and serum creatinine levels are measured frequently during therapy. A sputum culture is not necessary. Folic acid is not an antidote.

A client is prescribed mupirocin intranasally twice daily. The nurse correlates this prescription with the client's medical record and expects to note which result specifically related to the indication for this medication? 1. Positive MRSA in a surgical wound site on the abdomen 2. Positive streptococci in the blood and an elevated lactic acid level 3. Positive methicillin-resistant Staphylococcus aureas (MRSA) by polymerase chain reaction (PCR) 4. Positive vancomycin-resistant enterococci (VRE) in the urine for the client with a urinary catheter

3. Positive methicillin-resistant Staphylococcus aureas (MRSA) by polymerase chain reaction (PCR) Rationale: Mupirocin is applied intranasally twice daily for the client with colonization of MRSA in the nares. Clients are at risk for this colonization if they live in a health care facility because it is a common health care-acquired infection. MRSA in the surgical wound and VRE in the urine would likely be treated with intravenous antibiotics. Streptococci in the blood and an elevated lactic acid level are indicative of sepsis and would also likely be treated with intravenous antibiotics as well as intravenous fluids.

Zidovudine has been prescribed for a client, and the nurse provides instructions to the client about expected effects with this medication. Which statement by the client indicates the need for further instruction? 1. "I need to monitor my temperature." 2. "This medication can cause some nausea." 3. "I will have to have blood tests done periodically." 4. "If I experience diarrhea, I need to contact my primary health care provider."

4. "If I experience diarrhea, I need to contact my primary health care provider." Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Zidovudine is a nucleoside reverse transcriptase inhibitor that is used in combination with other retroviral agents to treat human immunodeficiency virus (HIV) infection. Diarrhea is an occasional side effect of the medication and does not warrant notification of the primary health care provider. Monitoring temperature, knowing that nausea can occur, and understanding the need for periodic blood tests reflect an understanding of the medication instructions.

The client is receiving tobramycin intravenously every 8 hours. Which finding would indicate to the nurse that the client is experiencing an adverse medication effect? 1. A sedimentation rate of 10 mm/hr (10 mm/hr) 2. A total bilirubin level of 0.5 mg/dL (8.5 mcmol/L) 3. A white blood cell count of 6000 mm3 (6 × 109/L) 4. A blood urea nitrogen (BUN) level of 30 mg/dL (10.8 mmol/L)

4. A blood urea nitrogen (BUN) level of 30 mg/dL (10.8 mmol/L) Rationale: Tobramycin is an aminoglycoside. Adverse effects of tobramycin include nephrotoxicity as evidenced by an increased BUN and serum creatinine; irreversible ototoxicity as evidenced by tinnitus, dizziness, ringing or roaring in the ears, and reduced hearing; and neurotoxicity as evidenced by headaches, dizziness, lethargy, tremors, and visual disturbances. The normal BUN concentration is 10 to 20 mg/dL (3.6 to 7.1 mmol/L). The normal sedimentation rate is less than or equal to 15 mm/hr. The normal total bilirubin level is 0.3 to 1.0 mg/dL (5.1 to 17 mcmol/L). A normal white blood cell count is 5000 to 10,000 mm3 (5 to 10 × 109/L).

A clinic nurse is assessing a client who has been on isoniazid for 6 months. Which client complaint should most concern the nurse? 1. Dry mouth 2. Cramping diarrhea 3. Frequent headaches 4. Difficulty tying shoes

4. Difficulty tying shoes Rationale: The client complaint that should most concern the nurse is difficulty tying shoes because this may indicate neuropathy. Dose-related peripheral neuropathy is one of the more common adverse effects of isoniazid. Dry mouth, cramping diarrhea, and frequent headaches are not concerns with administration of this medication.

The nurse is collecting subjective and objective data from a client and notes that the client is taking zidovudine. The nurse determines that this medication has been prescribed to treat which condition? 1. Ulcerative colitis 2. Hyperthyroidism 3. Addison's disease 4. Human immunodeficiency virus (HIV) infection

4. Human immunodeficiency virus (HIV) infection Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Zidovudine is a nucleoside reverse transcriptase inhibitor that is used in combination with other antiretroviral agents to treat HIV infection. It is not used to treat ulcerative colitis, hyperthyroidism, or Addison's disease.

The primary health care provider (PHCP) prescribed tetracycline for a 5-year-old pediatric client. The nurse questions this prescription for what reason? 1. It is classified as a narrow-spectrum antibiotic. 2. It is identified as safe for use during pregnancy. 3. It is used to treat a wide variety of disease processes. 4. It is contraindicated in children younger than 8 years of age.

4. It is contraindicated in children younger than 8 years of age. Rationale: All tetracyclines are contraindicated in children younger than 8 years of age because the medication deposits in bone and teeth enamel and can result in permanent discoloration of developing teeth. Tetracyclines are broad-spectrum antibiotics. Tetracyclines are used to treat specific infections and are contraindicated during pregnancy because of their effects on developing teeth.

The nurse is assigned to care for a client with cytomegalovirus retinitis and acquired immunodeficiency syndrome (AIDS) who is receiving foscarnet. The nurse reviews the primary health care provider's (PHCP's) prescriptions, expecting to note a prescription for which laboratory test while this client is taking the medication? 1. CD4+ cell count 2. Lymphocyte count 3. Serum albumin level 4. Serum creatinine level

4. Serum creatinine level Rationale: Foscarnet is an antiviral medication that is very toxic to the kidneys. Serum creatinine is monitored before therapy, 2 to 3 times weekly during induction therapy, and at least once weekly during maintenance therapy. It also may cause decreased levels of calcium, magnesium, phosphorus, and potassium in the bloodstream. Thus, these levels also are measured with the same frequency. The laboratory tests in the remaining options are not specific to this medication.

Azithromycin is prescribed for a client. The nurse provides instructions to the client about the medication and emphasizes that it is best to take the medication with which item? 1. Milk 2. Antacid 3. The evening meal 4. Water on an empty stomach

4. Water on an empty stomach Rationale: Azithromycin is a macrolide antibiotic that has excellent tissue penetration properties and can reach high concentrations in infected tissues. It has a long duration of action, which allows it to be dosed once daily. Taking the medication with milk, an antacid, or food decreases both the rate and the extent of gastrointestinal absorption. Therefore, it is best to take the medication with water on an empty stomach.

Azithromycin has been prescribed for a client. The nurse should instruct the client to take the medication in which way? 1. With meals 2. 1 hour before meals 3. With an aluminum-containing antacid 4. With a magnesium-containing antacid

2. 1 hour before meals Rationale: Azithromycin is a macrolide antibiotic. It should be taken 1 hour before or 2 hours after meals. It is not administered with meals, and it should not be taken with either aluminum- or magnesium-containing antacids.

The nurse is caring for a client admitted to the hospital for an infection who is receiving an aminoglycoside twice a day, intravenously. The nurse is planning to obtain blood for a peak aminoglycoside level. When should the blood be drawn? 1. Peak level not indicated 2. 30 minutes after completing the infusion 3. 1 hour before administration of the infusion 4. 15 minutes before administration of the infusion

2. 30 minutes after completing the infusion Rationale: Peak medication levels are obtained 30 minutes after completing the infusion. Therefore, the times in the remaining options are incorrect.

A client is receiving amphotericin B by the intravenous (IV) route. The nurse determines that the client is having an adverse effect to the medication if which laboratory study result is noted? 1. Elevated platelet count 2. Elevated serum creatinine 3. Low white blood cell count 4. Lowered hemoglobin and hematocrit

2. Elevated serum creatinine Rationale: Amphotericin B is an antifungal medication. It exerts direct toxicity on cells of the kidneys and causes renal impairment in most clients. To evaluate renal injury, tests of kidney function should be performed weekly, and intake and output should be monitored. If the serum creatinine level rises above 3.5 mg/dL (309 mcmol/L), the dose of amphotericin B should be reduced. The laboratory abnormalities in the remaining options are unrelated to the use of this medication.

The nurse notes that a client is receiving lamivudine. The nurse determines that this medication has been prescribed to treat which condition? 1. Pancreatitis 2. Pharyngitis 3. Tonic-clonic seizures 4. Human immunodeficiency virus (HIV)

4. Human immunodeficiency virus (HIV) Rationale: Lamivudine is a nucleoside reverse transcriptase inhibitor and antiviral medication. It slows HIV replication and reduces the progression of HIV infection. It also is used to treat chronic hepatitis B and provide prophylaxis in health care workers who are at risk of acquiring HIV infection after occupational exposure to the virus. This medication is not used to treat the conditions identified in the remaining options.

