EXAM 3 - PHARM3

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? a. "I must take the medication exactly as prescribed." b. "Once I start the medication, I will no longer be contagious." c. "I will not get any colds or infections while taking this medication." d. "This medication has minimal side effects and I can return to normal activities."

a. "I must take the medication exactly as prescribed."

A patient with Mycobacterium tuberculosis is prescribed ethambutol for long-term use. Which statement by the patient indicates understanding of the instructions? a. "I will need to have my eyes checked regularly while I am taking this drug." b. "Constipation will be a problem, so I will increase the fiber and fluids in my diet." c. "Dizziness, drowsiness, and decreased urinary output are common with this drug, but they will subside over time." d. "This medication may cause my bodily secretions to turn red-orange."

a. "I will need to have my eyes checked regularly while I am taking this drug." Ethambutol can cause optic neuritis. Ophthalmologic examinations should be performed periodically to assess visual acuity.

The nurse recognizes that compliance with antiretroviral therapy (ART) regimens is often problematic for patients. What level of compliance is needed to help ensure ongoing success with this therapy? a. 95% b. 65% c. 80% d. 50%

a. 95% Adherence challenges are common with any drug therapy, but ART presents a greater challenge because patients are asked to achieve an adherence of 95% or greater. Nonadherence can result in HIV viral replication and can potentiate drug resistance.

7. A mother of two children was just diagnosed with hepatitis C virus. Which of the following is incorrect about hepatitis C virus? a. A vaccine has been available for 5 years. b. Hepatitis C virus can be transmitted by blood and body fluids. c. Hepatitis C virus can cause hepatic carcinoma. d. Persons with hepatitis C virus can become chronic carriers.

a. A vaccine has been available for 5 years.

In an effort to prevent cytokine release syndrome associated with antirejection drugs, the nurse should anticipate the premedication with which agents? (Select all that apply.) a. Corticosteroids b. H2 antagonists c. Acetaminophen d. Antihistamines e. Phenothiazines

a. Corticosteroids c. Acetaminophen Premedication with corticosteroids or acetaminophen plus an antihistamine has been reported to be effective in reducing the severity of symptoms caused by cytokine release.

Which point should the nurse include in providing teaching regarding corticosteroid therapy? (Select all that apply.) a. Do not receive live vaccines. b. Delayed wound healing may occur. c. Monitor pulse daily. d. Risk for infection decreases. e. Do not stop medication abruptly.

a. Do not receive live vaccines. b. Delayed wound healing may occur. e. Do not stop medication abruptly. Long-term use may lead to impaired wound healing, skin atrophy, and decreased response to infections. Live vaccines could lead to significant infections and should be avoided. Sudden cessation of corticosteroids may lead to withdrawal symptoms with high doses or long-term use and the onset of Addison's crisis. Pulse rates should not be affected, and risk for infection increases. Long-term use may lead to impaired wound healing, skin atrophy, Cushing syndrome, glaucoma and cataracts, Kaposi sarcoma, and growth suppression in children. Cessation of corticosteroids may lead to withdrawal symptoms with high doses or long-term use. Pulse rates should not be affected, and risk for infection increases.

1. A patient is beginning isoniazid and rifampin treatment for tuberculosis. The nurse gives the patient which instruction? a. Do not skip doses. b. Take both drugs three times daily. c. Take an antacid with the drugs. d. Take rifampin initially.

a. Do not skip doses.

3. Nurses are key to promoting adherence in transplant recipients. What factors influence whether a recipient adheres to a drug regimen? (Select all that apply.) a. Drug side effects b. Episodes of rejection c. Cost d. Infection e. Marital status

a. Drug side effects b. Episodes of rejection c. Cost d. Infection

4. A patient has been diagnosed with tuberculosis and is to begin antitubercular therapy with isoniazid, rifampin, and ethambutol. Which actions are appropriate for the nurse to do? (Select all that apply.) a. Encourage periodic eye examinations. b. Instruct the patient to take medications with meals. c. Suggest that the patient take antacids with medications to prevent gastrointestinal distress. d. Advise the patient to report numbness and tingling of the hands or feet. e. Alert the patient that body fluids may develop a red-orange color. f. Teach the patient to avoid direct sunlight and to use sunblock.

a. Encourage periodic eye examinations. d. Advise the patient to report numbness and tingling of the hands or feet. e. Alert the patient that body fluids may develop a red-orange color. f. Teach the patient to avoid direct sunlight and to use sunblock.

