320 q2

Before administration of any antiviral medication, what nursing responsibilities would be performed? (Select all that apply.) A. Head-to-toe physical assessment B. Documentation of known allergies C. History of medication use D. Monitoring for adverse effects E. Baseline vital signs

A, B,C,E Before administering an antiviral drug, perform a thorough head-to-toe physical assessment and take a medical and medication history. Document any known allergies before use of these and any other medications. Also assess the patient’s baseline vital signs because of the profound effects of viral illnesses on physiologic status, especially if the patient is immunocompromised. Assess and document any contraindications, cautions, and drug interactions associated with all of the antiviral drugs. Monitoring for adverse effects would occur after the medication has been administered

What are the primary indications for SSRI's and SNRI's? A. Depression and Anxiety B. Obesity and Eating Disorders C. OCD D. Bipolar disorder and OCD

A. Depression and Anxiety

Which types of antiviral drugs are used to treat HIV infection? (Select all that apply.) A. Fusion inhibitors B. Protease inhibitors C. Neuraminidase inhibitors D. Reverse transcriptase inhibitors E. Nonnucleoside reverse transcriptase inhibitors

A. Fusion inhibitors B. Protease inhibitors D. Reverse transcriptase inhibitors E. Nonnucleoside reverse transcriptase inhibitors Neuraminidase inhibitors are used in the treatment of the influenza virus

Which statement, if made by a patient with HIV infection, demonstrates a need for continued patient teaching? A. "I will change my position slowly to prevent dizziness and potential injury." B. "I must take these medications exactly as prescribed for the rest of my life." C. "I don't need to use condoms as long as I take my medication as prescribed." D. "I should remain upright for 30 minutes after taking my zidovudine."

C. "I don't need to use condoms as long as I take my medication as prescribed." Antiretroviral drugs do not stop the transmission of HIV, and patients need to continue standard precautions

A young man has been taken to the emergency department because of a suspected overdose of morphine tablets. The nurse prepares to administer which drug? A. Atropine B. Meperidine (Demerol) C. Flumazenil (Romazicon) D. Naloxone (Narcan)

D. Naloxone (Narcan)

A patient has a prescription for a sulfa drug as treatment for a urinary tract infection. She is also taking an oral contraceptive, an oral sulfonylurea antidiabetic drug, and phenytoin for a history of seizures. Which drug may pose a potential serious interaction with the sulfa drug? A.The oral contraceptive B.The oral antidiabetic drug C.The phenytoin D.All of these `

D. All of these Rationale: The combination of the sulfa drug with the oral contraceptive may reduce the effectiveness of the contraceptive. The combination with the oral antidiabetic drug may potentiate the hypoglycemic effect of the sulfonylurea drug, while the combination with the phenytoin may potentiate the toxic effects of the phenytoin.

An 18-year-old basketball player fell and twisted his ankle during a game. The nurse will expect to administer which type of analgesic? A. Synthetic opioid, such as meperidine (Demerol) B. Opium alkaloid, such as morphine sulfate C. Opioid antagonist, such as naloxone HCL (Narcan) D. Nonopioid analgesic, such as indomethacin (Indocin)

D. Nonopioid analgesic, such as indomethacin (Indocin) Somatic pain, originating from skeletal muscles, ligaments, and joints, usually responds to nonopioid analgesics, such as nonsteroidal antiinflammatory drugs (NSAIDs). The other options are not the best choices for somatic pain.

How is the effectiveness of antiviral drugs administered to treat HIV infection assessed and evaluated? A. Megakaryocytes B. Red blood cell counts C. Lymphocyte counts D. Viral load

D. Viral load All antiretroviral drugs work to reduce the viral load, which is the number of viral RNA copies per milliliter of blood

Which of the following are used to treat UTI in women? a. TMP-SMZ b. nitrofurantoin (Macrobid) c. cephalexin (Keflex) d. fluoroquinolones (Ciprofloxacin)

a, b, d cephalexin (Keflex) is used for pregnant women with UTI

Which of the following are used to treat UTI in men? a. TMP-SMZ b. nitrofurantoin (Macrobid) c. cephalexin (Keflex) d. fluoroquinolones (Ciprofloxacin)

a, d

Which of the following are used to treat UTI in pregnant women? a. TMP-SMZ b. nitrofurantoin (Macrobid) c. cephalexin (Keflex) d. fluoroquinolones (Ciprofloxacin)

b, c

The nurse is reviewing the use of multidrug therapy for HIV with a patient. Which statements are correct regarding the reason for using multiple drugs to treat HIV? (Select all that apply.) a. The combination of drugs has fewer associated toxicities. b. The use of multiple drugs is more effective against resistant strains of HIV. c. Effective treatment results in reduced T-cell counts. d. The goal of this treatment is to reduce the viral load. e. This type of therapy reduces the incidence of opportunistic infections.

b, d, e

What drugs are used to treat children with UTI? a. TMP-SMZ b. nitrofurantoin (Macrobid) c. amoxicillin/clavulanate (Augmentin) d. fluoroquinolones (Ciprofloxacin)

c. amoxicillin/clavulanate (Augmentin) Augmentin is a second-line drug for UTI, but it is a first-line drug for children with UTI.

Which antiretroviral drug is classified as a fusion inhibitor? a. Abacavir b. Efavirenz c. Enfuvirtide d. Amprenavir

d. Enfuvirtide Enfuvirtide is the only drug that is classified as a fusion inhibitor. Abacavir is a nucleoside reverse transcriptase inhibitor. Efavirenz is a nonnucleoside reverse transcriptase inhibitor. Amprenavir is a protease inhibitor. p. 651

Which instruction does a nurse provide to a patient who is taking a selective serotonin reuptake inhibitor (SSRI)? 1 "Change positions frequently." 2 "Avoid foods or beverages rich in tyramine." 3 "Avoid hot baths, saunas, and hot climates." 4 "Increase the intake of dietary fiber supplements."

4 Fiber supplements are appropriate for a patient who is taking an SSRI and should be taken at least 2 hours before or after the administration of an SSRI to avoid interference with drug absorption. Frequent changes of position are recommended for patients who are taking tricyclic antidepressants or monoamine oxidase inhibitors (MAOIs) to prevent hypotension. The nurse advises patients who are taking MAOIs to avoid foods or beverages rich in tyramine to prevent cheese effect. Hot baths, saunas, and hot climates should be avoided by patients taking antipsychotics to prevent the risk of a further drop in blood pressure.

When monitoring a patient for adverse effects related to morphine sulfate, the nurse assesses for which response? 1 Stimulation of circulation 2 Stimulation of respiratory rate 3 Stimulation of the cough reflex 4 Stimulation of the chemoreceptor trigger zone

4 Morphine sulfate can irritate the gastrointestinal tract, causing stimulation of the chemoreceptor trigger zone in the brain, which in turn causes nausea and vomiting. Opioids cause a decrease in respiratory rate, not stimulation.

