Fall 2017 - Pathopharm - Test 2

Name one danger that stems from using sulfonamides long term and/or in high doses.

Blood disorders such as hemolytic anemia, aplastic anemia, and low white blood cell and platelet counts

The nurse is teaching a patient who has been prescribed hydrochlorothiazide [Microzide]. Which statement from the patient indicates a correct understanding of the teaching? "I will limit my intake of oats." "I will not eat melons or grapes." "I will take iron supplements every day." "I will take the dose only in the morning."*

"I will limit my intake of oats." "I will not eat melons or grapes." "I will take iron supplements every day." - this medication does not cause anemia "I will take the dose only in the morning."* - to avoid nocturia

The nurse is teaching a patient who has a new prescription for spironolactone [Aldactone]. Which statement by the patient indicates that the teaching was effective? "I will take this medication at bedtime each evening." "I will use salt substitutes to lower my sodium intake." "I will call my doctor if I begin having menstrual irregularities." "I will increase my intake of foods that are high in potassium."

"I will take this medication at bedtime each evening." "I will use salt substitutes to lower my sodium intake." "I will call my doctor if I begin having menstrual irregularities."* "I will increase my intake of foods that are high in potassium."

1. The nursing instructor is teaching student nurses about acute cystitis. Which statements by a student nurse indicate effective learning? Select all that apply. -"Acute cystitis is common in women." -"Acute cystitis is an upper urinary tract infection." -"Acute cystitis manifests as chills and high fever." -"Acute cystitis is often caused by Escherichia coli." -"Acute cystitis may be associated with suprapubic pain."

-"Acute cystitis is common in women."* -"Acute cystitis is an upper urinary tract infection." -"Acute cystitis manifests as chills and high fever." -"Acute cystitis is often caused by Escherichia coli."* -"Acute cystitis may be associated with suprapubic pain."*

The nurse knows that diuretics mostly affect which function of the kidneys? -Excretion of metabolic waste -Elimination of foreign substances -Maintenance of acid-base balance -Maintenance of extracellular fluid volume

-Excretion of metabolic waste -Elimination of foreign substances -Maintenance of acid-base balance -Maintenance of extracellular fluid volume* (Most diuretics block sodium and chloride reabsorption)

Which finding should the nurse expect when assessing a male patient with secondary syphilis? -Heart valve and aortic damage -Thin, watery urethral discharge -Skin lesions and flu-like symptoms -Red, protruding, painless sore on the penis

-Heart valve and aortic damage (tertiary syphilis) -Thin, watery urethral discharge (unrelated) -Skin lesions and flu-like symptoms* (secondary syphilis gets into bloodstream after first lesion) -Red, protruding, painless sore on the penis (primary syphilis)

A patient has been prescribed trimethoprim-sulfamethoxazole [Bactrim, Septra]. Which intervention is appropriate? -Instruct the patient to increase fluids in the diet. -Assess the patient's urine before and after treatment. -Instruct the patient to take the medication for 14 days. -Ensure the patient eats something when taking the medication.

-Instruct the patient to increase fluids in the diet.* -Assess the patient's urine before and after treatment. -Instruct the patient to take the medication for 14 days. -Ensure the patient eats something when taking the medication.

A patient with hypertension is receiving spironolactone [Aldactone] therapy. The nurse notes that the patient's serum potassium level is 6.2 mEq/L. What would the nurse anticipate to be prescribed for the patient? Insulin [Humulin] Mannitol [Osmitrol] Amiloride [Midamor] Triamterene [Maxzide]

-Insulin [Humulin]* (Meds should also be discontinued) Injection of insulin [Humulin] can help lower potassium levels by promoting potassium uptake into cells.) -Mannitol [Osmitrol] -Amiloride [Midamor] -Triamterene [Maxzide]

normal level for potassium

3.6 to 5.2 millimoles per liter (mmol/L)

A patient in the clinic is diagnosed with genital herpes. The nurse would anticipate the patient to be prescribed one of which medications? Select all that apply. Acyclovir Famciclovir Valacyclovir Oral metronidazole Vaginal metronidazole