22. Patients who are receiving an immune stimulant may experience any of the clinical signs of immune response activity, including: a. Flu-like symptoms b. Diarrhea c. Constipation d. Headache

a. Flu-like symptoms

The health care provider has ordered amphotericin B for the patient. The nurse recognizes that which is the most effective way to administer this medication to the patient? a. Intravenously over 2 to 6 hours b. Orally at regular intervals c. Intravenously over 1 hour d. By subcutaneous injection

a. Intravenously over 2 to 6 hours Amphotericin B should be administered by slow intravenous infusion.

3. The nurse advises human immunodeficiency virus (HIV)-positive patients about blood draws to obtain a CD4+ count. Which information would be correct? a. Laboratory tests should be done at the same laboratory at approximately the same time of day b. A 10-hour fast is required for laboratory tests c. Laboratory tests will need to be obtained approximately 1 hour after taking antiretroviral medications d. It does not matter where the labs are conducted as long as it is done

a. Laboratory tests should be done at the same laboratory at approximately the same time of day

1. An international traveler diagnosed with malaria is admitted to the emergency department and is prescribed mefloquine hydrochloride. The nurse anticipates that which laboratory test will be ordered? a. Liver function test (LFT) b. Blood glucose c. Sputum culture and sensitivity d. White blood cell count

a. Liver function test (LFT)

6. Acyclovir has been ordered for a patient with genital herpes. Which nursing interventions are appropriate for this patient? (Select all that apply.) a. Monitor the patient's blood urea nitrogen and creatinine. b. Monitor the patient's blood pressure for hypertension. c. Administer intravenous acyclovir over 30 minutes. d. Advise maintenance of adequate fluid intake. e. Monitor complete blood count for blood dyscrasias.

a. Monitor the patient's blood urea nitrogen and creatinine. d. Advise maintenance of adequate fluid intake. e. Monitor complete blood count for blood dyscrasias.

A nurse is preparing discharge instructions for a patient who had been on neutropenic precautions while hospitalized. What should the nurse include in the plan of care? a. Order foods prepared medium to medium well. b. Have the patient get a Flu vaccine in two weeks. c. Resume all prior activities with no restrictions. d. Tell the patient to return to the hospital if he/she experience a low-grade temperature between 99- and 100-degrees Fahrenheit.

a. Order foods prepared medium to medium well. A patient who had been on neutropenic precautions and is now being released from the hospital should maintain precautions to best accommodate potential effects due to immunosuppression. The patient should cook and eat food products such as meat and eggs that ware cooked all the way through to kill germs. The patient should be current with all vaccinations and take the Flu vaccine as soon as possible. In terms of fever, the patient should be instructed to return to the hospital for temperature elevations above 100.4 or higher for one hour or if he/she experiences a one-time fever higher than 101 degrees Fahrenheit. The patient should use caution in resuming any prior activities so as not to place them at risk.

The patient has been taking ritonavir for a week and informs the nurse that the patient is experiencing occasional episodes of abdominal discomfort. What patient teaching will the nurse provide to the patient? (Select all that apply.) a. Reassure the patient that this is an expected side effect of the medication. b. Instruct the patient to report episodes that increase in intensity or frequency. c. Instruct the patient to stop taking the medication. d. Instruct the patient to maintain a symptom diary. e. Take an over the counter h2 antagonist.

a. Reassure the patient that this is an expected side effect of the medication. b. Instruct the patient to report episodes that increase in intensity or frequency. c. Instruct the patient to stop taking the medication. Abdominal discomfort is an expected side effect of the medication and is not indicative of any significant problem with the medication. However, the patient should certainly report episodes of discomfort that increase in intensity and/or frequency. The patient should not be instructed to stop taking the medication at this time. Use of a symptom diary can assist with the reporting process. The patient should not add any over-the-counter medications.