The nurse is reviewing the food choices of a patient who is taking a monoamine oxidase inhibitor ( MAOI). Which food choice would indicate the need for additional teaching? a. Orange juice b. Fried eggs over-easy c. Salami and Swiss cheese sandwich d. Biscuits and honey

ANS: C Aged cheeses, such a Swiss or cheddar cheese, and Salami contain tyramine. Patients who are taking MAOIs need to avoid tyramine-containing foods because of a severe hypertensive reaction that may occur. Orange juice, eggs, biscuits, and honey do not contain tyramine. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 260 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

The nurse is reviewing medications used for depression. Which of these statements is a reason that selective serotonin reuptake inhibitors (SSRIs) are more widely prescribed today than tricyclic antidepressants? a. SSRIs have fewer sexual side effects. b. Unlike tricyclic antidepressants, SSRIs do not have drug-food interactions. c. Tricyclic antidepressants cause serious cardiac dysrhythmias if an overdose occurs. d. SSRIs cause a therapeutic response faster than tricyclic antidepressants.

ANS: C Death from overdose of tricyclic antidepressants usually results from either seizures or dysrhythmias. SSRIs are associated with significantly fewer and less severe systemic adverse effects, especially anticholinergic and cardiovascular adverse effects. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 257 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A 58-year-old woman has been admitted for a total abdominal hysterectomy. That evening she asks for pain medication. Upon assessment, you find that she rates her pain level an 8 on a scale from 1-10 and states that her pain is located mainly in the immediate area around her incision. You prepare to give her an IV dose of morphine sulfate. Within 1 hour of receiving the morphine, the patient complains that her skin feels "itchy," but she cannot see any hives. What do you tell her? All opioids cause some histamine release. It is thought that this histamine release is responsible for many unwanted side effects, such as itching.

All opioids cause some histamine release. It is thought that this histamine release is responsible for many unwanted side effects, such as itching.

Primary side effects of the SSRIs include which of the following symptoms? A. Rash and alopecia B. Gastritis and diarrhea C. Weight gain and sexual dysfunction D. Photosensitivity and discoloration of the skin

C. Weight gain and sexual dysfunction

What is the mechanism of action of nonsteroidal antiinflammatory drugs (NSAIDs)? a. Enhancing pain perception b. Inhibiting prostaglandin production c. Increasing blood flow to painful areas d. Increasing the supply of natural endorphins

b. Inhibiting prostaglandin production Prostaglandins are produced in response to activation of the arachidonic pathway. NSAIDs work by blocking cyclooxygenase (COX-1 and COX-2), the enzyme responsible for conversion of arachidonic acid into prostaglandins. Decreasing the synthesis of prostaglandins results in decreased pain and inflammation.

The nurse recognizes that manifestations of NSAID toxicity include a. constipation. b. nausea and vomiting. c. tremors. d. urinary retention.

b. nausea and vomiting.

After giving an injection to a patient with HIV infection, the nurse accidentally receives a needlestick from a too-full needle disposal box. Recommendations for occupational HIV exposure may include the use of which drugs. a) Didanosine b) Lamivudine and enfuvirtide c) Zidovudine, lamivudine, and indinavir d) Acyclovir

c) Zidovudine, lamivudine, and indinavir

Several patients have standard orders for acetaminophen as needed for pain. While reviewing their histories and assessments, the nurse discovers that one of the patients has a contraindication to acetaminophen therapy. Which patient should receive an alternate medication? a. A patient with a fever of 103.4° F (39.7° C) b. A patient admitted with deep vein thrombosis c. A patient admitted with severe hepatitis d. A patient who had abdominal surgery 1 week earlier

c. A patient admitted with severe hepatitis

A patent has been newly diagnosed with HIV has many questions about the effectiveness of drug therapy. After a teaching session, which statement by the patient reflects a need for more education

"These drugs will eventually eliminate the virus from my body."

A nurse is teaching a client who has a new prescription for combination oral NRTs (abacavir, lamivudine, and zidovudine) for treatment of HIV. Which of the following statements should the nurse include?

"these medications work by inhibiting enzymes to prevent HIV replication."

A nurse is caring for a client who takes several antiretroviral medications, including the NRTI zidovudine, to treat HIV infection. The nurse should monitor for which of the following adverse effects of zidovudine? (select all that apply)

-fatigue -hyperventilation -Vomiting

A nurse is caring for a client who has a new prescription for enfuvirtide to treat HIV infection. The nurse should monitor the client for which of the adverse reactions of this medication? (select all that apply).

-pneumonia -localized erythema --hypotension

A nurse is teaching a client who is beginning highly active antiretroviral therapy (HAART) for HIV infection about ways to prevent medication resistance. Which of the following information should the nurse teach the client about resistance?

-taking medication at the same times daily without missing doses minimizes resistance.

The nurse is reviewing the use of multidrug therapy for HIV with a patient. Which statements are correct regarding the reason for using multiple drugs to treat HIV? (select all that apply)

-the use of multiple drugs is more effective against resistant strains of HIV -The goal of this treatment is to reduce the viral load. -This type of therapy reduces the incidence of opportunistic infections.

A postoperative patient is receiving an epidural infusion of morphine sulfate. The patient's respiratory rate decreases to 8 breaths/min. Which medication should the nurse administer after attempting to have the patient respond to verbal and tactile stimuli? 1 Naloxone 2 Acetylcysteine 3 Protamine sulfate 4 Methylprednisolone

1 A respiratory rate of 8 breaths/min indicates respiratory depression. Naloxone is a narcotic antagonist that will reverse this effect of morphine sulfate. Acetylcysteine is used for acetaminophen toxicity. Protamine sulfate is used to reverse the drug effects of heparin. Methylprednisolone is administered to alleviate cytokine release syndrome caused by basiliximab and daclizumab, which are used to prevent rejection of transplanted kidneys.

Which are common symptoms of serotonin syndrome? Select all that apply. 1 Delirium 2 Myoclonus 3 Drowsiness 4 Coarse tremors 5 Suicidal thoughts

1, 2, 4 Serotonin syndrome is a condition that occurs because of an adverse effect of any drug or because a combination of drugs have serotoninergic activity. The symptoms of serotonin syndrome include delirium, myoclonus (muscle spasms), coarse tremors, agitation, sweating, and tachycardia. Drowsiness is an abnormal feeling that occurs as a side effect of sedatives, hypnotics, and mood stabilizers, but is not a symptom of serotonin syndrome. Suicidal thoughts are observed in patients who have severe depression. Which are common symptoms of serotonin syndrome? Select all that apply. 1 Delirium 2 Myoclonus 3 Drowsiness 4 Coarse tremors 5 Suicidal thoughts

The nurse is caring for a patient who is receiving morphine sulfate for pain management. Which assessment findings are cause for immediate nursing action? Select all that apply. 1 Hallucinations 2 Excess urination 3 Slow pupil reaction 4 Altered consciousness 5 Change in sputum color

1, 3, 4 Morphine sulfate is an opioid drug. The nurse should immediately notify the primary health care provider after finding symptoms such as hallucination, sluggish pupil reaction, or changes in consciousness level. These symptoms indicate adverse effects of morphine sulfate. After observing these symptoms, the nurse should not administer further doses of morphine sulfate to the patient. Excessive urination is a sign of polyuria, but it is not an adverse effect of morphine sulfate. Change in color of sputum may indicate infection but it is not an adverse effect of morphine sulfate.