The nurse is collecting subjective and objective data from a client and notes that the client is taking abacavir. The nurse determines that this medication has been prescribed to treat which condition? 1. Otitis media 2. Heart failure 3. Urinary tract infection 4. Human immunodeficiency virus (HIV) infection

4. Human immunodeficiency virus (HIV) infection Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Abacavir is an antiviral medication and is used to treat HIV infection, in combination with other agents. It is not used to treat the conditions noted in the other options.

The nurse is caring for a client receiving gentamicin intravenously. What statement made by the client should most concern the nurse? 1. "I am experiencing dizziness." 2. "I am experiencing heartburn." 3. "I am experiencing abdominal pain." 4. "I am experiencing ringing in my ears."

4. "I am experiencing ringing in my ears." Rationale: Gentamicin is an aminoglycoside. This medication is ototoxic. If the client experiences ringing in the ears, ototoxicity should be suspected. Dizziness, heartburn, and abdominal pain are not associated with this medication. Remembering that gentamicin causes ototoxicity will lead you to this option.

A child has been prescribed tetracycline hydrochloride. The nurse providing medication information to the mother should plan to emphasize which instruction about giving this medication to the child? 1. Give the medication with milk. 2. Give the medication with ice cream. 3. Mix the medication in a Styrofoam cup. 4. Use a straw when giving the medication.

4. Use a straw when giving the medication. Rationale: Tetracycline is an antibiotic. Because tetracycline can cause staining of the teeth, straws should be used and the mouth rinsed after administration. The medication should be administered 1 hour before or 2 hours after the administration of milk, which would eliminate the options of giving the medication with milk or ice cream. Mixing the medication in a Styrofoam cup is unnecessary.

The nurse is about to administer the next intravenous dose of tobramycin when the client complains of vertigo and a ringing in the ears. What is the most appropriate nursing action? 1. Hang the dose immediately. 2. Check the client's pupillary responses. 3. Give a dose of droperidol with the tobramycin. 4. Withhold the dose and call the primary health care provider (PHCP).

4. Withhold the dose and call the primary health care provider (PHCP). Rationale: Tobramycin is an aminoglycoside. Ringing in the ears and vertigo are symptoms that may indicate dysfunction of the eighth cranial nerve. Ototoxicity is a toxic effect of therapy with aminoglycosides and could result in permanent hearing loss. The nurse should withhold the dose and notify the PHCP. The remaining options are inappropriate nursing actions.

A client is prescribed sulfamethoxazole for treatment of urinary tract infection. Identification of which other medication noted on the client's medical record requires further collaboration with the primary health care provider (PHCP)? 1. Insulin 2. Phenytoin 3. Metoprolol 4. Propranolol

2. Phenytoin Rationale: Sulfonamides can intensify the effects of warfarin, phenytoin, and sulfonylurea-type oral hypoglycemics (e.g., glipizide, glyburide). The principal mechanism is inhibition of hepatic metabolism. When combined with sulfonamides, these medications may require a reduction in dosage to prevent toxicity. Therefore, the nurse should collaborate with the PHCP regarding dose adjustment of phenytoin.

The nurse receives a call from a client concerned about eliminating brown-colored urine after taking nitrofurantoin for a urinary tract infection. The nurse should make which appropriate response? 1. "Continue taking the medication; the brown urine occurs and is not harmful." 2. "Take magnesium hydroxide with your medication to lighten the urine color." 3. "Discontinue taking the medication and make an appointment for a urine culture." 4. "Decrease your medication to half the dose, because your urine is too concentrated."

1. "Continue taking the medication; the brown urine occurs and is not harmful." Rationale: Nitrofurantoin imparts a harmless brown color to the urine, and the medication should not be discontinued until the prescribed dose is completed. Magnesium hydroxide will not affect urine color. In addition, antacids should be avoided because they interfere with medication effectiveness.

The nurse is teaching a client who is beginning antiviral therapy for influenza. Which statement by the client indicates an understanding of the instructions? 1. "I must take the medication exactly as prescribed." 2. "Once I start the medication, I will no longer be contagious." 3. "I will not get any colds or infections while taking this medication." 4. "This medication has minimal side effects and I can return to normal activities."

1. "I must take the medication exactly as prescribed." Rationale: Antiviral medications for influenza must be taken exactly as prescribed. These medications do not prevent the spread of influenza, and clients are usually contagious for up to 2 days after the initiation of antiviral medications. Secondary bacterial infections may occur despite antiviral treatment. Side effects occur with these medications and may necessitate a change in activities, especially when driving or operating machinery if dizziness occurs.

Ketoconazole is prescribed for a client. Which interventions should the nurse include when teaching the client about the medication? Select all that apply. 1. Avoid alcohol. 2. Restrict fluid intake. 3. Avoid exposure to the sun. 4. Prepare for periodic liver function studies. 5. Administer the medication with an antacid. 6. Administer the medication on an empty stomach.

1. Avoid alcohol. 3. Avoid exposure to the sun. 4. Prepare for periodic liver function studies. Rationale: Ketoconazole is an antifungal medication. There is no reason for the client to restrict fluid intake; in fact, this could be harmful to the client. The medication is hepatotoxic, and the nurse monitors liver function. It is administered with food (not on an empty stomach), and antacids are avoided for 2 hours after taking the medication to ensure absorption. The client is also instructed to avoid alcohol. In addition, the client is instructed to avoid exposure to the sun because the medication increases photosensitivity.

Laboratory analysis of a urine sample for culture and sensitivity reveals a bacterial infection, and the client is diagnosed with cystitis. Nitrofurantoin is prescribed for the client. Which is the priority nursing assessment before administering this medication? 1. Checking lung sounds 2. Checking the blood pressure 3. Checking the apical heart rate 4. Checking the bowel sounds in all 4 quadrants

1. Checking lung sounds Rationale: Nitrofurantoin is an antibacterial used to treat urinary tract infections. Although rare, the medication can cause an asthmatic exacerbation in those with a history of asthma. Therefore, the priority baseline assessment should include questioning the client about a history of asthma and checking lung sounds. The assessments in the remaining options may be done but are unrelated to this medication and are not a priority.

A client who is human immunodeficiency virus (HIV) seropositive has been taking stavudine. The nurse should monitor which most closely while the client is taking this medication? 1. Gait 2. Appetite 3. Level of consciousness 4. Gastrointestinal function

1. Gait Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Stavudine is an antiretroviral used to manage human immunodeficiency virus (HIV) infection in clients who do not respond to or who cannot tolerate conventional therapy. The medication can cause peripheral neuropathy, and the nurse should monitor the client's gait closely and ask the client about paresthesia. The remaining options are unrelated to this medication.

A client who is human immunodeficiency virus seropositive has been taking stavudine. The nurse should monitor which most closely while the client is taking this medication? 1. Gait 2. Appetite 3. Level of consciousness 4. Gastrointestinal function

1. Gait Rationale: Stavudine is an antiretroviral used to manage human immunodeficiency virus infection in clients who do not respond to or who cannot tolerate conventional therapy. The medication can cause peripheral neuropathy, and the nurse should monitor the client's gait closely and ask the client about paresthesia. Options 2, 3, and 4 are unrelated to this medication.

A client with a urinary tract infection is receiving ciprofloxacin by the intravenous (IV) route. The nurse appropriately administers the medication by performing which action? 1. Infusing slowly over 60 minutes 2. Infusing in a light-protective bag 3. Infusing only through a central line 4. Infusing rapidly as a direct IV push medication

1. Infusing slowly over 60 minutes Rationale: Ciprofloxacin is prescribed for treatment of mild, moderate, severe, and complicated infections of the urinary tract, lower respiratory tract, and skin and skin structure. A single dose is administered slowly over 60 minutes to minimize discomfort and vein irritation. Ciprofloxacin is not light-sensitive, may be infused through a peripheral IV access, and is not given by IV push method.

A pediatric nurse has obtained ribavirin in powder form from the pharmacy to administer to a child with respiratory syncytial virus (RSV) infection. After preparing the medication, the nurse should administer it by which route? 1. Inhalation 2. Intravenous 3. Subcutaneous 4. Oral, in the child's formula

1. Inhalation Rationale: Ribavirin is an antiviral medication and is active against RSV, influenza virus types A and B, and herpes simplex virus. It is administered by oral inhalation. The medication is absorbed from the lungs and achieves high concentrations in respiratory tract secretions and erythrocytes. It is not administered by the routes identified in the remaining options.