Which intervention is a priority for a patient who is taking antiretroviral therapy (ART)? a. Teach adherence to the medication regimen. b. Increase fluids to 2400 mL/day. c. Teach hand washing to the patient. d. Refer the patient for preventive care measures.

a. Teach adherence to the medication regimen. Although all of these interventions should be carried out, teaching adherence to the regimen is the highest priority.

Which factor is identified as the major barrier to the transplantation as a routine medical treatment option? a. The body's immune system b. Availability or organs c. Lack of effective drugs d. State laws

a. The body's immune system The immune system remains the biggest barrier to transplantation as a routine medical treatment because it has effective mechanisms to fight off foreign organisms. These same mechanisms are involved in the rejection of transplanted organs, which are recognized as foreign by the recipient's immune system.

5. A patient is to start on efavirenz. Which points are important for the nurse to include in health teaching for this patient? (Select all that apply.) a. The dose is given at bedtime to minimize central nervous system adverse effects. b. Alcohol should be avoided because of adverse effects to the liver. c. The dose should be taken after breakfast to minimize central nervous system adverse effects. d. High-fat meals can increase absorption of the medication. e. Hyperglycemia, jaundice, and diabetes mellitus are side effects.

a. The dose is given at bedtime to minimize central nervous system adverse effects. b. Alcohol should be avoided because of adverse effects to the liver. d. High-fat meals can increase absorption of the medication.

4. In collaboration with a patient on antiretroviral therapy, the nurse formulates a plan of care. Which items are appropriate to include in planning? (Select all that apply.) a. Viral load will become and remain undetectable. b. The patient will not experience secondary infection. c. New onset of symptoms and side effects will be promptly reported. d. Laboratory blood work will be within normal limits. e. The patient will adhere to the medication regimen and will report any difficulties related to adherence.

a. Viral load will become and remain undetectable. b. The patient will not experience secondary infection. c. New onset of symptoms and side effects will be promptly reported. e. The patient will adhere to the medication regimen and will report any difficulties related to adherence.

22. Nursing interventions for the patient receiving antiviral drugs for the treatment of HIV would include a. monitoring renal and hepatic function periodically during therapy b. administering the drugs just once a day to increase drug effectiveness c. encouraging the patient to avoid eating if GI upset is severe d. stopping the drugs and notifying the prescriber if severe rash occurs

a. monitoring renal and hepatic function periodically during therapy

3. Which of the following is a priority to evaluate in a patient being treated for Taenia solium (pork tapeworm)? a. Increased appetite b. Abdominal distension c. Fatigue d. Constipation

b. Abdominal distension

A nurse is infusing IV amphotericin B to a patient with a systemic fungal infection. Based on the adverse effects of the medication, which blood work would NOT need to be evaluated? a. Complete blood count b. Albumin level c. Blood glucose level d. Renal function

b. Albumin level

The nurse is working with a patient who will be traveling to a country where the incidence of malaria is high. The nurse anticipates that the health care provider is most likely to place the patient on which medication? a. Artemether/lumefantrine b. Atovaquone/proguanil c. Amantadine HCl d. Praziquantel

b. Atovaquone/proguanil Of the drugs listed, atovaquone/proguanil is the drug of choice for prevention of malaria.

A patient traveling to an area of the world where malaria is known to be endemic should be taught to: a. Avoid drinking the water b. Begin and complete the antimalarial therapy as prescribed c. Pack a supply of antimalarial drugs in case they get a mosquito bite d. Change the dates of their trip to when there is less risk of infection

b. Begin and complete the antimalarial therapy as prescribed

The nurse is caring for a patient taking a polymyxin. What should the nurse monitor to identify potential side effects of this medication? a. Platelets b. Blood urea nitrogen and creatinine c. Hemoglobin and hematocrit d. Stool guaiac

b. Blood urea nitrogen and creatinine Polymyxins can cause kidney damage. Blood urea nitrogen and creatinine should be closely monitored.

