Chapters 8, 11, 9, 12 Pharm

Which of the following represent nursing diagnoses that may be made during administration of a fluoroquinolone? Select all that apply. A) Acute Pain B) Diarrhea C) Imbalanced Nutrition D) Anxiety E) Risk for Impaired Skin Integrity

A, B, D, E Feedback: Drug administration-specific nursing diagnoses that may be made during treatment with fluoroquinolones and miscellaneous anti-infective drugs include Acute Pain, Anxiety, Risk for Impaired Comfort, Risk for Impaired Skin Integrity, Diarrhea, Risk for Impaired Urinary Elimination, and Risk for Disturbed Sensory Perception.

The nurse is reviewing the medical records of several clients with infection. The nurse would anticipate the prescriber ordering a fluoroquinolone for a client with which of the following? Select all that apply. A) Urinary tract infections B) Sexually transmitted infections C) Upper respiratory tract infections D) Bone and joint infections E) Skin infections

A, B, D, E Feedback: Fluoroquinolones are primarily used to treat lower respiratory tract infections, bone and joint infections, urinary tract infections, skin infections, sexually transmitted infections, and some infections of the eye and ear.

During ongoing assessment of clients taking fluoroquinolone, which of the following adverse reactions should be reported to the physician immediately? Select all that apply. A) Respiratory difficulty B) Drowsiness C) Severe diarrhea D) Hypersensitivity reaction E) A significant drop in blood pressure

A, C, D, E Feedback: It is important for the nurse to report any adverse reaction to the physician prior to administering the next dose, but the nurse should notify the physician immediately if respiratory difficulty, hypersensitivity reaction, severe diarrhea, or a decided drop in blood pressure occurs.

Fluoroquinolones should be used with caution in which of the following clients? Select all that apply. A) Clients with diabetes B) Clients with hypertension C) Clients receiving dialysis D) Clients with chronic obstructive pulmonary disorder (COPD) E) Clients with epilepsy

A, C, E Feedback: Fluoroquinolones should be used with caution in clients with diabetes, renal impairment, or history of seizures; older clients; and clients on dialysis.

A nurse understands that anthelmintic drugs are contraindicated in which patients? A) Patients who are pregnant B) Patients with myasthenia gravis C) Patients with clinical depression D) Children younger than 15 years

Ans: A Feedback: Anthelmintic drugs are contraindicated in patients who are pregnant. Quinine, not anthelmintic drugs, should not be prescribed for patients with myasthenia gravis. Anthelmintic drugs are not known to be contraindicated in patients with clinical depression or in children younger than 15.

A patient is prescribed demeclocycline. The nurse would teach the patient to be alert for signs of which of the following? A) Photosensitivity B) Abdominal pain C) Cramping D) Blood dyscrasias

Ans: A Feedback: Demeclocycline causes photosensitivity reactions. Abdominal pain and cramping are adverse reactions of macrolides. Blood dyscrasias are an adverse reaction of lincosamides.

After teaching a group of nursing students about the actions of the various antifungal drugs, the instructor determines that the teaching was successful when the students identify which drug as having only fungistatic activity? A) Fluconazole B) Amphotericin B C) Miconazole D) Nystatin

Ans: A Feedback: Fluconazole has fungistatic activity, whereas amphotericin B, miconazole, and nystatin exert both fungicidal and fungistatic activity.

A patient has been prescribed oral tetracycline for the treatment of acne. Which of the following must the nurse include in the patient teaching plan? A) Take the drug on an empty stomach. B) Take the drug along with a meal. C) Take the drug along with milk or fruit juice. D) Take the drug immediately after meals.

Ans: A Feedback: Oral preparations of tetracycline should be administered on an empty stomach with a full glass of water to maximize absorption. Tetracycline is not absorbed effectively if taken with food, with dairy products, or immediately after meals.

A patient who is receiving antiretroviral therapy is about to be discharged. Which of the following precautions should the nurse instruct the patient to follow to reduce the effects of photosensitivity? A) Wear protective clothing when outside. B) Increase fluid intake. C) Avoid lights while indoors. D) Use tanning beds for tan.