Abacavir has been prescribed for a client, who asks the nurse about the side effects of the medication. What should the nurse tell the client is a frequent side effect of this medication? 1. Nausea 2. Sleepiness 3. Constipation 4. Increased appetite

1. Nausea Rationale: Abacavir is an antiretroviral agent that is used in combination with other medications to treat human immunodeficiency virus infection. Frequent side effects include nausea, vomiting, diarrhea, decreased appetite, and insomnia. Abacavir does not cause sleepiness, constipation, or increased appetite.

Levofloxacin is prescribed for a client. While teaching the client about the medication, what should the nurse tell the client to take the medication with? 1. Water 2. An antacid 3. A zinc preparation 4. An iron supplement

1. Water Rationale: Levofloxacin is a fluoroquinolone and should be administered with water. Antacids, zinc, and iron supplements decrease absorption and should be taken at least 4 hours before or 2 hours after the medication.

A client is receiving zalcitabine. The nurse should monitor the results of which study to determine the effectiveness of this medication? 1. Western blot 2. CD4+ cell count 3. Enzyme-linked immunosorbent assay (ELISA) 4. Complete blood cell (CBC) count with differential

2. CD4+ cell count Rationale: Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Zalcitabine slows the progression of acquired immunodeficiency syndrome (AIDS) by improving the CD4+ cell count. The Western blot and the ELISA are performed to diagnose the infection initially. A CBC count with differential may be done as part of ongoing monitoring of the status of the client with AIDS and to detect adverse effects of other medications.

A client taking rifampin reports, "My urine has blood in it." When the nurse assesses the urine, it is brown. Which is the nurse's best action? 1. Notify the primary health care provider (PHCP). 2. Chart the finding as a normal response to the rifampin. 3. Immediately start prescribed intravenous (IV) fluids to prevent shock. 4. Get the client into bed, and put the bed in modified Trendelenburg's position.

2. Chart the finding as a normal response to the rifampin. Rationale: Brown-tinged urine is a normal finding associated with rifampin; thus, there is no need to notify the PHCP. There is no indication that the client is in shock, so eliminate the options that indicate to start prescribed IV fluids and to place the client in modified Trendelenburg's position. The nurse should also inform the client that his is a harmless side effect.

Tobramycin sulfate is prescribed. The nurse is administering the medication by intermittent intravenous infusion every 8 hours. The nurse monitors the client for signs of an adverse effect related to this medication and determines that which, if noted on assessment, would indicate its presence? 1. Client complaint of diarrhea 2. Client complaint of ringing in the ears 3. A white blood cell count of 6000 mm3 (6 × 109/L) 4. A blood urea nitrogen (BUN) of 10 mg/dL (3.6 mmol/L)

2. Client complaint of ringing in the ears Rationale: Adverse effects of tobramycin sulfate include nephrotoxicity as evidenced by an increased BUN and serum creatinine; irreversible ototoxicity as evidenced by tinnitus, dizziness, ringing or roaring in the ears, and reduced hearing; and neurotoxicity as evidenced by headaches, dizziness, lethargy, tremors, and visual disturbances. The normal BUN is 10 to 20 mg/dL (3.6 to 7.1 mmol/L). A normal white blood cell count is 5000 to 10,000 mm3 (5 to 10 × 109/L). The correct option is the only one that indicates an adverse effect of the medication.

A client is receiving amphotericin B by the intravenous (IV) route. During ongoing therapy with this medication, the nurse should most closely assess the client for which finding that indicates a complication? 1. Decreased pulse 2. Decreased urine output 3. Decreased body temperature 4. Decreased blood urea nitrogen level

2. Decreased urine output Rationale: Amphotericin B is an antifungal medication and can cause side and adverse effects such as chills, fever, headache, vomiting, and impaired renal function. A decreased urine output is an indication of impaired renal function. Changes in the pulse and temperature are not related to impaired renal function. The blood urea nitrogen level would be elevated if renal function was impaired. The nurse monitors for these side and adverse effects and also carefully assesses the IV site because of the irritating effects of the medication.

The nurse is caring for a client with acquired immunodeficiency syndrome (AIDS) who is receiving didanosine. The nurse understands that side and adverse effects associated with this medication include which findings? Select all that apply. 1. Fatigue 2. Diarrhea 3. Pancreatitis 4. Lactic acidosis 5. Peripheral neuropathy

2. Diarrhea 3. Pancreatitis 4. Lactic acidosis 5. Peripheral neuropathy Rationale: Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Didanosine is a nucleoside-nucleotide reverse transcriptase inhibitor that is used to treat human immunodeficiency virus (HIV) infection. Side and adverse effects of this medication include diarrhea, pancreatitis, lactic acidosis, peripheral neuropathy, hepatic steatosis, chills or fever, and rash or pruritus. Fatigue can be a manifestation of AIDS but is not a side or adverse effect of this medication.

An aminoglycoside, given by intermittent intravenous infusion, is prescribed for a client with an infection. Which finding would indicate to the nurse that the client is experiencing an adverse effect of the medication? 1. Bradycardia 2. Difficulty hearing 3. Increased appetite 4. Weakness and drowsiness

2. Difficulty hearing Rationale: All aminoglycosides are capable of causing renal toxicity, vestibular and auditory toxicity. When aminoglycoside levels in the body exceed the normal, this can lead to different adverse effects that cannot be reversed and can be fatal. Symptoms of kidney toxicity are decreased urine output, increased thirst, tachycardia or elevated heart rate, decreased appetite, and dizziness. Symptoms of ototoxicity include loss of hearing, dizziness or unsteadiness, ear fullness, lightheadedness, and extreme sensitivity to head movements. Weakness and drowsiness are associated with infection but do not indicate an adverse effect.

The nurse is providing discharge instructions to a client receiving trimethoprim-sulfamethoxazole. Which instruction should be included in the list? 1. Advise that sunscreen is not needed. 2. Drink 8 to 10 glasses of water per day. 3. Decrease the dosage when symptoms are improving to prevent an allergic response. 4. If the urine turns dark brown, call the primary health care provider (PHCP) immediately.

2. Drink 8 to 10 glasses of water per day. Rationale: Each dose of trimethoprim-sulfamethoxazole should be administered with a full glass of water, and the client should maintain a high fluid intake to avoid crystalluria. The medication is more soluble in alkaline urine. The client should not be instructed to taper or discontinue the dose. Clients should be advised to use sunscreen since the skin becomes sensitive to the sun. Some forms of trimethoprim-sulfamethoxazole cause urine to turn dark brown or red. This does not indicate the need to notify the PHCP.

Abacavir has been prescribed for a client. The nurse tells the client that which blood test will be done periodically while the client is taking this medication? 1. Platelet count 2. Liver function tests 3. Serum creatinine assay 4. Blood urea nitrogen determination

2. Liver function tests Rationale: Abacavir sulfate is an antiretroviral agent that can increase liver enzymes, triglycerides, and the blood glucose level. Baseline liver function studies will be done at the initiation of therapy and at periodic intervals during therapy. The tests identified in the other options are unnecessary.

Ketoconazole is prescribed for a client with a diagnosis of candidiasis. Which interventions should the nurse include when administering this medication? Select all that apply. 1. Restrict fluid intake. 2. Monitor liver function studies. 3. Instruct the client to avoid alcohol. 4. Administer the medication with an antacid. 5. Instruct the client to avoid exposure to the sun. 6. Administer the medication on an empty stomach.

2. Monitor liver function studies. 3. Instruct the client to avoid alcohol. 5. Instruct the client to avoid exposure to the sun. Rationale: Ketoconazole is an antifungal medication. There is no reason for the client to restrict fluid intake; in fact, this could be harmful to the client. The medication is hepatotoxic, and the nurse monitors liver function. It is administered with food (not on an empty stomach), and antacids are avoided for 2 hours after taking the medication to ensure absorption. The client is also instructed to avoid alcohol. In addition, the client is instructed to avoid exposure to the sun, because the medication increases photosensitivity.

The nurse caring for a client who is taking an aminoglycoside should monitor the client for which adverse effects of the medication? Select all that apply. 1. Seizures 2. Ototoxicity 3. Renal toxicity 4. Dysrhythmias 5. Hepatotoxicity

2. Ototoxicity 3. Renal toxicity 4. Dysrhythmias Rationale: Aminoglycosides are administered to inhibit the growth of bacteria. Adverse effects of this medication include confusion, ototoxicity, renal toxicity, gastrointestinal irritation, palpitations or dysrhythmias, blood pressure changes, and hypersensitivity reactions. Therefore, the remaining options are incorrect.