A patient is receiving antiretroviral therapy (ART). Which outcome should the nurse identify as indicating a therapeutic response to the medication therapy? a. Elevation of HIV RNA levels b. CD4 T-cell increase c. Increased immune system functioning d. Decreased T-cell reactivity

b. CD4 T-cell increase The expected outcome of ART is a suppression of HIV RNA levels and CD4 T-cell increases in patients. Elevated HIV RNA levels decreased T-cell reactivity, and increased immune system functioning are not indicative of a therapeutic response to medication therapy.

4. Your patient is receiving basiliximab and develops cytokine release syndrome. You would expect to see: a. Coughing b. Chills c. Tremors d. Weakness

b. Chills

5. Your patient taking belatacept becomes pregnant. After discussion with her partner, you, and her health care provider, she decides the best thing to do is continue taking the drug while pregnant. In addition to making this informed decision, what else should she do? a. Discontinue all other drugs b. Contact the pregnancy registry c. Ensure her blood level stays between 16 and 24 ng/mL d. Decrease her dose by 50%

b. Contact the pregnancy registry

A patient diagnosed with human immunodeficiency virus (HIV) is in her first trimester of pregnancy and is reluctant to take any antiretroviral therapy (ART). What is the best response by the nurse? a. You still have time to decide about starting ART later in the pregnancy. b. Educate the patient about the relative risks/benefits of ART. c. Treatment must be started immediately to help prevent the transmission of the virus to the fetus. d. You can start therapy once you have safely delivered the infant.

b. Educate the patient about the relative risks/benefits of ART. HIV can be transmitted in utero to the fetus; therefore, the nurse should provide information about the relative risks/benefits associated with ART therapy. One cannot state that ART therapy must be started immediately as it requires informed consent and patient agreement. As the individual is pregnant, a timely decision would be the best approach to help prevent transmission. ART therapy during pregnancy is aimed at both the mother and the fetus.

Systemic antifungal agents are easily tolerated by patients with a low risk of toxicity. a. True b. False

b. False

22. HIV selectively enters which of the following cells? a. B clones b. Helper T cells c. Suppressor T cells d. Cytotoxic T cells

b. Helper T cells

2. A patient taking isoniazid is worried about the negative effects of the drug. The nurse provides information knowing that which is an adverse effect of the drug? a. Ototoxicity b. Hepatotoxicity c. Nephrotoxicity d. Optic nerve toxicity

b. Hepatotoxicity

To ensure effective treatment of pinworm infections, which instruction would be most important to emphasize to the patient and family? a. Keeping nails long so cutting will not introduce more infection b. Laundering undergarments, bed linens, and pajamas every day c. Boiling all drinking water d. Maintaining a clear liquid diet for at least 7-10 days

b. Laundering undergarments, bed linens, and pajamas every day

The patient has been diagnosed with candidiasis. The nurse recognizes that the patient is most likely to be ordered which drug? a. Tolnaftate b. Miconazole nitrate c. Haloprogin d. Sulconazole

b. Miconazole nitrate Miconazole nitrate can be ordered to treat candidiasis. The other drugs listed can be used to treat tinea pedis, corporis, and cruris.

The health care provider has ordered ribavirin for the patient with respiratory syncytial virus (RSV). The nurse recognizes that which route is the most effective way to administer this medication to the patient? a. By subcutaneous injection b. Orally at regular intervals c. Aerosol inhalation d. Intravenously over 1 hour

b. Orally at regular intervals Ribavirin should be administered by aerosol inhalation.

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? a. Hypercalcemia b. Peripheral neuritis c. Small blood vessel spasm d. Impaired peripheral circulation

b. Peripheral neuritis

The nurse is working with a patient who has been diagnosed with tapeworms. The nurse anticipates that the health care provider is most likely to place the patient on which medication? a. Artemether/lumefantrine b. Praziquantel c. Atovaquone/proguanil d. Amantadine HCl

b. Praziquantel Praziquantel is the drug of choice for the treatment of tapeworms.

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

b. Report yellow eyes or skin immediately

A patient taking amantadine complains of depression and dizziness. What intervention will the nurse perform first? a. Call the health care provider. b. Take the patient's blood pressure sitting and standing. c. Order a consult for counseling. d. Evaluate the patient for other central nervous system effects from the medication.

b. Take the patient's blood pressure sitting and standing. The side effects and adverse reactions to amantadine include central nervous system effects, such as insomnia, depression, anxiety, confusion, and ataxia; orthostatic hypotension; neurologic problems, such as weakness, dizziness, and slurred speech; and gastrointestinal disturbances, such as anorexia, nausea, vomiting, and diarrhea. The nurse should evaluate the patient for orthostatic hypotension first to address safety issues.