A patient with a history of abusing opioid analgesics needs an antianxiety agent. Which medication should the nurse expect to administer? 1 Diazepam 2 Buspirone 3 Venlafaxine 4 Escitalopram

2 Because the potential for abuse is low, buspirone is a suitable antianxiety agent for this patient. Diazepam is contraindicated because benzodiazepines are highly addictive. Venlafaxine is a serotonin-norepinephrine reuptake inhibitor, and escitalopram is a selective serotonin reuptake inhibitor; both medications have a low potential for abuse and are first-line antidepressant therapies. The nurse does not know whether the patient has depression along with the anxiety, so these drugs are not indicated.

A patient is being switched from amitriptyline to citalopram. Which statement made by the patient reflects understanding of patient education? 1 "I can just stop taking my Elavil and start taking the Celexa as ordered." 2 "I will not get as dizzy when I change positions after I switch medications." 3 "The doctor is switching me to this medication because it is less expensive but just as effective." 4 "I will need to limit my intake of cheese when taking Celexa to prevent a rise in my blood pressure."

2 Citalopram, a selective serotonin reuptake inhibitor (SSRI), produces minimal anticholinergic and cardiovascular side effects. Aged cheese should be avoided by patients taking monoamine oxidase inhibitors, not SSRIs.

Which assessment finding indicates that the patient may have received an overdose of morphine sulfate? 1 Blood in urine 2 Pinpoint pupils 3 Heart rate 110 beats/min 4 Respiratory rate 28 breaths/min

2 Morphine sulfate is an opioid drug used for pain management. After administration of morphine sulfate, the nurse should assess the patient's pupillary reaction to light. Pinpoint pupils indicate an overdose of morphine sulfate. Overdose of morphine sulfate does not cause blood in the urine, increased heart rate or increased respiratory rate.

If the decision is made to switch to an SSRI from a MAOI, there must be a ____ to ____ week "wash-out" period.

2, 5

Which finding alerts the nurse to the possibility that the patient is experiencing adverse effects of morphine sulfate? 1 Diarrhea 2 Insomnia 3 Drowsiness 4 Hyperactive bowel sounds

3 Morphine sulfate depresses the central nervous system, resulting in drowsiness. It also causes a decrease in gastrointestinal motility, leading to constipation. This effect is helpful in treating diarrhea. Morphine sulfate does not cause insomnia. Morphine does not cause hyperactive bowel sounds.

A patient's medication administration record has the following entry: morphine sulfate 1 mg IV push q2h PRN severe pain. Upon assessment, the patient continues to complain of pain that is 8 on a scale of 0 to 10. The patient received 1 mg of morphine an hour ago. What is the nurse's best action? 1 Administer 1 mg of morphine and notify the primary health care provider. 2 Hold the drug, record the assessment, and reassess the patient in 1 hour. 3 Consult the primary health care provider and obtain another drug prescription. 4 Administer another 1 mg of morphine and reevaluate the pain scale in 15 minutes.

3 The nurse needs to consult with the primary health care provider for a medication for breakthrough pain. The patient is in severe pain. Hence the patient needs to be administered an analgesic. The nurse should not wait to treat the patient's pain.

The nurse is caring for a patient diagnosed with depression who has been prescribed isocarboxazid. Due to a slight increase in blood pressure and agitation, the primary health care provider prescribed buspirone for the patient. What does the nurse do to prevent adverse effects in the patient? 1 Administer buspirone at night and isocarboxazid after lunch. 2 Administer buspirone intravenously and isocarboxazid orally. 3 Administer buspirone and isocarboxazid by dissolving in water. 4 Administer buspirone 14 days after discontinuing isocarboxazid

4 Buspirone is prescribed for the treatment of agitation. It should not be coadministered with monoamine oxidase inhibitors such as isocarboxazid because the drugs interact and increase blood pressure. In order to prevent such adverse effects, the drug must be administered after a sufficient washout period. Therefore the nurse should administer buspirone 14 days after discontinuing isocarboxazid. On the other hand, continuing the administration of isocarboxazid by changing the administration time, by changing the dosage forms, or by diluting the drugs in water may not be helpful in preventing adverse effects. Therefore in order to prevent the drug interaction, the nurse should not simply administer isocarboxazid after lunch, dissolve the drug in water, or give it orally. The nurse is caring for a patient diagnosed with depression who has been prescribed isocarboxazid. Due to a slight increase in blood pressure and agitation, the primary health care provider prescribed buspirone for the patient. What does the nurse do to prevent adverse effects in the patient? 1 Administer buspirone at night and isocarboxazid after lunch. 2 Administer buspirone intravenously and isocarboxazid orally. 3 Administer buspirone and isocarboxazid by dissolving in water. 4 Administer buspirone 14 days after discontinuing isocarboxazid

Several months later the patient returns to the health care provider's office for follow-up regarding use of the SSRI. The patient tells the nurse that he is feeling better and stopped taking the SSRI yesterday. He doesn't plan on taking the medication again. When talking with the patient, which knowledge should guide the nurse's response?

A 1- to 2-month taper period is indicated to prevent adverse effects of abrupt drug discontinuation.

A patient that has been prescribed Buspirone (Buspar) should be aware that this drug will interact with which of the following? (Select all that apply) A. Alcohol B. NSAIDs C. SSRI's D. Grapefruit juice E. MAOI's

A. Alcohol C. SSRI's D. Grapefruit juice E. MAOI's

A patient with a diagnosis of depression is being discharged with a prescription for an MAOI. Which instruction should the nurse include for this medication? A. Avoid eating aged cheese. B. Encourage use of fiber supplements. C. Explain the symptoms of tardive dyskinesia. D. Emphasize that tremors are a common adverse effect.

A. Avoid eating aged cheese. Eating foods high in tyramine, including aged cheese, can cause a hypertensive crisis in patients taking MAOIs.

When assessing a patient for adverse effects related to morphine sulfate, which effects would the nurse expect to find? (Select all that apply)

A. Decreased peristalsis C. Delayed gastric emptying D. Urinary retention

The patient has been taking morphine for postoperative pain. Before discharge, what patient teaching should be provided to prevent constipation? (Select all that apply.) A. Increase fluid intake throughout the day B. Increase rest periods C. Take a stool softener D. Decrease the medication dosage with constipation E. Eat more animal protein and dairy

A. Increase fluid intake throughout the day C. Take a stool softener Constipation may be managed with increased intake of fluids, use of stool softeners such as docusate sodium, or use of stimulants such as bisacodyl or senna. Agents such as lactulose, sorbitol, and polyethylene glycol (Miralax) have been proven effective. Less commonly used are bulk-forming laxatives such as psyllium, for which increased fluid intake is especially important to avoid fecal impactions or bowel obstructions.