Trimethoprim-sulfamethoxazole is prescribed to be administered by intravenous infusion to a client with a recurrent urinary tract infection. How should the nurse administer this medication? 1. Over 30 minutes 2. Over 60 to 90 minutes 3. Piggybacked into the peripheral line containing parenteral nutrition 4. Piggybacked into the existing infusion of normal saline and potassium chloride

2. Over 60 to 90 minutes Rationale: Trimethoprim-sulfamethoxazole may be administered by intravenous infusion but should not be mixed with any other medications or solutions. Trimethoprim-sulfamethoxazole is infused over 60 to 90 minutes, and bolus infusions or rapid infusions must be avoided.

A client has been taking isoniazid for 2 months. The client complains to the nurse about numbness, paresthesias, and tingling in the extremities. The nurse interprets that the client is experiencing which problem? 1. Hypercalcemia 2. Peripheral neuritis 3. Small blood vessel spasm 4. Impaired peripheral circulation

2. Peripheral neuritis Rationale: Isoniazid is an antitubercular medication. A common side effect of isoniazid is peripheral neuritis, manifested by numbness, tingling, and paresthesias in the extremities. This can be minimized with pyridoxine (vitamin B6) intake. Options 1, 3, and 4 are not associated with the information in the question.

A client is receiving levofloxacin for treatment of urinary tract infection. Which finding warrants an immediate call to the primary health care provider (PHCP)? 1. Client complaint of constipation 2. Prolonged QT interval on electrocardiogram 3. Client will not take the levofloxacin without food 4. The client's culture shows Staphylococcus aureus

2. Prolonged QT interval on electrocardiogram Rationale: Levofloxacin can prolong the client's QT interval, which would be noted on electrocardiogram. This warrants a call to the PHCP because a prolongation in the QT interval can lead to torsades de pointes, a lethal dysrhythmia. The client may complain of diarrhea, not constipation, as a side or adverse effect. The medication can be taken with or without food and is effective against Staphylococcus aureus.

The nurse would anticipate that the primary health care provider (PHCP) would add which medication to the regimen of the client receiving isoniazid? 1. Niacin 2. Pyridoxine 3. Gabapentin 4. Cyanocobalamin

2. Pyridoxine Rationale: Isoniazid is an antituberculosis medication. Clients receiving isoniazid can develop neuropathy, and the agent of choice to help prevent this adverse effect is pyridoxine, vitamin B6. Niacin is used to lower the cholesterol level. Gabapentin is used to prevent seizures and for peripheral neuropathy, and cyanocobalamin is used to treat anemia.

Nitrofurantoin is prescribed for the client. The nurse checks the client's record, knowing that this medication is contraindicated in which disorder? 1. Heart failure 2. Renal disease 3. Hepatic disease 4. Diabetes insipidus

2. Renal disease Rationale: Nitrofurantoin is contraindicated in clients with renal impairment. The disorders in the other options are not a concern with the use of this medication.

A client is to begin a 6-month course of therapy with isoniazid. The nurse should plan to teach the client to take which action? 1. Use alcohol in small amounts only. 2. Report yellow eyes or skin immediately. 3. Increase intake of Swiss or aged cheeses. 4. Avoid vitamin supplements during therapy.

2. Report yellow eyes or skin immediately. Rationale: Isoniazid is hepatotoxic, and therefore the client is taught to report signs and symptoms of hepatitis immediately, which include yellow skin and sclera. For the same reason, alcohol should be avoided during therapy. The client should avoid intake of Swiss cheese, fish such as tuna, and foods containing tyramine because they may cause a reaction characterized by redness and itching of the skin, flushing, sweating, tachycardia, headache, or lightheadedness. The client can avoid developing peripheral neuritis by increasing the intake of pyridoxine (vitamin B6) during the course of isoniazid therapy.

A client is to begin a 6-month course of therapy with isoniazid. The nurse should plan to teach the client to take which action? 1. Use alcohol in small amounts only. 2. Report yellow eyes or skin immediately. 3. Increase intake of Swiss or aged cheeses. 4. Avoid vitamin supplements during therapy.

2. Report yellow eyes or skin immediately. Rationale: Isoniazid is hepatotoxic, and therefore the client is taught to report signs and symptoms of hepatitis immediately, which include yellow skin and sclera. For the same reason, alcohol should be avoided during therapy. The client should avoid intake of Swiss cheese, fish such as tuna, and foods containing tyramine, because they may cause a reaction characterized by redness and itching of the skin, flushing, sweating, tachycardia, headache, or lightheadedness. The client can avoid developing peripheral neuritis by increasing the intake of pyridoxine (vitamin B6) during the course of isoniazid therapy.

Nitrofurantoin is prescribed for a client with urinary tract infection. The nurse is instructing the client regarding the administration of the medication. Which information about the best time to take this medication should be included in the client's education? 1. At bedtime 2. With meals 3. One hour before the dinner meal 4. In the morning, 2 hours after breakfast

2. With meals Rationale: Nitrofurantoin is an antibacterial used to treat urinary tract infections. The nurse would instruct the client to take the medication with food to reduce any gastrointestinal upset that the medication can cause. Therefore, the best time to take the medication is with meals.

Abacavir has been prescribed for a client, and the nurse provides instructions about the medication. Which statement by the client indicates the need for further instruction? 1. "This medication will not cure my infection." 2. "Eating small, frequent meals will help offset the nausea." 3. "This medication will reduce the risk of transmitting the infection to others." 4. "I should check with my primary health care provider before taking any over-the-counter medications."

3. "This medication will reduce the risk of transmitting the infection to others." Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Abacavir is an antiretroviral agent that is used to treat human immunodeficiency virus (HIV) infection in combination with other medications. It will not cure HIV infection, nor will it reduce the risk of transmitting the infection to others. Eating small, frequent meals will help offset nausea. The client who is taking this medication should check with the primary health care provider before taking any over-the-counter medications.

A client has been started on long-term therapy with rifampin. The nurse should provide which information to the client about the medication? 1. Should always be taken with food or antacids 2. Should be double-dosed if 1 dose is forgotten 3. Causes orange discoloration of sweat, tears, urine, and feces 4. May be discontinued independently if symptoms are gone in 3 months

3. Causes orange discoloration of sweat, tears, urine, and feces Rationale: Rifampin causes orange-red discoloration of body secretions and will stain soft contact lenses permanently. Rifampin should be taken exactly as directed. Doses should not be doubled or skipped. The client should not stop therapy until directed to do so by a primary health care provider. It is best to administer the medication on an empty stomach unless it causes gastrointestinal upset, and then it may be taken with food. Antacids, if prescribed, should be taken at least 1 hour before the medication.

A client with acquired immunodeficiency syndrome (AIDS) has been started on therapy with zidovudine. The nurse should monitor the results of which laboratory blood study for adverse effects of therapy? 1. Creatinine level 2. Potassium concentration 3. Complete blood cell (CBC) count 4. Blood urea nitrogen (BUN) level

3. Complete blood cell (CBC) count Rationale: Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Common adverse effects of zidovudine are agranulocytopenia and anemia. The nurse should monitor the CBC count for these changes. Creatinine, potassium, and BUN are unrelated to this medication.

Amikacin is prescribed for a client with a bacterial infection. The nurse instructs the client to contact the primary health care provider (PHCP) immediately if which occurs? 1. Nausea 2. Lethargy 3. Hearing loss 4. Muscle aches

3. Hearing loss Rationale: Amikacin is an aminoglycoside. Adverse effects of aminoglycosides include ototoxicity (hearing problems), confusion, disorientation, gastrointestinal irritation, palpitations, blood pressure changes, nephrotoxicity, and hypersensitivity. The nurse instructs the client to report hearing loss to the PHCP immediately. Lethargy and muscle aches are not associated with the use of this medication. It is not necessary to contact the PHCP immediately if nausea occurs. If nausea persists or results in vomiting, the PHCP should be notified.

Amikacin is prescribed for a client with a bacterial infection. The nurse instructs the client to contact the primary health care provider (PHCP) immediately if which occurs? 1. Nausea 2. Lethargy 3. Hearing loss 4. Muscle aches

3. Hearing loss Rationale: Amikacin is an aminoglycoside. Side and adverse effects of aminoglycosides include ototoxicity (hearing problems), confusion, disorientation, gastrointestinal irritation, palpitations, blood pressure changes, nephrotoxicity, and hypersensitivity. The nurse instructs the client to report hearing loss to the PHCP immediately. Lethargy and muscle aches are not associated with the use of this medication. It is not necessary to contact the PHCP immediately if nausea occurs. If nausea persists or results in vomiting, the PHCP should be notified.

A client admitted to the hospital is taking abacavir. The nurse should monitor the client for which adverse effect of the medication? 1. Insomnia 2. Diarrhea 3. Hypotension 4. Decreased appetite

3. Hypotension Rationale: Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Abacavir is an antiretroviral agent that is used in combination with other medications to treat human immunodeficiency virus infection. Adverse effects include hypersensitivity, hypotension, lactic acidosis, and severe hepatomegaly. Insomnia, diarrhea, and decreased appetite are not adverse effects of this medication; rather, they are side effects of the medication.