A patient is diagnosed with an oral candida infection. Which is the best intervention for the nurse to perform? a. Administer valacyclovir hydrochloride and monitor lips and gums. b. Teach the patient how to take nystatin. c. Start an IV so the patient does not have to eat by mouth. d. Instruct the patient to brush her teeth and gargle hourly.

b. Teach the patient how to take nystatin. Nystatin is an antifungal ointment that is used for a variety of candida infections. The patient needs to be taught how to "swish and swallow" to treat this infection. There is no need to brush the teeth hourly or administer Valtrex and starting an IV is an extreme measure.

2. A patient is admitted to the hospital with multidrug-resistant urinary tract infection. Laboratory tests show Pseudomonas aeruginosa. Colistimethate sodium is ordered in powder form and must be diluted for intramuscular injection. The nurse understands that which of the following is the purpose for this drug? a. This drug prevents toxic adverse reactions. b. This drug treats gram-negative bacteria. c. This drug is safe for patients with renal impairments. d. This drug prevents antibiotic resistance.

b. This drug treats gram-negative bacteria.

The nurse should identify which drug as the antibiotic of choice for Pneumocystis jirovecii pneumonia (PJP)? a. Vancomycin b. Trimethoprim-sulfamethoxazole c. Augmentin d. Gentamycin

b. Trimethoprim-sulfamethoxazole Pneumocystis jirovecii pneumonia (PJP) is a life-threatening illness in immunocompromised patients. Routine prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMZ) has significantly reduced the morbidity and mortality of PJP following transplantation.

22. Locally active antiviral agents can be used to treat a. HIV infection b. Warts c. RSV d. CMV systemic infections

b. Warts

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 may get a headache from this medication." b. "I do not have to worry about taking the medication on an empty stomach or not." c. "I do not need to use condoms as long as I take my medication as prescribed." d. "I might have difficulty sleeping with this medication."

c. "I do not need to use condoms as long as I take my medication as prescribed." Antiretroviral agents do not stop the transmission of HIV, and patients need to continue standard precautions. Zidovudine (Retrovir, AZT) is not known for causing headaches or producing insomnia and does not require being taken with food.

Which statement indicates to the nurse that the patient understands the medication instructions regarding ketoconazole for treatment of candidiasis? a. "I can take this medication with antacids if it causes gastrointestinal discomfort. " b. "I can expect my skin to turn yellow from taking this drug." c. "I need to take this drug with food to minimize gastrointestinal distress." d. "I will take this medication with orange juice for better absorption."

c. "I need to take this drug with food to minimize gastrointestinal distress." Taking this medication with food will help minimize gastrointestinal upset. Ketoconazole should not be taken with coffee, tea, or acidic fruit juices. Additionally, it needs to be taken at least 2 hours before or after the ingestion of alkaline products or antacids.

What is the mechanism of action of systemic antifungal medications? a. Breaking apart the fungus nucleus b. Interfering with fungus DNA production c. Altering cell permeability of the fungus, leading to cell death d. Preventing the fungus from absorbing needed nutrients

c. Altering cell permeability of the fungus, leading to cell death

The patient is being treated with intravenous amphotericin B. What is the nurse's initial intervention? a. Assess the IV site for infiltration. b. Administer with dextrose. c. Assess blood urea nitrogen and creatinine. d. Encourage the patient to drink at least a liter of fluid per shift.

c. Assess blood urea nitrogen and creatinine. Amphotericin B is considered highly toxic and can cause nephrotoxicity and electrolyte imbalance, especially hypokalemia and hypomagnesemia (low serum potassium and magnesium levels). Urinary output, blood urea nitrogen, and serum creatinine levels need to be closely monitored.