A patient will be receiving nitrofurantoin (Macrodantin) treatment for a urinary tract infection. The nurse is reviewing the patient's history and will question the nitrofurantoin order if which disorder is present in the history? (Select all that apply.) A. Liver disease B. Coronary artery disease C. Hyperthyroidism D. Type 1 diabetes mellitus E. Chronic renal disease

A. Liver Disease E. Chronic Renal Disease Rationale: Nitrofurantoin is contraindicated in cases of known drug allergy and also in cases of significant renal function impairment, because the drug concentrates in the urine. Because adverse effects include hepatotoxicity, which is rare but often fatal, the nurse should also question the order if liver disease is present. The other options are not contraindications.

During therapy for depression with a selective serotonin reuptake inhibitor (SSRI), it is most important for the nurse to instruct the family to monitor for which adverse effect? A. Suicidal thoughts B. Visual disturbances C. Tardive dyskinesia D. Bleeding tendencies

A. Suicidal thoughts

A patient who has been taking a selective serotonin reuptake inhibitor (SSRI) is complaining of "feeling so badly" when he started taking an over-the-counter St. John's wort herbal product at home. The nurse suspects that he is experiencing serotonin syndrome. Which of these are symptoms of serotonin syndrome? (Select all that apply.) a. Agitation b. Drowsiness c. Tremors d. Bradycardia e. Sweating f. Constipation

ANS: A, C, E Common symptoms of serotonin syndrome include delirium, agitation, tachycardia, sweating, hyperreflexia, shivering, coarse tremors, and others. See Box 16-1 for a full list of symptoms. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 260 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

The nurse is providing counseling to a woman who is HIV positive and has just discovered that she is pregnant. Which anti-HIV drug is given to HIV-infected pregnant women to prevent transmission of the virus to the infant? a. Acyclovir (Zovirax) b. Zidovudine (Retrovir) c. Ribavirin (Virazole) d. Foscarnet (Foscavir)

ANS: B Zidovudine, along with various other antiretroviral drugs, is given to HIV-infected pregnant women and even to newborn babies to prevent maternal transmission of the virus to the infant. The other drugs are non-HIV antiviral drugs.

While monitoring a depressed patient who has just started SSRI antidepressant therapy, the nurse will observe for which problem during the early time frame of this therapy? a. Hypertensive crisis b. Self-injury or suicidal tendencies c. Extrapyramidal symptoms d. Loss of appetite

ANS: B In 2005, the U.S. Food and Drug Administration (FDA) issued special black-box warnings regarding the use of all classes of antidepressants in both adult and pediatric patient populations. Data from the FDA indicated a higher risk for suicide in patients receiving these medications. As a result, current recommendations for all patients receiving antidepressants include regular monitoring for signs of worsening depressive symptoms, especially when the medication is started or the dosage is changed. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 256 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

When a patient is receiving a second-generation antipsychotic drug, such as risperidone (Risperdal), the nurse will monitor for which therapeutic effect? a. Fewer panic attacks b. Decreased paranoia and delusions c. Decreased feeling of hopelessness d. Improved tardive dyskinesia

ANS: B The therapeutic effects of the antipsychotic drugs include improvement in mood and affect, and alleviation or decrease in psychotic symptoms (decrease in hallucinations, paranoia, delusions, garbled speech). Tardive dyskinesia is a potential adverse effect of these drugs. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 272 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Physiological Adaptation

Before beginning a patient's therapy with selective serotonin reuptake inhibitor (SSRI) antidepressants, the nurse will assess for concurrent use of which medications or medication class? a. Aspirin b. Anticoagulants c. Diuretics d. Nonsteroidal anti-inflammatory drugs

ANS: B Use of selective serotonin reuptake inhibitor (SSRI) antidepressants with warfarin results in an increased anticoagulant effect. SSRI antidepressants do not interact with the other drugs or drug classes listed. See Table 16-6 for important drug interactions with SSRIs. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 258 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

A 78-year-old patient is in the recovery room after having a lengthy surgery on his hip. As he is gradually awakening, he requests pain medication. Within 10 minutes after receiving a dose of morphine sulfate, he is very lethargic and his respirations are shallow, with a rate of 9 per minute. The nurse prepares for which action at this time? A. Close observation of signs of opioid tolerance B. Immediate intubation and artificial ventilation C. Administration of naloxone (Narcan), an opioid reversal agent D. Administration of an agonist opioid such as fentanyl

ANS: C Naloxone, an opioid-reversal agent, is used to reverse the effects of acute opioid overdose and is the drug of choice for reversal of opioid-induced respiratory depression. This situation is describing an opioid overdose, not opioid tolerance. Intubation and artificial ventilation are not appropriate because the patient is still breathing at nine breaths per minute. It would be inappropriate to administer an opioid agonist.

11.A patient has a urinary tract infection. The nurse knows that which class of drugs is especially useful for such infections? a.Macrolides b.Carbapenems c.Sulfonamides d.Tetracyclines

ANS: C Sulfonamides achieve very high concentrations in the kidneys, through which they are eliminated. Therefore, they are often used in the treatment of urinary tract infections

Which statements are true regarding the selective serotonin reuptake inhibitors (SSRIs)? (Select all that apply.) a. Avoid foods and beverages that contain tyramine. b. Monitor the patient for extrapyramidal symptoms. c. Therapeutic effects may not be seen for about 4 to 6 weeks after the medication is started. d. If the patient has been on an MAOI, a 2- to 5-week or longer time span is required before beginning an SSRI medication. e. These drugs have anticholinergic effects, including constipation, urinary retention, dry mouth, and blurred vision. f. Cogentin is often also prescribed to reduce the adverse effects that may occur.

ANS: C, D During SSRI medication, therapeutic effects may not be seen for 4 to 6 weeks. To prevent the potentially fatal pharmacodynamic interactions that can occur between the SSRIs and the MAOIs, a 2- to 5-week washout period is recommended between uses of these two classes of medications. The other options apply to other classes of psychotherapeutic drugs, not SSRIs. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 261 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A patient is taking a combination of antiviral drugs as treatment for early stages of HIV infection. While discussing the drug therapy, the patient asks the nurse if the drugs will kill the virus. When answering, the nurse keeps in mind which fact about antiviral drugs? a. They are given for palliative reasons only. b. They will be effective as long as the patient is not exposed to the virus again. c. They can be given in large enough doses to eradicate the virus without harming the body's healthy cells. d. They may also kill healthy cells while killing viruses

ANS: D Because viruses reproduce in human cells, selective killing is difficult; consequently, many healthy human cells, in addition to virally infected cells, may be killed in the process, and this results in the serious toxicities that are involved with these drugs. The other options are incorrect.