A client with tuberculosis is being started on antituberculosis therapy with isoniazid. Before giving the client the first dose, the nurse should ensure that which baseline study has been completed? 1. Electrolyte levels 2. Coagulation times 3. Liver enzyme levels 4. Serum creatinine level

3. Liver enzyme levels Rationale: Isoniazid therapy can cause an elevation of hepatic enzyme levels and hepatitis. Therefore, liver enzyme levels are monitored when therapy is initiated and during the first 3 months of therapy. They may be monitored longer in the client who is older than 50 years or abuses alcohol. The laboratory tests in options 1, 2, and 4 are not necessary.

A client with tuberculosis is starting antituberculosis therapy with isoniazid. Before giving the client the first dose, the nurse should ensure that which baseline study has been completed? 1. Electrolyte levels 2. Coagulation times 3. Liver enzyme levels 4. Serum creatinine level

3. Liver enzyme levels Rationale: Isoniazid therapy can cause an elevation of hepatic enzyme levels and hepatitis. Therefore, liver enzyme levels are monitored when therapy is initiated and during the first 3 months of therapy. They may be monitored longer in the client who is older than 50 years or abuses alcohol. The laboratory tests in options 1, 2, and 4 are not necessary.

The nurse is reviewing the results of serum laboratory studies drawn on a client with acquired immunodeficiency syndrome (AIDS) who is receiving didanosine. The nurse interprets that the client may have the medication discontinued by the primary health care provider if which elevated result is noted? 1. Serum protein level 2. Blood glucose level 3. Serum amylase level 4. Serum creatinine level

3. Serum amylase level Rationale: Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Didanosine is a nucleoside analog reverse transcriptase inhibitor that blocks the reverse transcriptase enzyme. This enzyme changes HIV's genetic material (RNA) into the form of DNA. Didanosine can cause pancreatitis. A serum amylase level that is increased to 1.5 to 2 times normal may signify pancreatitis in the client with AIDS and is potentially fatal. The medication may have to be discontinued. The medication is also hepatotoxic and can result in liver failure.

A client diagnosed with active tuberculosis has been prescribed a combination of isoniazid and rifampin for treatment. The nurse teaches the client to perform which action? 1. Report any change in urine color. 2. Take both medications with food. 3. Take both medications together once a day. 4. Expect to take the medications for 2 to 3 weeks.

3. Take both medications together once a day. Rationale: Rifampin in combination with isoniazid prevents the emergence of medication-resistant organisms. This combination, taken together daily, eliminates the tubercle bacilli from the sputum and improves clinical status. Rifampin produces a harmless red-orange color in all body fluids and should be taken along with the isoniazid 1 hour before or 2 hours after eating to maximize absorption. The treatment regimen is maintained for at least 6 months for effectiveness, and the therapeutic effect may be evident in 2 to 3 weeks.

A client taking metronidazole calls the home health nurse to report dark discoloration to the urine. The nurse interprets that the client's complaint warrants which nursing action at this time? 1. Instruct the client to increase fluid intake. 2. Tell the client to discontinue the medication. 3. Tell the client that this is a harmless medication side effect. 4. Instruct the client to call the primary health care provider (PHCP).

3. Tell the client that this is a harmless medication side effect. Rationale: Harmless darkening of the urine may occur, and the client should be told of this effect. Metronidazole can produce a variety of side effects, but they rarely require termination of treatment. Increasing fluid intake is a good health measure but will not prevent this side effect from occurring. It is not necessary to discontinue the medication or call the PHCP.

The nurse is creating a plan of care for a client who is receiving amphotericin B intravenously. A main component of the plan of care is monitoring for adverse effects related to the administration of this medication. Which should the nurse include in a list of manifestations to watch for? 1. Fatigue 2. Confusion 3. Visual difficulties 4. Increased urinary output

3. Visual difficulties Rationale: Amphotericin B is an antifungal. Vision and hearing alterations, seizures, hepatic failure, paresthesias (tingling, numbness, or pain in the hands and feet), and coagulation defects also occur. Other adverse effects include nephrotoxicity, which occurs commonly and is evidenced by decreased urine output. Cardiovascular toxicity (as evidenced by hypotension and ventricular fibrillation) and anaphylactic reaction occur rarely.

A client with tuberculosis (TB) has a prescription for rifampin. What instruction should the nurse include in the client's teaching plan? 1. Yellow-colored skin is common with this medication. 2. The medication must always be taken on an empty stomach. 3. Wearing glasses instead of soft contact lenses will be necessary. 4. As soon as the cultures come back negative, the medication may be stopped.

3. Wearing glasses instead of soft contact lenses will be necessary. Rationale: Soft contact lenses may be permanently damaged by the orange discoloration in body fluids caused by rifampin. Any sign of possible jaundice (yellow-colored skin) should always be reported. If rifampin is not tolerated on an empty stomach, it may be taken with food. The client may be on the medication for 12 months even if cultures give negative results.

The nurse is providing teaching for a client prescribed ciprofloxacin for a urinary tract infection. Which statement made by the client indicates that there is a need for further teaching? 1. "I can take the ciprofloxacin with or without food." 2. "I'll need to wear sunscreen and protective clothing while taking ciprofloxacin." 3. "I'll need to contact my primary health care provider if I develop any white patches in my mouth." 4. "If I develop any tendon pain while taking ciprofloxacin, exercise should help to decrease the pain."

4. "If I develop any tendon pain while taking ciprofloxacin, exercise should help to decrease the pain." Rationale: The primary health care provider should be contacted immediately if the client develops any tendon pain, swelling, or inflammation because of the risk of tendon rupture. Exercise is contraindicated until tendon rupture is ruled out. Fluorquinolones such as ciprofloxacin need to be discontinued at the first sign of any tendon pain, swelling, or inflammation. Ciprofloxacin can be taken with or without food, can cause photosensitivity, and can increase the risk for oral Candida infections.

Itraconazole is prescribed for a client with a fungal infection of the hands. The nurse provides instructions to the client about the medication. Which statement by the client indicates an understanding of the instructions? 1. "I should take the medication on an empty stomach." 2. "I should decrease my fluid intake while taking the medication." 3. "I may become unusually fatigued while taking this medication." 4. "If my urine becomes very dark in color, I should contact my primary health care provider (PHCP)."

4. "If my urine becomes very dark in color, I should contact my primary health care provider (PHCP)." Rationale: Itraconazole is an antifungal medication. The client should be instructed to take the medication with food because it increases the absorption of the medication. Fluid should be increased to prevent constipation, which can occur as a side effect. Hepatitis is an adverse reaction associated with the medication, and if anorexia of any degree, abdominal pain, unusual tiredness or weakness, dark urine, or jaundice develops, the PHCP should be notified.

A client with acquired immunodeficiency syndrome (AIDS) experiences nausea, vomiting, and abdominal pain radiating to the back after taking didanosine. The ambulatory care nurse should provide which response as telephone advice to this client? 1. "Take crackers and milk with each dose of the medication." 2. "Decrease the dose of the medication until the next clinic visit." 3. "This is an uncomfortable but expected side or adverse effect of the medication." 4. "Report to the health care clinic to be seen by the primary health care provider."

4. "Report to the health care clinic to be seen by the primary health care provider." Rationale: Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Didanosine is a nucleoside-nucleotide reverse transcriptase inhibitor. Pancreatitis, which can be fatal, is the major dose-limiting toxicity associated with the administration of didanosine. Clients should be monitored for indications of developing pancreatitis, which include increased serum amylase in association with increased serum triglycerides; decreased serum calcium; and nausea, vomiting, or abdominal pain radiating to the back. If evolving pancreatitis is diagnosed, the medication should be discontinued. The client should be seen by the primary health care provider.

Itraconazole is prescribed for a client to treat a fungal infection. The nurse monitors the client closely for which manifestation that is indicative of an adverse effect? 1. Diarrhea 2. Headache 3. Increased urine output 4. Anorexia and abdominal pain

4. Anorexia and abdominal pain Rationale: Itraconazole is an antifungal medication. Hepatitis is an adverse effect associated with the medication, and if anorexia of any degree, abdominal pain, unusual tiredness or weakness, dark urine, or jaundice develops, the health care provider should be notified.