Ans: A Feedback: The nurse should encourage the patient to wear protective clothing while going out in the sun to reduce the effect of photosensitivity. While increasing the fluid intake is recommended, it does not help combat the effects of photosensitivity. There is no need to avoid indoor lights as the skin becomes sensitive to sunlight but not indoor lights. The use of tanning beds should be avoided.

A nurse is reviewing the medical records of several patients who are to receive antibacterial drug therapy. The nurse understands that aminoglycosides would be contraindicated in clients with which of the following conditions? Select all that apply. A) Pre-existing hearing loss B) Pregnancy C) Parkinsonism D) Diabetes E) Hyperlipidemia

Ans: A, B, C Feedback: The aminoglycosides are contraindicated in clients with pre-existing hearing loss, myasthenia gravis, and parkinsonism and during lactation and pregnancy.

A nurse would expect to administer antihelminthic therapy cautiously to which of the following clients? Select all that apply. A) Clients who are lactating B) Clients with hepatic impairment C) Clients with anemia D) Clients with diabetes E) Clients with renal impairment

Ans: A, B, C, E Feedback: Antihelminthic drugs should be used cautiously in lactating clients and clients with hepatic or renal impairment and malnutrition or anemia.

1. After teaching a group of students about tetracyclines, the instructor determines that the teaching was successful when the students identify which of the following as a true statement? Select all that apply. A) Tetracyclines are broad-spectrum antibiotics. B) Tetracyclines may cause permanent discoloration of the teeth in children. C) Tetracyclines can be used when penicillins are contraindicated. D) Tetracyclines are contraindicated in children younger than 6 years. E) Tetracyclines are used to treat Rocky Mountain spotted fever.

Ans: A, B, C, E Feedback: Tetracyclines are broad-spectrum antibiotics used to treat rickettsial disease, such as Rocky Mountain spotted fever, and when the use of penicillins is contraindicated. Tetracyclines are not given to children younger than 9 years of age unless absolutely necessary because these drugs may cause permanent yellow-gray-brown discoloration of the teeth.

A client is receiving antiretroviral therapy. Which adverse reactions would the nurse include in the teaching plan for this client? Select all that apply. A) Altered taste B) Peripheral numbness C) Oral candidiasis D) Rash E) Fever

Ans: A, B, D, E Feedback: Adverse reactions associated with antiretroviral drugs are nausea, vomiting, diarrhea, altered taste, headache, fever, chills, rash, and numbness and tingling in the circumoral area or peripherally or both. Oral candidiasis is not associated with antiretroviral therapy.

A group of nursing students are reviewing information about helminthes. The students demonstrate understanding when they identify which of the following as a helminth? Select all that apply. A) Roundworms B) Pinworms C) Ringworms D) Hookworms E) Tapeworms

Ans: A, B, D, E Feedback: Roundworms, pinworms, hookworms, and tapeworms are examples of helminths. Ringworm is a fungal infection.

The nurse is preparing a plan of care for a client who is to receive antiviral therapy. Which nursing diagnoses would the nurse most likely include related to drug therapy? Select all that apply. A) Acute Pain B) Risk for Impaired Skin Integrity C) Risk for Injury D) Risk for Imbalanced Nutrition E) Body Image Disturbances

Ans: A, C, D, E Feedback: Drug-specific diagnoses for antiviral drugs include Risk for Imbalanced Nutrition, Risk for Impaired Skin Integrity, Risk for Injury, Body Image Disturbance, and Acute Pain.

A nurse is preparing to administer an aminoglycoside to a client. The nurse would be alert for the development of which of the following toxicities? Select all that apply. A) Nephrotoxicity B) Cardiotoxicity C) Ototoxicity D) Hepatotoxicity E) Neurotoxicity

Ans: A, C, E Feedback: More serious adverse reactions of aminoglycosides include nephrotoxicity, ototoxicity, and neurotoxicity. A nurse recognizing these can greatly reduce permanent damage to the client's hearing, kidneys, and nerves. Aminoglycosides are not associated with cardiotoxicity or hepatotoxicity.