A patient who is HIV- positive has been receiving medication therapy that includes zidovudine(Retrovir). However, the prescriber has decided to stop the zidovudine because of its dose-limiting adverse effect. Which of these conditions is the dose-limiting adverse effect of zidovudine therapy? a. Retinitis b. Renal toxicity c. Hepatoxicity d. Bone marrow suppression

ANS: D Bone marrow suppression is often the reason that a patient with HIV infection has to be switched to another anti-HIV drug such as didanosine. The two drugs can be taken together, cutting back on the dosages of both and thus decreasing the likelihood of toxicity. The other options are incorrect.

A patient has been taking the monoamine oxidase inhibitor (MAOI) phenelzine (Nardil) for 6 months. The patient wants to go to a party and asks the nurse, "Will just one beer be a problem?" Which advice from the nurse is correct? a. "You can drink beer as long as you have a designated driver." b. "Now that you've had the last dose of that medication, there will be no further dietary restrictions." c. "If you begin to experience a throbbing headache, rapid pulse, or nausea, you'll need to stop drinking." d. "You need to avoid all foods that contain tyramine, including beer, while taking this medication."

ANS: D Foods containing tyramine, such as beer and aged cheeses, should be avoided while a patient is taking an MAOI. Drinking beer while taking an MAOI may precipitate a dangerous hypertensive crisis. The other options are incorrect. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 258 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

A patient has been taking the selective serotonin reuptake inhibitor (SSRI) sertraline (Zoloft) for about 6 months. At a recent visit, she tells the nurse that she has been interested in herbal therapies and wants to start taking St. John's wort. Which response by the nurse is appropriate? a. "That should be no problem." b. "Good idea! Hopefully you'll be able to stop taking the Zoloft." c. "Be sure to stop taking the herb if you notice a change in side effects." d. "Taking St. John's wort with Zoloft may cause severe interactions and is not recommended."

ANS: D The herbal product St. John's wort must not be used with SSRIs. Potential interactions include confusion, agitation, muscle spasms, twitching, and tremors. The other responses by the nurse are inappropriate. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 260 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

Intravenous morphine is prescribed for a patient who has had surgery. The nurse informs the patient that which common adverse effects can occur with this medication? (Select all that apply.) a. Diarrhea b. Constipation c. Pruritus d. Urinary frequency e. Nausea

B constipation C pruritus E nausea

A patient taking a SSRI is complaining of a headache, nausea, and vomiting. Which statement by the nurse is appropriate? A. "You should notify your MD." B. "These s/s should go away within a couple weeks." C. "Discontinue the drug."

B. "These s/s should go away within a couple weeks."

The nurse prepares morphine sulfate IV for a patient but decides to consult with the pharmacist before administering the medication. Which condition is the most likely reason the nurse has decided to consult the pharmacist? A. Cancer B. Asthma C. Diarrhea D. Anorexia

B. Asthma Morphine should be used with caution in patients with asthma because naturally occurring opioids cause the release of histamine; a release of histamine in a patient with asthma can trigger bronchoconstriction. Because morphine is bound to protein 20% to 35%, the patient's cancer and anorexia are causes for concern because both conditions can result in hypoproteinemia and a lack of protein-binding sites for morphine and, therefore, altered pharmacokinetics of the medication. The administration of morphine can help diminish diarrhea.

Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) both function by which mechanism? A. Decrease the catecholamine release into the blood B. Block the reuptake of neurotransmitters at nerve endings C. Inhibit an enzyme that stops the action of neurotransmitters D. Stimulate areas of the brain associated with mental alertness

B. Block the reuptake of neurotransmitters at nerve endings The SSRIs block the reuptake of serotonin. The TCAs block the reuptake of norepinephrine and serotonin. The monoamine oxidase inhibitors (MAOIs) inhibit the MAO enzyme that stops the actions of neurotransmitters such as dopamine, serotonin, and norepinephrine. Amphetamines stimulate areas of the brain associated with mental alertness.

SSRI's should not be taking with MAIO's because of their risk of serotonin syndrome. What are the classic S/S of serotonin Syndrome? A. Fatigue B. Hypertension C. Muscle weakness D. Bradycardia

B. Hypertension

The nurse is preparing to administer an injection of morphine to a patient. Assessment notes a respiratory rate of 10 breaths/min. Which action will the nurse perform? A. Administer a smaller dose and record the findings B. Notify the physician and delay drug administration C. Administer the prescribed dose and notify the physician D. Hold the drug, record the assessment, and recheck in 1 hour

B. Notify the physician and delay drug administration

A patient is recovering from abdominal surgery, which he had this morning. He is groggy but complaining of severe pain around his incision. What is the most important assessment data to consider before the nurse administers a dose of morphine sulfate to the patient? A. Pulse Rate B. Respiratory Rate C. The appearance of his incision D. The date of his last bowel movement

B. Respiratory Rate One of the most serious adverse effects of opioids is respiratory depression. The nurse must assess the patient's respiratory rate before administering an opioid. The other options are not correct.

Which of these are S/S of a MAOI overdose? A. Bradycardia B. Seizure C. Tachycardia D. Respiratory Depression

B. Seizure C. Tachycardia

A patient diagnosed with depression is being discharged with a prescription for TCAs after no improvement of symptoms on an SSRI. Which instruction should the nurse include about this new medication? A. There are no drug or food contraindications with this medication. B. There is a risk of toxicity when this medication is taken with alcohol. C. Take St. John's wort every day to minimize the adverse effects of the medication. D. This drug does not cause problems with sleep, constipation, or low blood pressure.

B. There is a risk of toxicity when this medication is taken with alcohol. There is an increased risk of toxicity with TCAs when taken with alcohol and a high rate of morbidity.

What is the primary indication for the administration of morphine? A. To diminish feelings of anxiety B. To relieve acute and chronic pain C. To induce a state of unconsciousness D. To increase cardiac filling pressures

B. To relieve acute and chronic pain The principal indication for morphine is the relief of moderate to severe pain, including postoperative pain and cancer pain. In addition, morphine is used during acute myocardial infarction to relieve pain, anxiety, and dypsnea and to promote relaxation of vascular smooth muscle. Morphine may also be administered before surgery for sedation.

A patient with active HIV has been taking zidovudine (Retrovir). Which potential adverse effect may limit the length of time this medication can be taken?

B.Bone marrow suppression Rationale: The major dose-limiting adverse effect of zidovudine (Retrovir) is bone marrow suppression, and this is often the reason a patient with an HIV infection must be switched to another anti-HIV drug.