Which instruction should the nurse include in the education of a patient beginning therapy with metronidazole for diarrhea due to a clostridium infection? a. Monitor pulse daily. b. Use sunscreen or wear long sleeves. c. Avoid alcohol and products containing alcohol. d. Take with food.

c. Avoid alcohol and products containing alcohol. Patients taking metronidazole should avoid alcohol and products containing alcohol.

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

c. Causes organ discoloration of sweat, tears, urine and feces

22. Which of the following would the nurse recommend that a patient with repeated vaginal yeast infections keep on hand? a. Tolnaftate b. Butenafine c. Clotrimazole d. Naftifine

c. Clotrimazole

What is the priority assessment the nurse should make for a patient who is taking ganciclovir sodium? a. Bowel elimination b. Input and output c. Complete blood count d. Blood urea nitrogen

c. Complete blood count Bone marrow suppression is a dose-limiting toxicity of ganciclovir, and a complete blood count should be monitored.

3. The nurse teaches a patient taking amphotericin B to report which signs and symptoms to the health care provider? a. Change in sight b. Decrease in hearing c. Decrease in urine d. Painful red rash and blisters

c. Decrease in urine

The nurse is describing fungi that cause infections of the skin and mucous membranes, appropriately calling these which of the following? a. Mycoses b. Meningeal fungi c. Dermatophytes d. Worms

c. Dermatophytes

22. Which of the following is an important teaching point for the patient receiving an agent to treat herpes virus or CMV? a. Stop taking the drug as soon as the lesions have disappeared. b. Sexual intercourse is fine because as long as you are taking the drug, you are not contagious. c. Drink plenty of fluids to decrease the drug's toxic effects on the kidneys. d. There are few associated GI adverse effects.

c. Drink plenty of fluids to decrease the drug's toxic effects on the kidneys.

2. Which virus has been associated with posttransplant lymphoproliferative disorder? a. Cytomegalovirus b. Herpes simplex virus c. Epstein-Barr virus d. Human immunodeficiency virus

c. Epstein-Barr virus

A patient enters the emergency department with suspected influenza. Prior to starting the patient on the prescribed oseltamivir phosphate, what priority information should the nurse determine? a. Over-the-counter medications taken in the last 48 hours b. Allergies to antibiotics c. Length of time since onset of symptoms d. Immunization history

c. Length of time since onset of symptoms Oseltamivir phosphate inhibits the replication and spread of influenza if given within 48 hours of symptoms. Even though determination of allergies is important, this medication is an antiviral and not an antibiotic. While it is important to know what OTC medications were taken recently as well as immunization history, these do not represent priority information.

22. 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? a. Electrolyte levels b. Coagulation times c. Liver enzyme levels d. Serum creatinine level

c. Liver enzyme levels

What will the nurse teach a patient who is taking isoniazid (INH)? a. Multidrug therapy is necessary to prevent the occurrence of resistant bacteria. b. You should not be on that drug. I will check with the health care provider. c. Pyridoxine (vitamin B6) will prevent numbness and tingling that can occur when taking isoniazid. d. You will need to take vitamin C to potentiate the action of INH.

c. Pyridoxine (vitamin B6) will prevent numbness and tingling that can occur when taking isoniazid. Isoniazid can cause neurotoxicity. Pyridoxine (vitamin B6) is the drug of choice to prevent this adverse reaction. It is not an anti-infective agent and thus will work to destroy the mycobacterium or prevent drug resistance. Vitamin C is not taken with this drug; the drug is appropriate for most patients, and INH with pyridoxine is not multidrug therapy. If the nurse has any concerns about the medication, this should be discussed directly with the health care provider and not with the patient.

6. A 30-year-old woman presents with a recurrence of Trichomonas vaginalis infection, and metronidazole is ordered. The patient's history reveals which of the following contraindications? a. A recent pregnancy test is negative. b. She previously took metronidazole and had no side effects. c. She drinks a glass of wine before bedtime. d. She takes an oral contraceptive.

c. She drinks a glass of wine before bedtime.

A patient who will be traveling to a malaria-infested country is receiving instructions on the prophylactic use of chloroquine. What priority instruction will the nurse give the patient? a. Do not take the medication until you are certain you do not have the disease. b. Take the medication for 4 weeks. c. Start the medication 2 weeks before the trip. d. After leaving the affected area, take the medication for a year.

c. Start the medication 2 weeks before the trip. Treatment for malaria prophylaxis is usually started 2 weeks before travel and continued for 8 weeks after travel is completed.