Acyclovir* Famciclovir* Valacyclovir* Oral metronidazole Vaginal metronidazole

The nurse is assessing a patient who is receiving a sulfonamide for treatment of a urinary tract infection. To monitor the patient for the most severe response to sulfonamide therapy, the nurse should assess for which condition? Bleeding Diarrhea Hypertension Skin rash and lesions

Bleeding Diarrhea Hypertension Skin rash and lesions*

Which of the following may cause an increase in potassium upon administration (Choose all that apply): Amiloride [Midamor] Triamterene [Maxzide] Mannitol [Osmitrol]

Amiloride [Midamor]* Triamterene [Maxzide]* Mannitol [Osmitrol]

A patient has hypomagnesemia. Which drug should the patient learn about in a teaching session with the nurse? Calcium salt Magnesium oxide Calcium gluconate Magnesium sulfate*

Calcium salt (given for hypermagnesemia) Magnesium oxide (preventative but not good for treatment) Calcium gluconate (given for hypermagnesemia) Magnesium sulfate* (IM or IV)

Oral trimethoprim-sulfamethoxazole [Bactrim, Septra] is prescribed for a patient and is being administered four times a day. Which intervention is appropriate? -Call the healthcare provider. -Instruct the patient about potential ringing in the ears. -Schedule the medication before meals and at bedtime. -Instruct the patient not to drink milk with the medication.

Call the healthcare provider to clarify this order. The half-life of this drug is 8 to 12 hours; the patient should receive the medication twice a day.

1. A patient who has acquired immunodeficiency syndrome (AIDS) is receiving trimethoprim/sulfamethoxazole [Bactrim]. Which response should a nurse expect if the medication is achieving the desired effect? Decrease in joint pain Increase in CD4 T cells Resolution of pneumonia Increased appetite and weight gain

Decrease in joint pain Increase in CD4 T cells Resolution of pneumonia* Increased appetite and weight gain

The majority (more than 80%) of uncomplicated, community-associated urinary tract infections (UTIs) are caused by which bacteria?

E coli

Which organism most commonly causes cystitis? Escherichia coli Aspergillus niger Staphylococcus aureus Streptococcus pneumonia

Escherichia coli* Aspergillus niger Staphylococcus aureus Streptococcus pneumonia

A patient presents to the clinic with a urinary tract infection (UTI). The nurse anticipates an antibacterial medication that is effective against which organism to be prescribed? Escherichia coli Enterobacter spp. Pseudomonas spp. Klebsiella pneumoniae

Escherichia coli* Enterobacter spp. Pseudomonas spp. Klebsiella pneumoniae

Sulfonamides are often preferred drugs for acute urinary tract infections (UTIs). About 90% of UTIs are due to which bacteria? Escherichia coli Pneumocystis jiroveci Chlamydia trachomatis Plasmodium falciparum

Escherichia coli* Pneumocystis jiroveci Chlamydia trachomatis Plasmodium falciparum

A patient who has acute cystitis is receiving treatment with trimethoprim/sulfamethoxazole (TMP/SMZ). Which manifestation should indicate to a nurse that the patient's condition is worsening? Flank pain Incontinence 3+ pedal edema Hyperactive bowel sounds

Flank pain* Incontinence - unrelated 3+ pedal edema - unrelated Hyperactive bowel sounds - unrelated

An 18-year-old female patient presents to the clinic to obtain an oral contraceptive. The nurse knows she should also be screened for which bacterial sexually transmitted disease (STD)? Gonorrhea Bacterial vaginosis Trichomonas infection Chlamydia trachomatis infection

Gonorrhea Bacterial vaginosis Trichomonas infection Chlamydia trachomatis infection*

A breast-feeding mother has been prescribed a sulfonamide. The nurse should recommend the patient either request a different antibiotic or discard expressed breast milk and provide the infant with formula in order to prevent kernicterus. Which term should the nurse use to describe kernicterus to the mother? Hemolytic anemia Neurologic disorder Ophthalmic infection Hepatocellular failure

Hemolytic anemia Neurologic disorder* Ophthalmic infection Hepatocellular failure

symptoms of pyelonephritis

High fever and chills

Which information would cause the nurse to notify the provider for a patient taking hydrochlorothiazide [Microzide]? -History of gout -Potassium 4.0 mEq/L -Urine output 40 mL/hr -Output more than intake

History of Gout (the other answer choices are normal)

When should you discontinue use of Aldactone?