A woman who had been taking an antibiotic for a UTI calls the nurse practitioner to complain of severe vaginal itching. she also had noticed a thick, white vaginal discharge. the nurse practitioner suspects that A. this is an expected response to antibiotic therapy B. the UTO had become worse instead of better C. a superinfection has developed D. the UTI is resistant to the antibiotic

C a super infection has developed

In developing a plan of care for a patient receiving morphine sulfate, which nursing diagnosis is a priority? A. Acute pain B. Risk for injury related to central nervous system side effects C. Impaired gas exchange related to respiratory depression D. Constipation related to gastrointestinal side effects

C. Impaired gas exhange related to respiratory depression

A patient who is prescribed duloxetine (Cymbalta) comes to the medical clinic complaining of restlessness, sweating, and tremors. The nurse suspects serotonin syndrome and questions the patient regarding concurrent use of which herbal product or dietary supplement? A. Zinc B. Vitamin E C. St. John's wort D. Glucosamine chondroitin

C. St. John's wort Serotonin syndrome may occur with SSRIs when they are combined with herbal products such as St. John's wort.

A patient with HIV infection is seen in the clinic. The nurse notes the patient is experiencing weight loss, chronic diarrhea, fever, and dropping CD4 counts. The nurse anticipates the patient is in which stage of HIV infection?

C.Stage 3 Rationale: During stage 3, the infection progresses to a moderately symptomatic state. Weight loss, chronic diarrhea, and fever continue, and CD4 counts continue to drop. Opportunistic infections begin, including severe bacterial pneumonias and pulmonary tuberculosis (TB). Pulmonary TB is usually more severe in persons with AIDS and is currently the leading cause of death worldwide for HIV-infected patients.

The nurse instructs a patient who is undergoing therapy with monoamine oxidase inhibitors (MAOIs) to avoid tyramine-containing foods. What medical emergency may occur if the patient eats these foods while taking MAOIs? A. Gastric hemorrhage B. Toxic shock C. Cardiac arrest D. Hypertensive crisis

D. Hypertensive crisis

A patient needs to switch analgesic drugs secondary to an adverse reaction to the present regimen. The patient is concerned that he will not receive an effective doese of a new drug to control pain. The nurse responds based on knowledge that potencies of analgesics are determined using an equianalgesic table comparing doses of these drugs with what prototype? A. meperidine B. fentanyl C. codeine D. morphine

D. morphine

The nurse administers maraviroc (Selzentry) to a patient with HIV infection. It is most important for the nurse to monitor which of the following?

D.Liver function tests Rationale: The antiretroviral drug maraviroc requires assessment of allergies and liver function as well as review of the list of medications the patient is taking because of the lengthy list of interacting drugs.

A patient is in the HIV clinic for a follow-up appointment. He has been on antiretroviral therapy for HIV for more than 3 years. The nurse will assess for which potential adverse effects of long-term antiretroviral therapy? (Select all that apply.)

Lipodystrophy Liver damage Osteoporosis Type 2 diabetes

A patient with HIV infection is seen in the clinic. The nurse notes the patient is experiencing weight loss, chronic diarrhea, fever, and dropping CD4 counts. Then nurse anticipates the patient in which stage of HIV infection?

Stage 3 Rationale: During stage 3, the infection progresses to a moderately symptomatic state. Weight loss, chronic diarrhea, and fever continue, and CD4 counts continue to drop. Opportunistic infections begin, including severe bacterial pneumonias and pulmonary TB, pulmonary TB is usually more severe in persons with AIDS and is currently the leading cause of death worldwide for HIV-infected patients.

When patients are taking selective serotonin reuptake inhibitors (SSRIs) for the first time for depression, which is most important to monitor for during the first few weeks of therapy?

Suicidal thoughts

The nurse cares for a patient on the second day following major abdominal surgery. The patient is receiving morphine via patient-controlled analgesia (PCA) and currently reports pain as a 2 on a scale of 0 to 10. The patient tearfully says to the nurse, "I'm so worried that I won't be able to go back to work. How am I going to manage my bills?" What is the best response by the nurse? a. "Tell me more about your fears." b. "Your pain is well controlled now. Why are you so worried?" c. "Everything will be fine. You will be back to work in about 6 weeks." d. "The disability benefit of your insurance plan will help pay your bills."

a. "Tell me more about your fears." Anxiety exacerbates the pain experience. By demonstrating caring and concern and using therapeutic communication skills such as active listening and open-ended questions, the patient's anxiety can be explored. Telling the patient that the insurance plan will help to pay bills will not completely alleviate the patient's anxiety. Telling the patient that the pain is in control and not to worry shows a lack of concern for the patient's feelings. Telling the patient that it will take only 6 weeks to get well may be a false reassurance, because it may take longer for the patient to recover.

A patient with a severe urinary tract infection is prescribed amikacin and penicillin. What administration process will the nurse be asked to implement? a. Administer penicillin followed by amikacin. b. Administer amikacin first and then penicillin. c. Administer amikacin orally and penicillin intravenously. d. Administer both amikacin and penicillin simultaneously.

a. Administer penicillin followed by amikacin. Penicillin is administered first, because it breaks the bacterial cell wall. Then amikacin is administered; this drug destroys the bacterial cell, thereby enhancing the effect of the antibiotic. Amikacin can be administered only via the intravenous and intramuscular routes. The nurse should not infuse the drugs simultaneously, because this would not be as effective in treating the severe infection. Beta-lactam antibiotics are initially administered to enhance the drug's activity against microbes. p. 626

The nurse is caring for a patient who has a urinary tract infection and is being treated with sulfamethoxazole/trimethoprim (SMZ-TMP). Which findings does the nurse report to the primary health care provider to prevent complications? . a. Diarrhea b. Yellowish eyes c. Blood in the urine d. Shortness of breath e. Change in the color of the sputum

a. Diarrhea c. Blood in the urine d. Shortness of breath Sulfamethoxazole/trimethoprim (SMZ-TMP) is a sulfonamide antibiotic. The nurse should monitor the patient for diarrhea, blood in the urine, and shortness of breath. These symptoms indicate an adverse reaction to the drug. Hepatotoxicity is a possibility with sulfonamides.

A patient who has acquired immune deficiency syndrome takes indinavir, zidovudine, maraviroc, and zanamavir. Which medication should the nurse first administer in the morning before breakfast to maximize its effectiveness? a. Indinavir b. Maraviroc c. Zanamavir d. Zidovudine

a. Indinavir The nurse should administer indinavir on an empty stomach, because high-fat or high-protein food in the patient's stomach will impair its absorption. The other medications would be provided sequentially after indinavir. Maraviroc, zanamavir, and zidovudine may be used as prescribed after indinavir is administered. pp. 653, 657

Which NSAID would the nurse anticipate administering parenterally for the treatment of acute postoperative pain? a. Ketorolac (Toradol) b. Diclofenac (Cataflam) c. Allopurinol (Zyloprim) d. Indomethacin (Indocin)

a. Ketorolac (Toradol) Ketorolac can be administered by injection (intramuscularly or intravenously) and is indicated for the short-term treatment of moderate to severe acute pain.