The nurse is preparing to administer an antiviral drug to a client. Which of the following would the nurse include in the preadministration assessment? Select all that apply. A) Client's general state of health B) Blood glucose levels C) Resistance to infection D) Electrocardiogram findings E) Vital signs

Ans: A, C, E Feedback: The nurse's preadministration assessment of the client prior to administration of antiviral drugs should include determination of the client's general state of health and resistance to infection, record of client's symptoms and complaints, and record of vital signs. Blood glucose levels and electrocardiogram findings are not needed.

Which of the following would the nurse include in the teaching plan for a client about the use of an antifungal cream preparation for the treatment of ringworm in the ambulatory care setting? Select all that apply. A) Clean involved area before applying cream. B) Increase the amount of cream used if skin infection worsens. C) Decrease the frequency of applying cream if skin infection improves. D) Keep towels and washcloths for bathing separate from other family members during treatment. E) Keep the affected area clean and moist.

Ans: A, D Feedback: When instructing a client about the use of an antifungal cream preparation for the treatment of ringworm in the ambulatory care setting, the nurse should include the following: cleaning the involved area and applying the cream to the skin as directed by the physician, not increasing or decreasing the amount used or number of times the cream should be applied unless directed to do so by the physician, keeping the affected area clean and dry, and keeping towels and washcloths for bathing separate from those of other family members to avoid the spread of infection.

1. When teaching a client about antiviral therapy, the nurse would include information about the possibility of which adverse reactions? Select all that apply. A) Rash B) Sedation C) Chills D) Diarrhea E) Headache

Ans: A, D, E Feedback: Adverse reactions associated with antiviral drugs include nausea, vomiting, diarrhea, headache, rash, fever, and insomnia.

The nurse is teaching a client about possible adverse reactions that can occur with tetracyclines. The nurse determines that the teaching was successful when the client identifies which of the following? Select all that apply. A) Photosensitivity B) Hypoglycemia C) Hypotension D) Diarrhea E) Stomatitis

Ans: A, D, E Feedback: The nurse should advise the client that nausea, vomiting, diarrhea, epigastric distress, stomatitis, sore throat, skin rashes, and photosensitivity are adverse reactions that may occur with the administration of tetracyclines.

A patient is receiving telithromycin. Based on the nurse's understanding of potential adverse reactions, the nurse would identify which nursing diagnosis as a priority? A) Ineffective Renal Tissue Perfusion B) Risk for Injury C) Diarrhea D) Risk for Impaired Skin Integrity

Ans: B Feedback: Telithromycin can cause visual disturbances such as difficulty focusing and accommodating to light. Therefore, the priority nursing diagnosis would be Risk for Injury related to these visual disturbances. Aminoglycosides can cause nephrotoxicity, leading to a nursing diagnosis of Ineffective Renal Perfusion. Although diarrhea and skin rashes can occur, these would not be a priority at this time.

After teaching a group of nursing students about antiretroviral drugs, the instructor determines that the teaching was successful when the students identify that these drugs are used to treat which infections? Select all that apply. A) Hepatitis C virus (HCV) B) Human immunodeficiency virus (HIV) C) Acquired immunodeficiency syndrome (AIDS) D) Herpes simplex virus (HSV) 1 E) Herpes simplex virus (HSV) 2

Ans: B, C Feedback: Antiretroviral drugs are used to treat HIV and AIDS.

Which of the following would the nurse include in the teaching plan as an adverse reaction for a client receiving antihelminthic therapy? Select all that apply. A) Hypotension B) Drowsiness C) Abdominal pain D) Hypoglycemia E) Nausea

Ans: B, C, E Feedback: Antihelminthics cause several generalized adverse reactions that the client should be advised of, including drowsiness, dizziness, nausea, vomiting, abdominal pain and cramps, and diarrhea.

A nurse is preparing to administer antiviral therapy. The nurse integrates knowledge of this therapy, administering the drugs cautiously to clients with which of the following? Select all that apply. A) Hepatic impairment B) Renal impairment C) Diabetes D) Low blood cell count E) Hypertension

Ans: B, D Feedback: Antivirals should be used cautiously in clients with renal impairment, low blood cell counts, history of epilepsy (rimantadine), and history of respiratory disease (zanamivir).