If serum potassium rises above 5 mEq/L, or if signs of hyperkalemia develop (eg, abnormal heart rhythm)

The nurse should educate a patient with pelvic inflammatory disease (PID) about which potential long-term complication of PID?

Infertility

What is cystitis?

Inflammation of the bladder

What are three rare causes of UTIs?

Klebsiella pneumoniae, Enterobacter, and Pseudomonas

Hospital-associated UTIs are frequently caused by which bacteria?

Klebsiella, Proteus, Enterobacter, Pseudomonas, staphylococci, and enterococci

Which acid-base imbalance is caused by retention of CO2 secondary to hypoventilation? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Metabolic acidosis Metabolic alkalosis Respiratory acidosis* (high CO2 in body increases acidity Respiratory alkalosis

UTIs with multiple organisms may occur in which patients?

Patients with an indwelling catheter, renal stones, or chronic renal abscesses.

What combines with sulfamethoxazole to create an antimicrobial preparation? Penicillin Tetracycline Erythromycin Trimethoprim

Penicillin Tetracycline Erythromycin Trimethoprim*

Name three bacteria treated by sulfonamides (not related to UTIs)

Pneumocystis jiroveci, Chlamydia trachomatis, and Plasmodium falciparum

symptoms of an upper urinary tract infection, such as pyelonephritis

Pus in the urine, high fever, and chills

Potassium-sparing, aldosterone-blocking diuretic

Spironolactone [Aldactone]

Which of the following sulfonamides, applied topically, has the greatest therapeutic benefit for burns? Sulfadiazine Trimethoprim [Primsol] Sulfacetamide [Bleph-10] Silver sulfadiazine [Silvadene]

Sulfadiazine (not topical) Trimethoprim [Primsol] (not topical) Sulfacetamide [Bleph-10] (used for eye infections) Silver sulfadiazine [Silvadene]*

Why aren't Sulfonamides good for pregnant mothers and infants under 2?

Sulfonamides promote kernicterus by displacing protein-bound bilirubin from the proteins, leaving newly freed bilirubin access to brain sites.

T/F Although most UTIs involve only one organism, infection with multiple organisms may occur.

True

The primary healthcare provider has prescribed trimethoprim-sulfamethoxazole [Bactrim] for a patient. The nurse recognizes that this may be prescribed to treat which condition? Urinary incontinence Pain during urination Overactive bladder disorder Chronic urinary tract infection

Urinary incontinence Pain during urination Overactive bladder disorder Chronic urinary tract infection*

Gout

a type of arthritis

Before administering trimethoprim, it is most important for the nurse to assess the patient for a history of which condition? Diabetes Alcoholism Emphysema Heart failure

alcoholism (trimethoprim inhibits synthesis of folic acid; alcoholism usually involves folate deficiency)

isotonic

equal tonicity - considered normal

What should you avoid while taking spironolactone [Aldactone]?

high potassium foods such as salt substitutes

What time of the day should diuretics be taken?

in the morning to prevent nocturia.

potassium sparing diuretic

increase urination without decreasing potassium

Adverse effects of Spironolactone [Aldactone]

it can cause endocrine effects, such as gynecomastia, menstrual irregularities, impotence, hirsutism, and deepening of the voice

Symptoms of Acute cyctitis include: pain and burning during urination nausea and vomiting

pain and burning sensation during urination Nausea and vomiting are not symptoms of acute cystitis

hypertonic

pulls fluid from cells (greater than .9% for sodium chloride IV)

hypotonic

puts fluid in the cells (less than .9% for sodium chloride IV)