The nurse would question a prescription to administer misoprostol (Cytotec) to a client with which condition? a. Pregnancy b. Peptic ulcer c. Gastroesophageal reflux disease d. Chronic obstructive pulmonary disease

a. Pregnancy Misoprostol is an abortifacient and thus is contraindicated in pregnancy

When a patient is receiving long-term NSAID therapy, which drug may be given to prevent the serious gastrointestinal adverse effects of NSAIDs? a. misoprostol (Cytotec) b. metoprolol (Lopressor) c. metoclopramide (Reglan) d. magnesium sulfate

a. misoprostol (Cytotec)

A patient has taken an excessive dose of acetaminophen for pain management. Which adverse effects associated with acetaminophen are likely to be found in the patient? Select all that apply. a. Nausea b. Vomiting c. Blurred vision d. Decreased hearing e. Elevated liver enzymes

a. nausea b. vomiting e. elevated liver enzymes Acetaminophen is a nonsteroidal antiinflammatory drug. Nausea, vomiting, and elevated liver enzymes are the effects of an excess dose of acetaminophen. Acetaminophen does not affect vision or hearing function.

The nurse has instructed a patient diagnosed with human immunodeficiency virus (HIV) on the use of zidovudine. Which patient statement demonstrates a need for additional teaching? a. "I might experience a headache when taking this medication." b. "I should lie down after I take this medication to prevent dizziness." c. "I still need to use condoms even though I'm taking this medication." d. "I don't have to worry about taking the medication on an empty or full stomach."

b. "I should lie down after I take this medication to prevent dizziness." The patient should be instructed to remain upright or with the head of the bed elevated while administering the medication and for up to 30 minutes afterward to prevent esophageal ulceration. Headaches and insomnia are side effects of zidovudine. Antiretroviral agents do not stop the transmission of HIV, and patients need to continue standard precautions. Absorption of oral dosage forms of zidovudine is not impeded by taking the drug with food or milk. p. 657

The acetic acid derivative indomethacin (Indocin) has which properties? (Select all that apply.) a. Antinausea b. Antipyretic c. Anticonvulsant d. Antirheumatic e. Antiinflammatory

b. Antipyretic d. Antirheumatic e. Antiinflammatory NSAIDs are known for their antiinflammatory effects. Indomethacin, in addition, is also used for its antirheumatic and antipyretic properties. NSAIDs are often known to have nausea as a common adverse effect. Indomethacin is not used as an anticonvulsant.

The primary health care provider prescribes levofloxacin to treat a patient's urinary tract infection. What foods will the nurse instruct the patient to avoid during the course of the therapy? a. Sugary foods b. Dairy products c. Fiber-rich foods d. Protein-rich foods

b. Dairy products Levofloxacin is a quinolone antibiotic. When taken with dairy products, the absorption of quinolones may decrease. Hence, the nurse instructs the patient to reduce the intake of dairy products during quinolone therapy. Foods rich in sugar, fiber, and proteins do not affect absorption of quinolones. Thus, these foods can be eaten when the patient is receiving quinolone therapy.

In developing a plan of care for a patient receiving morphine sulfate (MS Contin), which nursing diagnosis has the highest priority? a. Acute pain related to metastatic tumor cancer b. Impaired gas exchange related to respiratory depression c. Constipation related to decreased GI motility d. Risk for injury related to CNS adverse effects

b. Impaired gas exchange related to respiratory depression Using Maslow's hierarchy of needs and the ABCs of prioritization, impaired gas exchange is a priority over pain, constipation, and a risk for injury. If a patient cannot oxygenate sufficiently, all of the other problems will not matter because the patient will not live to worry about them.

Which type of interaction is associated with the use of zidovudine along with acyclovir? a. Increased risk for seizures b. Increased risk for neurotoxicity c. Increased risk for hematologic toxicity d. Increased adverse anticholinergic effects

b. Increased risk for neurotoxicity Zidovudine, when administered along with acyclovir, increases the patient's risk for neurotoxicity because of drug interactions. Imipenem, when administered along with ganciclovir, increases the patient's risk for seizures. Zidovudine, when administered along with ganciclovir, increases the patient's risk for hematologic toxicity. Anticholinergic drugs, when administered along with amantadine, increase adverse anticholinergic effects. p. 646

The nurse prepares to administer 5 mg of intravenous (IV) morphine sulfate to a patient who underwent surgery 30 minutes earlier. What is the most important reason for the nurse to record baseline vital signs before administering this drug? a. Morphine sulfate dilates vascular smooth muscle. b. Morphine sulfate depresses the respiratory center. c. Morphine sulfate causes the release of histamines. d. Morphine sulfate reduces the level of consciousness.

b. Morphine sulfate depresses the respiratory center. Respiratory depression is the most important reason that the nurse records baseline vital signs before administering the IV morphine. Opioid analgesics can cause respiratory depression and death when administered in standard dosages and in an overdose, respectively. Because this patient is in the immediate postoperative period and is likely to experience residual effects of anesthesia, including an inability to maintain an airway and respiratory depression, the risk for respiratory depression is high. The patient is also at risk because the IV route of administration is used. IV administration of an opioid means that the onset of action occurs quickly, the peak drug level occurs more quickly, and the risk of respiratory depression increases as a result of a generally high plasma drug concentrations. The nurse records baseline data for comparison to vital signs taken 15 minutes after IV administration of morphine to determine whether the patient is experiencing adverse effects of therapy. Morphine dilates vascular smooth muscle, releases histamines, and causes sedation; however, airway and breathing issues are more important. Death following overdose is almost always a result of respiratory arrest.

A patient who has acquired immune deficiency syndrome (AIDS) exhibits convulsions while receiving antiretroviral therapy that includes maraviroc. Which anticonvulsive drug is contraindicated in this patient because it is likely to decrease the effectiveness of the therapy? a. Diazepam b. Phenytoin c. Topiramate d. Phenobarbital

b. Phenytoin Phenytoin may decrease the effectiveness of maraviroc, because it is a cytochrome P3A4 hepatic enzyme inducer; this means that the metabolism of maraviroc occurs more quickly, leading to a lower concentrations circulating in the blood for a shorter period. Diazepam, topiramate, and phenobarbital may be indicated in the treatment of AIDS-associated convulsions. p. 654

A patient who is resistant to several antiretroviral therapies is prescribed maraviroc. What substance in the patient's history would decrease the therapeutic effect of the drug? a. Ginger b. St. John's wort c. Acetaminophen d. Oral contraceptives

b. St. John's wort Maraviroc is a new class of antiviral drugs that is used to treat patients who have developed resistance to antiretroviral therapies. Maraviroc has a reduced effect when given in combination with St. John's wort, which is an herbal medication that is used for depression. St. John's wort quickly processes maraviroc, reducing its absorption time and thereby reducing its effect. The drug does not interact with ginger, acetaminophen, or oral contraceptives. p. 646

The nurse is teaching a patient about treatment with an SSRI antidepressant. Which teaching considerations are appropriate? (Select all that apply.) a. The patient should be told which foods contain tyramine and instructed to avoid these foods. b. The patient should be instructed to use caution when standing up from a sitting position. c. The patient should not take any products that contain the herbal product St. John's wort. d. This medication should not be stopped abruptly. e. Drug levels may become toxic if dehydration occurs. f. The patient should be told to check with the prescriber before taking any over-the-counter medications.

b. The patient should be instructed to use caution when standing up from a sitting position. c. The patient should not take any products that contain the herbal product St. John's wort. d. This medication should not be stopped abruptly. f. The patient should be told to check with the prescriber before taking any over-the-counter medications.