The nurse is monitoring a client with herpes simplex virus (HSV) who is receiving intravenous (IV) acyclovir. Which laboratory result would be of concern as a possible adverse effect of this medication? 1. Platelet count of 300,000 mm3 (300 × 109/L) 2. Prothrombin time of 12 seconds (12 seconds) 3. White blood cell count of 6000 mm3 (6 × 109/L) 4. Blood urea nitrogen (BUN) of 36 mg/dL (12.9 mmol/L)

4. Blood urea nitrogen (BUN) of 36 mg/dL (12.9 mmol/L) Rationale: Acyclovir is an antiviral medication. Although the most common side and adverse reactions with this medication are phlebitis and inflammation at the IV site, reversible nephrotoxicity, evidenced by elevated serum creatinine and BUN levels, can occur in some clients. The cause of nephrotoxicity is deposition of acyclovir in the renal tubules. The risk of renal injury is increased by dehydration and the use of other nephrotoxic medications. The laboratory values identified in the remaining options are within normal limits.

A client who is receiving nitrofurantoin calls the clinic complaining of troublesome effects related to the medication. Which side or adverse effect(s) indicates the need to stop treatment with this medication? 1. Nausea 2. Anorexia 3. Diarrhea 4. Cough and chest pain

4. Cough and chest pain Rationale: Nitrofurantoin is an antimicrobial medication. Gastrointestinal (GI) effects are the most frequent side effects to this medication and can be minimized by administering the medication with milk or meals. However, they are not an indication for discontinuing the medication. Pulmonary reactions, manifested as dyspnea, chest pain, chills, fever, cough, and the presence of alveolar infiltrates on radiography, indicate the need to stop the treatment. These abnormalities typically resolve in 2 to 4 days after discontinuation of this medication.

A client has been receiving foscarnet as part of therapy for the treatment of cytomegalovirus (CMV) retinitis and acquired immunodeficiency syndrome (AIDS). The home care nurse should periodically review results of which laboratory blood test to assess for adverse effects to this medication? 1. CD4+ cell count 2. Lymphocyte count 3. Albumin concentration 4. Creatinine concentration

4. Creatinine concentration Rationale: Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Foscarnet is an antiviral medication. Because foscarnet is toxic to the kidneys, serum creatinine is monitored before therapy, 2 or 3 times per week during induction therapy, and at least weekly during maintenance therapy. It also may cause decreased levels of calcium, magnesium, phosphorus, and potassium, so these are monitored with the same frequency. The blood tests in the remaining options are not associated with adverse effects of the medication.

The nurse has given a client taking ethambutol information about the medication. The nurse determines that the client understands the instructions if the client states that he or she will immediately report which finding? 1. Impaired sense of hearing 2. Gastrointestinal side effects 3. Orange-red discoloration of body secretions 4. Difficulty in discriminating the color red from green

4. Difficulty in discriminating the color red from green Rationale: Ethambutol causes optic neuritis, which decreases visual acuity and the ability to discriminate between the colors red and green. This poses a potential safety hazard when a client is driving a motor vehicle. The client is taught to report this symptom immediately. The client also is taught to take the medication with food if gastrointestinal upset occurs. Impaired hearing results from antitubercular therapy with streptomycin. Orange-red discoloration of secretions occurs with rifampin.

The nurse has given a client taking ethambutol information about the medication. The nurse determines that the client understands the instructions if the client states that they will immediately report which finding? 1. Impaired sense of hearing 2. Gastrointestinal side effects 3. Orange-red discoloration of body secretions 4. Difficulty in discriminating the color red from green

4. Difficulty in discriminating the color red from green Rationale: Ethambutol causes optic neuritis, which decreases visual acuity and the ability to discriminate between the colors red and green. This poses a potential safety hazard when a client is driving a motor vehicle. The client is taught to report this symptom immediately. The client also is taught to take the medication with food if gastrointestinal upset occurs. Impaired hearing results from antitubercular therapy with streptomycin. Orange-red discoloration of secretions occurs with rifampin.

The ambulatory care nurse is providing instructions to a client with a urinary tract infection (UTI) being started on nitrofurantoin. The nurse should provide the client with which information? 1. It can cause urinary retention. 2. It will cause the urine to become clear. 3. The sun should be avoided because it is a sulfa-based medication. 4. If taken with meals, it will help decrease the risk for gastrointestinal (GI) upset.

4. If taken with meals, it will help decrease the risk for gastrointestinal (GI) upset. Rationale: Nitrofurantoin is a urinary antiseptic (not a sulfa-based medication) and should be taken with meals to decrease the incidence of GI side effects. Food or milk decreases the GI upset. The medication could cause the urine to turn rust yellow or brown. It does not cause urinary retention.

The nurse is caring for a client who has cytomegalovirus retinitis and is receiving foscarnet. Which assessment finding, if reported by the client, indicates a need for follow-up? 1. Intact hearing capacity 2. Urine noted to be clear yellow 3. Urinary output of 30 mL per hour 4. Impaired balance while ambulating

4. Impaired balance while ambulating Rationale: Cytomegalovirus retinitis is an opportunistic viral infection of the eye. Foscarnet is an antiviral agent that is used to treat viral infections in the client with leukemia. Serious side and adverse effects, such as ototoxicity and nephrotoxicity, can occur as a result of this medication. Impaired balance while ambulating and impaired hearing are signs of ototoxicity. Intact hearing capacity, urine noted to be clear yellow, and a urinary output of 30 mL per hour are normal assessment findings.

Abacavir has been prescribed for a client, and the client asks the nurse about the action of the medication. How should the nurse respond? 1. Promotes viral DNA growth 2. Prevents the production of DNA 3. Splits DNA to prevent its production 4. Inhibits activity of HIV-1 reverse transcriptase

4. Inhibits activity of HIV-1 reverse transcriptase Rationale: Abacavir is an antiretroviral agent that inhibits activity of HIV-1 reverse transcriptase and inhibits viral DNA growth. Abacavir does not promote viral DNA growth or do anything that would prevent the production of DNA.

A client is receiving ganciclovir. Which nursing action is appropriate during the time the client is receiving this medication? 1. Monitoring blood glucose levels for elevation 2. Administering the medication on an empty stomach only 3. Applying pressure to venipuncture sites for at least 1 minute 4. Providing the client with a soft toothbrush and an electric razor

4. Providing the client with a soft toothbrush and an electric razor Rationale: Ganciclovir is an antiviral medication. Common adverse effects of ganciclovir are neutropenia and thrombocytopenia. For this reason, the nurse implements the same precautions that are used for a client receiving anticoagulant therapy. These include providing a soft toothbrush and an electric razor to minimize risk of trauma that could result in bleeding. The medication may cause hypoglycemia, but not hyperglycemia. The medication does not have to be taken on an empty stomach. Pressure on venipuncture sites should be held for approximately 10 minutes.

The nurse is assigned to care for a client with cytomegalovirus retinitis and acquired immunodeficiency syndrome (AIDS) who is receiving foscarnet. The nurse should monitor the results of which laboratory study while the client is taking this medication? 1. CD4 cell count 2. Lymphocyte count 3. Serum albumin level 4. Serum creatinine level

4. Serum creatinine level Rationale: Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Cytomegalovirus retinitis is an opportunistic viral infection of the eye. Foscarnet is an antiviral medication that is toxic to the kidneys. The serum creatinine level is monitored before therapy, 2 or 3 times per week during induction therapy, and at least weekly during maintenance therapy. Foscarnet also may cause decreased levels of calcium, magnesium, phosphorus, and potassium. Thus, these levels also are measured with the same frequency.

The nurse is assigned to care for a client with cytomegalovirus retinitis and acquired immunodeficiency syndrome who is receiving foscarnet, an antiviral medication. The nurse should monitor the results of which laboratory study while the client is taking this medication? 1. CD4+ T cell count 2. Lymphocyte count 3. Serum albumin level 4. Serum creatinine level

4. Serum creatinine level Rationale: Foscarnet is toxic to the kidneys. The serum creatinine level is monitored before therapy, two or three times per week during induction therapy, and at least weekly during maintenance therapy. Foscarnet also may cause decreased levels of calcium, magnesium, phosphorus, and potassium. Thus, these levels also are measured with the same frequency.

A client has been given a prescription for a course of azithromycin. The nurse should tell the client that this medication will relieve which problem? 1. Pain 2. Joint inflammation 3. High blood pressure 4. Signs and symptoms of infection

4. Signs and symptoms of infection Rationale: Azithromycin is a macrolide antibiotic used to treat infection. It is not used to treat pain, joint inflammation, or blood pressure.