Phenazopyridine hydrochloride is a urinary analgesic that is used for...

relieving pain and burning during urination

Antimuscarinic drugs, such as tolterodine tartrate [Detrol], are used for...

the treatment of overactive bladder disorder

Why is it important to increase fluid intake while taking trimethoprim-sulfamethoxazole [Bactrim, Septra]?

to prevent crystallization in the urine

Urinary antispasmodics, such as oxybutynin [Ditropan], are used to treat...

urinary incontinence and urgency

hyperkalemia

when potassium is drawn out of cells (creating a high level of potassium in blood)

Which outcome should a nurse establish for a patient with trichomoniasis who is receiving metronidazole [Flagyl]? -Resolution of genital and perianal warts -Improvement in pain in the back of the testicles -Absence of painful urination and watery discharge -Correct Decrease in yellow-green, odorous vaginal discharge

-Resolution of genital and perianal warts -Improvement in pain in the back of the testicles -Absence of painful urination and watery discharge -Decrease in yellow-green, odorous vaginal discharge*

The nurse is caring for a patient receiving intravenous (IV) therapy with a 3% sodium chloride infusion at 75 mL/hr. The nurse should closely monitor for which adverse effect of treatment? -Sodium level of 140 mEq/L -Blood urea nitrogen of 22 mg/dL -Distended neck veins and ankle edema -Tenting of the skin and dry mucous membranes

-Sodium level of 140 mEq/L (normal value) -Blood urea nitrogen of 22 mg/dL (normal value) -Distended neck veins and ankle edema* (indicates fluid overload) -Tenting of the skin and dry mucous membranes (opposite effect)

Based on the condition of the patient, a hypertonic fluid is needed. Which intravenous fluid is most likely to be ordered by the provider? 3% sodium chloride 0.9% sodium chloride 0.45% sodium chloride 0.25% sodium chloride

3% sodium chloride* 0.9% sodium chloride (normal saline - isotonic) 0.45% sodium chloride (hypotonic) 0.25% sodium chloride (hypotonic)

The nurse should monitor for which adverse effect after administering hydrochlorothiazide [HydroDIURIL] and digoxin [Lanoxin] to a patient? Digoxin toxicity Dehydration Heart failure Decreased diuretic effect

Digoxin toxicity* (digoxins have an inverse relationship with potassium levels and hydrodiuril lowers potassium) Dehydration Heart failure Decreased diuretic effect

The nurse is assessing a patient's laboratory reports and discovers that the serum pH indicates the patient is in acidosis. The nurse is scheduled to administer a potassium-sparing diuretic. Which action should the nurse take? Hold the drug Discontinue the drug Offer with a full glass of water Give with low potassium food

Hold the drug* (acidosis increases potassium in blood) Discontinue the drug - doctor must do this Offer with a full glass of water - would make worse Give with low potassium food - would make worse

What is pyelonephritis?

Inflammation of the kidney(s)

What is urethritis?

Inflammation of the urethra

What is Vaginitis?

Inflammation of the vagina

The nurse is assessing a patient with acute cystitis. Which symptom would the nurse expect to find in the patient?

Pus in the urine Painful urination* High fever and chills Nausea and vomiting

A patient is hypokalemic and taking sustained release oral potassium chloride. What should the nurse teach about taking this drug? Take with meals. Take with calcium. Take with bicarbonate. Take with sips of water.

Take with meals.* (to minimize upset stomach) Take with calcium. Take with bicarbonate. Take with sips of water. (would need a full glass)

A patient has been taking sulfonamides long-term. The nurse assesses the patient and finds bruises on the legs and arms. What is the nurse's best action? Tell the patient to be more careful. Administer vitamin K to the patient. Assess the patient's platelet counts. Ask the patient if someone is abusing her.

Tell the patient to be more careful. Administer vitamin K to the patient (appropriate in certain bleeding instances but not automatically ordered for bruises.) Assess the patient's platelet counts.* Ask the patient if someone is abusing her.