What will the nurse monitor to evaluate the effectiveness of antiviral agents administered to treat human immunodeficiency virus infection? a. Megakaryocyte counts b. Lymphocyte counts c. Viral load d. Red blood cell counts

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

The patient states that she has been prescribed prophylactic medication for tuberculosis for a period of 4 weeks. What is the nurse's best response? a. "You should be on the medications for only 2 weeks." b. "Let me teach you about the medications." c. "We do not use medications prophylactically for tuberculosis." d. "You should be on the drugs for a longer period of time."

d. "You should be on the drugs for a longer period of time." Between 6 months and 1 year is sufficient time for prevention of active tuberculosis. Because the tuberculosis mycobacterium is slow-growing, shorter lengths of time may not sufficiently eradicate the organism.

The nurse is caring for a patient who has been diagnosed with genital herpes. Which medication is the drug of choice for this patient? a. Amantadine b. Ribavirin c. Zidovudine d. Acyclovir

d. Acyclovir Acyclovir is the drug of choice to treat herpes simplex infections. Ribavirin is effective against respiratory syncytial virus (RSV); zidovudine is effective against HIV; amantadine is effective against H. influenzae type A.

4. A patient with a history of malaria who is being treated with chloroquine is in the clinic for a follow-up visit. What should the nurse advise the patient to do? a. Get frequent hearing checks. b. Take antimalarials before meals. c. Get frequent testing of stool specimens. d. Avoid sun exposure.

d. Avoid sun exposure.

Organ transplants are often rejected by the body because the T cells recognize the transplanted cells as foreign and try to destroy them. Treatment with an immune suppressant would: a. Activate antibody production b. Stimulate interleukin release c. Stimulate thymus secretions d. Block the initial damage to the transplanted cells

d. Block the initial damage to the transplanted cells

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

d. Difficulty in discriminating the color red from green

The nurse is caring for a patient who is taking rifampin. The patient has a heart rate of 90 beats/min, blood pressure of 100/89 mm Hg, and red-orange urine. What is the nurse's best action? a. Call the health care provider. b. Collect a urine culture. c. Discard the first void and start a 24-hour urine collection. d. Document the findings and teach the patient.

d. Document the findings and teach the patient. Red-orange discoloration of body fluids is a common side effect of rifampin, but it is not harmful and does not indicate infection. There is no need to call the health care provider, collect a urine culture, or start 24-hour urine collection.

2. A recent laboratory results indicated an "undetectable" human immunodeficiency virus viral load. Which response is best by the nurse? a. Inform the patient that they must be seen immediately because the undetectable viral load indicates that the medication stopped working. b. Have the patient reschedule the clinic visit. c. Congratulate the patient on the treatment success. d. Educate the patient about the continued need for medications and ongoing laboratory monitoring.

d. Educate the patient about the continued need for medications and ongoing laboratory monitoring.

The patient has been diagnosed with tinea pedis. The nurse recognizes that the patient is most likely to be ordered which drug? a. Miconazole nitrate b. Butoconazole nitrate c. Terconazole d. Griseofulvin

d. Griseofulvin Of the drugs listed, the patient is most likely to be treated with griseofulvin. The other drugs treat candidiasis.

5. Zanamivir is ordered for a patient with which disorder? a. Herpes simplex virus type 2 b. Herpes simplex virus type 1 c. Varicella-zoster virus d. Hepatitis B virus

d. Hepatitis B virus

1. All transplant drugs have the same advisory, to use caution when administering them with another immunosuppressant drug because of the increased risk for: a. Nausea and vomiting b. Edema c. Anemia d. Infection

d. Infection

The patient has been started on stavudine (d4T). After taking the drug for 3 days, the patient contacts the nurse to report the onset of muscle pain and weakness. What is the nurse's priority action? a. Instruct the patient to self-medicate with an NSAID medication. b. Reassure the patient that this is an expected side effect of the medication. c. Reassure the patient that the symptom is time-limited and will resolve. d. Instruct the patient to hold doses of the medication until further notice.

d. Instruct the patient to hold doses of the medication until further notice. The patient should not take any more doses of the medication until the health care provider can evaluate the patient. Muscle pain and weakness may be related to lactic acidosis, a serious side effect of the medication. The nurse's scope of practice does not allow for adjusting the patient's medication regimen.