Why is a patient advised to drink at least 48 oz of liquids every day while taking indinavir? a. To prevent lactic acidosis b. To prevent nephrolithiasis c. To prevent Kaposi's sarcoma d. To prevent bone marrow suppression

b. To prevent nephrolithiasis Indinavir may cause nephrolithiasis, or the presence of calculi in the kidney; the patient is advised to drink at least 48 oz of liquids every day to prevent this. Lactic acidosis is caused by tenofovir, not indinavir. Kaposi's sarcoma is a tumor caused by infection with human herpesvirus and is treated with antiretroviral drugs. Bone marrow suppression is an adverse effect of zidovudine.

Which condition listed in the patients' medical history could be a contraindication to administration of morphine sulfate? a. Cancer b. Asthma c. Diarrhea d. Anorexia

b. asthma Morphine sulfate should be used with caution in patients with asthma, because naturally occurring opioids cause the release of histamine; a release of histamine in a patient with asthma can trigger bronchoconstriction. Because 20% to 35% of morphine sulfate binds to protein, cancer and anorexia are causes for concern, because both conditions can result in hypoproteinemia and a lack of protein-binding sites for morphine, which can alter the pharmacokinetics of the medication. The administration of morphine sulfate can help diminish diarrhea.

A mother calls the clinic to ask what medication to give her 5-year-old child for a fever during a bout of chickenpox. The nurse's best response would be: a. "Your child is 5 years old, so it would be okay to use children's aspirin to treat his fever." b. "Start with acetaminophen or ibuprofen, but if these do not work, then you can try aspirin." c. "You can use children's dosages of acetaminophen or ibuprofen, but aspirin is not recommended." d. "It is best to wait to let the fever break on its own without medication."

c. "You can use children's dosages of acetaminophen or ibuprofen, but aspirin is not recommended."

While admitting a patient for treatment of an acetaminophen (Tylenol) overdose, the nurse prepares to administer which medication to prevent toxicity? a. Naloxone (Narcan) b. Phytonadione (vitamin K) c. Acetylcysteine (Mucomyst) d. Methylprednisolone (Solu-Medrol)

c. Acetylcysteine (Mucomyst) Acetylcysteine is the antidote for acetaminophen overdose. It must be administered as a loading dose followed by subsequent doses every 4 hours for 17 additional doses and started as soon as possible after the acetaminophen ingestion (ideally within 12 hours)

When teaching a client about potential adverse effects of NSAID therapy, the nurse will teach the client to immediately notify the health care provider of which effect? a. Diarrhea b. Mild indigestion c. Black tarry stools d. Nonproductive cough

c. Black tarry stools A major adverse effect of NSAID therapy is gastrointestinal (GI) distress with potential GI bleeding. Black or tarry stools are indicative of a GI bleed.

When assessing a patient for adverse effects related to morphine sulfate (MS Contin), which clinical findings is the nurse MOST likely to find? (Select all that apply.) a. Diarrhea b. Weight gain c. Constipation d. Inability to void e. Excessive bruising

c. Constipation d. Inability to void Morphine sulfate causes a decrease in GI motility (delayed gastric emptying and slowed peristalsis). This leads to constipation, not diarrhea. Morphine can also cause urinary retention (inability to void)

A patient who has been newly diagnosed with HIV has many questions about the effectiveness of drug therapy. After a teaching session, which statement by the patient reflects a need for more education? a. "I will be monitored for side effects and improvements while I'm taking this medicine." b. "These drugs do not eliminate the HIV, but hopefully the amount of virus in my body will be reduced." c. "There is no cure for HIV." d. "These drugs will eventually eliminate the virus from my body."

d. "These drugs will eventually eliminate the virus from my body."

The nurse should question a prescription to administer acetylsalicylic acid (aspirin) to which client? a. A 62-year-old patient with a history of stroke b. A 45-year-old patient with a history of heart attack c. A 28-year-old patient with a history of sports injury d. A 14-year-old patient with a history of flulike symptoms

d. A 14-year-old patient with a history of flulike symptoms Aspirin should never be administered to children with flulike symptoms. The use of aspirin in children with flulike symptoms has been associated with Reye's syndrome.

A patient who is treated with zidovudine develops blistering rashes, fever, and myalgia. What should the nurse do first? a. Ask the patient to take bed rest. b. Administer antipyretic medications. c. Administer antihistamine medications. d. Inform the primary health care provider.

d. Inform the primary health care provider. Rashes, blistering, fever, and myalgia indicate ineffectiveness of the therapy and worsening of symptoms. Therefore, the nurse should immediately inform the health care provider about it. Taking bed rest may make the patient comfortable but may not help to reduce the symptoms. Antipyretics may help to treat fever but may not reduce viral symptoms. The nurse should not administer antihistamines, because the rashes are not caused by an allergy.

The nurse is caring for a patient with opioid addiction. The nurse anticipates that the patient will be prescribed which medication? a. Naloxone (Narcan) b. Meperidine (Demerol) c. Morphine (MS Contin) d. Methadone (Dolophine)

d. Methadone (Dolophine) Methadone is a synthetic opioid analgesic with gentler withdrawal symptoms and is the drug of choice for detoxification treatment

Patient teaching for a patient receiving an MAOI would include instructions to avoid which food product? a. Orange juice b. Milk c. Shrimp d. Swiss cheese

d. Swiss cheese

A nurse is reviewing the lab reports for a patient with human immunodeficiency virus (HIV) who is taking zidovudine. Which finding in the patient suggests possible drug-related adverse effects? a. Blood urea nitrogen of 10 mg/dL b. Serum sodium levels of 120 mEq/L c. Alkaline phosphatase levels of 100 IU/L d. White blood cell count 1000 cells/mcL of blood

d. White blood cell count 1000 cells/mcL of blood Zidovudine reacts with different blood proteins, leading to bone marrow suppression. The levels of all blood cells are greatly reduced in bone marrow suppression. The normal white blood cell count is 4500 to 10,000 cells/mcL of blood. A white blood cell count of 1000 cells/mcL of blood would suggest that the patient has bone marrow suppression. Alterations in blood urea levels would indicate renal dysfunction. These levels are normal in the patient; moreover, zidovudine does not affect renal function. Sodium levels are not altered in the patient. Moreover, zidovudine does not affect electrolyte levels. Alkaline phosphatase levels are indicators of liver function. Zidovudine does not affect liver function in the patient. Moreover, the alkaline phosphatase levels of the patient are within normal range. pp. 654, 655