Zidovudine has been prescribed for a client who asks the nurse about the action of the medication. The nurse responds that this medication performs which function? 1. Increases neutrophils 2. Kills bacteria and fungi 3. Promotes the function of natural killer cells 4. Slows the replication of human immunodeficiency virus (HIV)

4. Slows the replication of human immunodeficiency virus (HIV) Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Zidovudine is a nucleoside reverse transcriptase inhibitor that is used in combination with other antiretroviral agents to treat HIV infection. It interferes with viral RNA-dependent DNA polymerase, an enzyme necessary for viral HIV replication. It slows HIV replication, reducing the progression of HIV infection. Zidovudine does not increase neutrophils, kill bacteria and fungi, or promote the function of natural killer cells.

Trimethoprim-sulfamethoxazole is prescribed for a client. The nurse should instruct the client to report which symptom if it develops during the course of this medication therapy? 1. Nausea 2. Diarrhea 3. Headache 4. Sore throat

4. Sore throat Rationale: Clients taking trimethoprim-sulfamethoxazole should be informed about early signs and symptoms of blood disorders that can occur from this medication. These include sore throat, fever, and pallor, and the client should be instructed to notify the primary health care provider (PHCP) if these occur. The other options do not require PHCP notification.

A client has been taking pyrazinamide for 6 months. The nurse determines that the medication is effective if which cultures yield a negative result? 1. Urine 2. Blood 3. Wound 4. Sputum

4. Sputum Rationale: Pyrazinamide is an antituberculosis medication that is given in conjunction with other antituberculosis medications. Its use may be discontinued by the prescriber if sputum cultures become negative. The remaining options are incorrect.

A client has been taking pyrazinamide for 1 month. The client asks the nurse whether the therapy is due to be terminated soon. The nurse determines that the medication probably will be continued based on a positive finding in which report? 1. Blood culture 2. Urine culture 3. Wound culture 4. Sputum culture

4. Sputum culture Rationale: Pyrazinamide is an antituberculosis medication given with other antituberculosis medications. Pyrazinamide might not be discontinued if sputum cultures continue to be positive. The remaining options are not related directly to the use of this medication.

A client is prescribed trimethoprim-sulfamethoxazole for a recurrent urinary tract infection (UTI). The nurse should give the client which instruction regarding this medication? 1. Expect rashes or skin changes as a result of therapy. 2. Discontinue the medication when symptoms subside. 3. Take most doses early in the day when fluid intake is greatest. 4. Take each dose with 8 oz of water, and drink extra water each day.

4. Take each dose with 8 oz of water, and drink extra water each day. Rationale: Trimethoprim-sulfamethoxazole is a combination medication. The client takes each dose with 8 oz of water and drinks several extra glasses of water each day. The client should space doses evenly around the clock for stable blood levels and should take the medication for the full course of therapy. The client should report rashes or other skin changes, which could indicate an allergy to sulfa.

A client with human immunodeficiency virus infection is taking indinavir. The nurse plans to provide the client with which direction when providing instructions about the use of this medication? 1. Store the medication in the refrigerator. 2. Take the medication with a high-fat snack. 3. Take the medication with the large meal of the day. 4. Take the medication with water on an empty stomach.

4. Take the medication with water on an empty stomach. Rationale: Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Indinavir is a protease inhibitor. To maximize absorption, the medication should be administered with water on an empty stomach. The medication may be taken 1 hour before a meal or 2 hours after a meal, or it may be administered with skim milk, coffee, tea, or a low-fat meal. It is not administered with a large meal. The medication should be stored at room temperature and protected from moisture because moisture can degrade the medication.

The nurse receives a call from a client concerned about eliminating brown-colored urine after taking nitrofurantoin for a urinary tract infection. The nurse should make which appropriate response? 1. "Continue taking the medication; the brown urine occurs and is not harmful." 2. "Take magnesium hydroxide with your medication to lighten the urine color." 3. "Discontinue taking the medication and make an appointment for a urine culture." 4. "Decrease your medication to half the dose because your urine is too concentrated."

1. "Continue taking the medication; the brown urine occurs and is not harmful." Rationale: Nitrofurantoin imparts a harmless brown color to the urine, and the medication should not be discontinued until the prescribed dose is completed. Magnesium hydroxide will not affect urine color. In addition, antacids should be avoided because they interfere with medication effectiveness.

A client with acute pyelonephritis who was started on antibiotic therapy 24 hours earlier is still complaining of burning with urination. The nurse should anticipate that the primary health care provider will prescribe which medication? 1. Phenazopyridine 2. Oxybutynin chloride 3. Bethanechol chloride 4. Propantheline bromide

1. Phenazopyridine Rationale: The pain experienced with pyelonephritis usually resolves as antibiotic therapy becomes effective. However, clients may be treated for urinary tract pain with phenazopyridine, which is a urinary analgesic. Oxybutynin chloride and propantheline bromide are antispasmodics that are used to treat bladder spasm. Bethanechol chloride is a cholinergic agent used to treat neurogenic bladder or urinary retention.

The home health nurse is visiting a client who has been started on therapy with clotrimazole. The nurse should monitor which item to monitor the effectiveness of this medication with each visit? 1. Rash 2. Fever 3. Pain relief 4. Sore throat

1. Rash Rationale: Clotrimazole is a topical antifungal agent used in the treatment of cutaneous fungal infections. The nurse monitors the effectiveness of this medication by noting the presence or absence of a skin rash, which is characteristic of this infection. Fever, pain relief, and sore throat are unrelated to the use of this medication.

A client is receiving acyclovir by the intravenous (IV) route for treatment of cytomegalovirus (CMV) infection. After reconstituting the powder dispensed by the pharmacy, the nurse should administer this medication via which method? 1. Slow IV infusion over 1 hour 2. Rapid IV bolus over 5 minutes 3. Continuous IV infusion over 24 hours 4. Continuous IV infusion over 12 hours

1. Slow IV infusion over 1 hour Rationale: Acyclovir is an antiviral medication. It is dispensed as a powder to be reconstituted for IV administration and is administered by slow IV infusion over 1 hour. It is not given as an IV bolus or continuous infusion or by intramuscular or subcutaneous injection. To minimize the risk of renal damage, the client should be hydrated during the infusion and for 2 hours after the infusion.

A client has begun a course of therapy with rifampin. The home care nurse instructs the client on which measure due to an anticipated side effect? 1. Wear dark clothing to avoid staining. 2. Always take the medication with food or antacids. 3. Double the next medication dose if one is forgotten. 4. Stop the medication if symptoms disappear in 2 months.

1. Wear dark clothing to avoid staining. Rationale: Rifampin causes orange-red discoloration of body secretions and will permanently stain light clothing as well as soft contact lenses. The medication should be taken on an empty stomach unless it causes gastrointestinal upset, and then it may be taken with food. Antacids, if prescribed, should be taken at least 1 hour before the medication. Rifampin should be taken exactly as directed, and doses should not be doubled or skipped. The client should not stop therapy until directed to do so by a primary health care provider.

The nurse caring for a client who is taking an aminoglycoside should monitor the client for which adverse effects of the medication? Select all that apply. 1. Seizures 2. Ototoxicity 3. Renal toxicity 4. Dysrhythmias 5. Hepatotoxicity

2. Ototoxicity 3. Renal toxicity 4. Dysrhythmias Rationale: Aminoglycosides are administered to inhibit the growth of bacteria. Adverse effects of this medication include confusion, ototoxicity, renal toxicity, gastrointestinal irritation, palpitations (dysrhythmias), blood pressure changes, and hypersensitivity reactions. Therefore, the remaining options are incorrect.

A child with human immunodeficiency virus (HIV) infection is receiving zidovudine. Which finding indicates to the nurse that the child may be experiencing an adverse effect from the medication? 1. The child complains of pain in his lower legs. 2. The child's skin is pale and he is feeling tired. 3. The child has some swelling in the hands and around the ankles. 4. The child is clinging to his parents and won't allow them to leave.

2. The child's skin is pale and he is feeling tired. Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Zidovudine effectively interferes with HIV replication but can cause bone marrow suppression. Anemia occurs most commonly after 4 to 6 weeks of therapy. Hematology studies need to be monitored for anemia and granulocytopenia. Tiredness and a pale color could indicate that the child is anemic. Complaints of pain is not associated with the medication but can be associated with the diagnosis; swelling is not usually a characteristic of the infection but could be an indication of an underlying problem. If the child is clinging to the parents, this could indicate fear but is not associated with an adverse effect of the medication.

A client is receiving amoxicillin orally every 8 hours. Which finding would indicate to the nurse that the client is experiencing a frequent minor side effect related to the medication? 1. Fever 2. Vaginal drainage 3. Severe watery diarrhea 4. Severe abdominal cramps

2. Vaginal drainage Rationale: Amoxicillin is a type of penicillin. Frequent minor side effects include gastrointestinal disturbances, headache, and oral or vaginal candidiasis (perineal itching). A less common but more harmful effect that can occur includes superinfection, such as potentially fatal antibiotic-associated colitis, which results from altered bacterial balance. Symptoms and signs include abdominal cramps, severe watery diarrhea, and fever.