22. After assessing a patient, the nurse would question an order for amphotericin B to prevent possibility of serious nephrotoxicity if the patient was also receiving which of the following medications? a. Digoxin b. Oral anticoagulants c. Phenytoin d. Loop diuretic

d. Loop diuretic

The health care provider is considering placing the patient on ritonavir. The patient tells the nurse that the patient has recently been diagnosed with type 2 diabetes mellitus. What is the nurse's priority action? a. Instruct the patient to keep an accurate glucose log. b. Instruct the patient to monitor blood sugars more often. c. Notify the pharmacist that a larger dose will be needed. d. Notify the health care provider of the new information.

d. Notify the health care provider of the new information. The health care provider should be notified of this new information. Patients with diabetes mellitus or hyperglycemia may experience an exacerbation of their condition during ritonavir treatment.

The nurse should identify which drug as the antibiotic of choice for fungal infections manifested as thrush in the mouth or esophagus? a. Amphotericin B b. Amoxicillin c. Vancomycin d. Nystatin

d. Nystatin Transplant recipients use nystatin to prevent or treat thrush in the mouth and esophagus. This is usually given when the patient is on a high-dose immunosuppression regimen and is stopped when the steroid dose is reduced below 20 mg/day.

Prior to the administration of intravenous amphotericin B, what action should the nurse take? a. Administer insulin as prescribed to prevent severe hyperglycemia. b. Set up an IV solution with potassium. c. Administer intravenous dextrose as prescribed to prevent severe hypoglycemia. d. Premedicate the patient with an antipyretic, antihistamine, and antiemetic as prescribed.

d. Premedicate the patient with an antipyretic, antihistamine, and antiemetic as prescribed. Almost all patients given intravenous amphotericin B develop fever, chills, nausea and vomiting, and hypotension. Pretreatment with an antipyretic, antihistamine, and antiemetic can minimize or prevent these adverse reactions. There is no need to treat with IV potassium or administer insulin or IV dextrose.

1. During routine prenatal testing, a patient is diagnosed with human immunodeficiency virus infection. To help prevent perinatal transmission of human immunodeficiency virus to the fetus, which nursing action is best? a. Provide the patient with contact information for an acquired immunodeficiency syndrome support group. b. Educate the patient about the risks of human immunodeficiency virus disease to the fetus. c. Notify the Centers for Disease Control and Prevention of the patient's diagnosis. d. Provide written and oral education about the use of antiretroviral therapy during pregnancy.

d. Provide written and oral education about the use of antiretroviral therapy during pregnancy.

Which order should the nurse question if added to the patient receiving belatacept as a portion of the patient's drug regimen? a. Amphotericin B b. Acetaminophen c. An antihistamine d. Shingles vaccine

d. Shingles vaccine Transplant recipients receiving belatacept should not receive live vaccines because their immune response may be inadequate, and they are at risk for disseminated infection resulting from the live virus.

5. A 50-year-old woman is being discharged from the hospital after treatment for malaria. Which teaching topic would best inform the patient about adverse reactions? a. The occurrence of headaches b. Experiencing dizziness c. Developing mild pruritus d. Skin and eyes that appear yellowish

d. Skin and eyes that appear yellowish

Which instruction should the nurse include in the education of a patient beginning therapy with ivermectin for a helminth infection? a. Use sunscreen or wear long sleeves. b. Take with food. c. Monitor pulse daily. d. Take on an empty stomach.

d. Take on an empty stomach. Ivermectin should be taken on an empty stomach with water. The pulse does not need to be monitored, and the drug does not produce photosensitivity.

In which situation would the nurse least likely expect to administer an immune suppressant? a. Treatment of transplant rejection b. Treatment of autoimmune disease c. Reduction of number of relapses in multiple sclerosis d. Treatment of aggressive cancers

d. Treatment of aggressive cancers