A nurse is preparing a plan of care for a client who is prescribed an antiparasitic agent. Which nursing diagnosis would the nurse most likely identify related to the client's drug therapy? Select all that apply. A) Impaired Comfort B) Diarrhea C) Risk for Ineffective Tissue Perfusion D) Risk for Deficient Fluid Volume E) Risk for Impaired Respiratory Function

Ans: B, D, E Feedback: Drug-specific nursing diagnoses when discussing the treatment of parasitic infection include Diarrhea, Risk for Deficient Fluid Volume, Imbalanced Nutrition, and Risk for Impaired Respiratory Function.

A patient for whom antiretroviral therapy has been prescribed informs the nurse that she is taking oral contraceptives. The nurse responds that the combination of oral contraceptives and antiretroviral therapy can lead to which of the following? A) Decreased effectiveness of antiviral therapy B) Increased risk of vaginal bleeding C) Decreased effectiveness of birth control pills D) Increased serum level of the antiretroviral

Ans: C Feedback: Antiretrovirals decrease the effectiveness of oral birth control agents. Combining antiretrovirals with birth control pills does not, however, increase the risk of vaginal bleeding, increase serum levels of the antiretroviral, or decrease the effectiveness of antiviral therapy.

A patient is scheduled for abdominal surgery and is ordered to receive kanamycin as part of the bowel preparation. The patient asks the nurse why he is getting this drug. Which response by the nurse would be most appropriate? A) You have an infection now and will probably have one after surgery, so this will help control it. B) We need to lower the levels of ammonia in your bloodstream to prevent problems. C) The drug helps eliminate bacteria so that your GI tract is as clean as possible for surgery. D) This is to help prevent you from developing any blood clots during and after the surgery.

Ans: C Feedback: Kanamycin and neomycin are used before surgery to reduce intestinal bacteria. It is thought that this reduces the possibility of abdominal infection that may occur after surgery on the bowel. By destroying bacteria in the gut and washing it out with laxatives or enemas, the surgical area becomes as clean as possible before the operation. The drug is not used to control an infection preoperatively. It does help to reduce blood ammonia levels with hepatic coma, but this is not the reason for its use with this patient. The drug has no effect on preventing blood clots postoperatively.

A group of nursing students are reviewing information about fungal infections. The students demonstrate understanding of the information when they identify which of the following as a superficial fungal infection? A) Aspergillosis B) Cryptococcal meningitis C) Thrush D) Malaria

Ans: C Feedback: Thrush is also oral candidiasis, a superficial fungal infection of the oral mucosa. Aspergillosis and cryptococcal meningitis are systemic fungal infections. Malaria is a protozoal infection.

A nurse is caring for a patient who is prescribed amantadine. The nurse would assess the patient for which of the following? A) Asthenia and abdominal pain B) Fever and dizziness C) Anorexia and dyspnea D) Hypotension and insomnia

Ans: D Feedback: A nurse should monitor the patient for hypotension and insomnia, since these are adverse reactions of amantadine. Asthenia and abdominal pain are adverse reactions of adefovir. Fever and dizziness are adverse reactions of acyclovir. Anorexia and dyspnea are adverse reactions of cidofovir. Therefore, a nurse need not monitor the patient for fever, dizziness, asthenia, abdominal pain, anorexia, and dyspnea, as these are not adverse reactions of amantadine.

A client who is receiving oral systemic antifungal therapy has a nursing diagnosis of Risk for Ineffective Renal Tissue Perfusion. Which of the following would be least appropriate for the nurse to include in the client's plan of care? A) Monitoring urine output hourly B) Monitoring serum creatinine levels C) Evaluating blood urea nitrogen levels D) Premedicating the client with an antihistamine

Ans: D Feedback: For the nursing diagnosis of ineffective renal tissue perfusion, the nurse would monitor the client's urine output hourly and evaluate serum creatinine and BUN levels frequently. Premedicating the client with an antihistamine would only be appropriate if the client was receiving amphotericin B via IV infusion.