A client is taking a prescribed course of therapy with ethambutol. The home health nurse assesses the client at each home visit for which adverse effect of this medication? 1. Orange urine 2. Visual disturbances 3. Hearing disturbances 4. Gastrointestinal (GI) upset

2. Visual disturbances Rationale: Ethambutol causes optic neuritis, which decreases visual acuity and impairs the ability to discriminate between red and green. This form of color blindness poses a potential safety hazard in driving a motor vehicle. The client is taught to report this symptom immediately. The client also is taught to take the medication with food if GI upset occurs. Impaired hearing results from antituberculosis therapy with streptomycin. Orange-red discoloration of secretions occurs with rifampin.

A client with a urinary tract infection (UTI) is given a prescription for levofloxacin. The nurse should provide the client with which information about this medication? 1. "You may experience altered taste." 2. "You may get dizzy, so move around slowly." 3. "Pain in the back of the leg should be reported." 4. "Your urine may become dark and if it does, you should call your primary health care provider."

3. "Pain in the back of the leg should be reported." Rationale: Levofloxacin is a fluoroquinolone antibiotic and is used for a variety of infections, including UTI. Adverse effects include peripheral neuropathy, rhabdomyolysis, tendonitis, tendon rupture, Clostridium difficile infection, muscle weakness in clients with myasthenia gravis, and photosensitivity. Levofloxacin can also prolong the client's QT interval, leading to dysrhythmias. Pain in the back of the leg could be indicative of tendonitis and therefore risk for tendon rupture. The other adverse effects are associated with gemifloxacin, not levofloxacin.

The nurse is caring for a client who has been taking a sulfonamide and should monitor for signs and symptoms of which adverse effects of the medication? Select all that apply. 1. Ototoxicity 2. Palpitations 3. Nephrotoxicity 4. Bone marrow depression 5. Gastrointestinal (GI) effects 6. Increased white blood cell (WBC) count

3. Nephrotoxicity 4. Bone marrow depression 5. Gastrointestinal (GI) effects Rationale: Sulfonamides (sulfa drugs) are a type of antibiotic. They work by disrupting the production of dihydrofolic acid, a form of folic acid that bacteria and human cells use for producing proteins. Adverse effects of sulfonamides include nephrotoxicity, bone marrow depression, GI effects, hepatotoxicity, dermatological effects, and some neurological symptoms, including headache, dizziness, vertigo, ataxia, depression, and seizures. The remaining options are unrelated to this medication.

The nurse is caring for a client who has been taking a sulfonamide and should monitor for signs and symptoms of which adverse effects of the medication? Select all that apply. 1. Ototoxicity 2. Palpitations 3. Nephrotoxicity 4. Bone marrow suppression 5. Gastrointestinal (GI) effects 6. Increased white blood cell (WBC) count

3. Nephrotoxicity 4. Bone marrow suppression 5. Gastrointestinal (GI) effects Rationale: Adverse effects of sulfonamides include nephrotoxicity, bone marrow suppression, GI effects, hepatotoxicity, dermatological effects, and some neurological symptoms including headache, dizziness, vertigo, ataxia, depression, and seizures. Options 1, 2, and 6 are unrelated to these medications.

A client who has been diagnosed with pneumonia has been given a prescription for erythromycin. Client teaching about this medication should include which best instruction? 1. Take the medication with juice. 2. Take the medication with a meal. 3. Take the medication on an empty stomach. 4. Take the medication at bedtime with a snack.

3. Take the medication on an empty stomach. Rationale: Erythrmycin (Erythromycin) is a macrolide antibiotic. Oral erythromycin should best be administered on an empty stomach with a full glass of water (1 hour before or 2 hours following ingestion of food). Some preparations may be administered with food if gastrointestinal upset occurs, but it is best to administer on an empty stomach.

Isoniazid is prescribed for a child with human immunodeficiency virus (HIV) infection who has a positive tuberculin skin test result. The mother of the child asks the nurse how long the child will need to take the medication. For how long should the nurse tell the mother the medication will need to be taken? 1. 4 months 2. 6 months 3. 9 months 4. 12 months

4. 12 months Rationale: For children with HIV infection who demonstrate a positive tuberculin skin test result, a minimum of 12 months of treatment with isoniazid is recommended.

The nurse is caring for a client with a urinary tract infection (UTI). The culture report reveals the presence of Pseudomonas aeruginosa. The nurse anticipates that which medication will be prescribed to treat the infection? 1. Isoniazid 2. Rifampin 3. Ethambutol 4. Ciprofloxacin

4. Ciprofloxacin Rationale: Ciprofloxacin is an antimicrobial agent that is used to treat UTIs caused by P. aeruginosa. The medications identified in the other options are antituberculosis medications.

The client with acquired immunodeficiency syndrome (AIDS) has been prescribed raltegravir. The nurse determines that the client may be experiencing an adverse effect related to this medication if which assessment finding is noted? 1. Insomnia 2. Dizziness 3. Indigestion and belching 4. Temperature of 101.2º F (38.4º C)

4. Temperature of 101.2º F (38.4º C) Rationale: Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Raltegravir is classified as an integrase inhibitor and acts by inhibiting human immunodeficiency virus (HIV) replication. Insomnia, dizziness, and indigestion are some side effects of the mediation. A temperature of 101.2º F is indicative of potential opportunistic infection, which is an adverse effect of this medication.

Nitrofurantoin is prescribed for a client with a urinary tract infection. The client contacts the nurse and reports a cough, chills, fever, and difficulty breathing. The nurse should make which interpretation about the client's complaints? 1. The client may have contracted the flu. 2. The client is experiencing anaphylaxis. 3. The client is experiencing expected effects of the medication. 4. The client is experiencing a pulmonary reaction requiring cessation of the medication.

4. The client is experiencing a pulmonary reaction requiring cessation of the medication. Rationale: Nitrofurantoin can induce 2 kinds of pulmonary reactions: acute and subacute. Acute reactions, which are most common, manifest with dyspnea, chest pain, chills, fever, cough, and alveolar infiltrates. These symptoms resolve 2 to 4 days after discontinuing the medication. Acute pulmonary responses are thought to be hypersensitivity reactions. Subacute reactions are rare and occur during prolonged treatment. Symptoms (e.g., dyspnea, cough, malaise) usually regress over weeks to months following nitrofurantoin withdrawal. However, in some clients, permanent lung damage may occur. The remaining options are incorrect interpretations.

A client with acquired immunodeficiency syndrome who is taking zidovudine 200 mg orally 3 times daily has severe neutropenia noted on follow-up laboratory studies. The nurse interprets that which change is likely to occur at this point? 1. The medication dose probably will be reduced. 2. Prednisone probably will be added to the medication regimen. 3. Epoetin alfa probably will be added to the medication regimen. 4. The medication probably will be discontinued until laboratory results indicate bone marrow recovery.

4. The medication probably will be discontinued until laboratory results indicate bone marrow recovery. Rationale: Zidovudine is a nucleoside-nucleotide reverse transcriptase inhibitor. Hematological monitoring should be done every 2 weeks in the client taking zidovudine. If severe anemia or severe neutropenia develops, treatment should be discontinued until evidence of bone marrow recovery is noted. If anemia or neutropenia is mild, a reduction in dosage may be sufficient. The administration of prednisone may further alter the immune function. Epoetin alfa is administered to clients experiencing anemia.

A client with a documented exposure to tuberculosis is on medication therapy with isoniazid. The nurse is monitoring laboratory results and determines that which laboratory value indicates the need for follow-up? 1. Platelet count 325,000 mm3 (325 × 109/L) 2. Serum creatinine 1.0 mg/dL (88.3 mcmol/L) 3. Blood urea nitrogen (BUN) 20 mg/dL (7.1 mmol/L) 4. Aspartate aminotransferase (AST) 55 U/L (55 U/L)

Platelet count 325,000 mm3 (325 × 109/L) Serum creatinine 1.0 mg/dL (88.3 mcmol/L) Blood urea nitrogen (BUN) 20 mg/dL (7.1 mmol/L) Aspartate aminotransferase (AST) 55 U/L (55 U/L) Rationale: Because isoniazid therapy can cause elevated hepatic enzymes and hepatitis, liver enzymes are monitored when therapy is initiated and during the first 3 months of therapy. They may be monitored longer in the client who is older than 50 years of age or who abuses alcohol. The normal AST level is 0 to 35 U/L (0 to 30 U/L). The other options are not monitored routinely and are also normal.