Pyrantel has been prescribed for a patient with roundworms. The patient demonstrates understanding of the teaching about this drug when the patient identifies which of the following as an adverse reaction that should be reported to the health care provider immediately? A) Abdominal cramping B) Headache C) Nausea D) Rashes

Ans: D Feedback: Rashes are a serious adverse reaction associated with pyrantel and should be reported immediately. Headache, nausea, and abdominal cramping are not major side effects associated with pyrantel.

A client has been receiving an aminoglycoside for several weeks and comes to the clinic complaining of ringing in his ears and some dizziness. The nurse suspects ototoxicity. When developing this client's plan of care, which nursing diagnosis would be the priority? A) Impaired Comfort B) Altered Thought Process C) Diarrhea D) Risk for Injury

Ans: D Feedback: The development of ototoxicity would lead the nurse to identify a nursing diagnosis of Risk for Injury related to the effects of ototoxicity. Although the client's ringing in the ears could cause discomfort, the priority nursing diagnosis would be Risk for Injury. There is no evidence of impaired comfort, altered thought process or diarrhea.

A client develops pseudomembranous colitis secondary to fluoroquinolone therapy. The nurse understands that this is the result of which organism? A) E. coli B) C. difficile C) Staphylococcus D) Group B hemolytic Streptococcus

B Feedback: Pseudomembranous colitis is one type of a bacterial superinfection. This potentially life-threatening problem develops because of an overgrowth of the microorganism Clostridium difficile (C. diff) in the bowel.

Which of the following information should the nurse obtain during the preadministration assessment of a client prescribed a fluoroquinolone? Select all that apply. A) Blood glucose levels B) Allergy history C) Signs and symptoms of infection D) Blood pressure E) Temperature

B, C, D, E Feedback: Before administering a fluoroquinolone, the nurse identifies and records the signs and symptoms of the infections, takes a thorough allergy history, takes and records vital signs, and, if ordered, obtains cultures.

A nursing student is engaged in researching information about fluoroquinolones. When reviewing the information, the student would most likely find that this class of drugs is effective in treating which type of infection? Select all that apply. A) Viral infections B) Gram-positive infections C) Fungal infections D) Gram-negative infections E) Parasitic infections

B, D Feedback: Fluoroquinolones are effective in treating infections caused by gram-positive and gram-negative microorganisms.

A patient develops a superinfection due to fluoroquinolone therapy. The patient asks the nurse why this happened. Which response by the nurse would be most appropriate? A) "Your infection was really severe, so the drug wasn't as effective as it could have been." B) "This happens when your original infection begins to clear." C) "The drug disrupts your normal bacteria so it allows other organisms to grow." D) "We really don't know why this happens; it just does sometimes."

C Feedback: Antibiotics can disrupt the normal flora (nonpathogenic bacteria in the bowel), causing a secondary infection or superinfection. This new infection is "superimposed" on the original infection. The destruction of large numbers of nonpathogenic bacteria (normal flora) by the antibiotic alters the chemical environment. This allows uncontrolled growth of bacteria or fungal microorganisms that are not affected by the antibiotic being administered. It has nothing to do with the drug's effectiveness or the original infection being cleared.

A client is receiving a fluoroquinolone and is also taking ibuprofen for pain relief. The nurse would be alert for which of the following? A) Increased risk for bleeding B) Decreased effectiveness of the fluoroquinolone C) Increased risk for seizures D) Delayed elimination of the fluoroquinolone

C Feedback: When a nonsteroidal anti-inflammatory drug such as ibuprofen is used in conjunction with a fluoroquinolone, the patient has an increased risk for seizures. An increased risk of bleeding would occur with oral anticoagulants in conjunction with fluoroquinolone therapy. Decreased effectiveness of the fluoroquinolone would occur if it was given with antacids, iron salts, or zinc because of decreased absorption of the antibiotic. Cimetidine interferes with the elimination of the fluoroquinolone, leading to prolonged presence of the drug in the bloodstream.