Pharm 4

A nurse is teaching a client who has a new diagnosis of breast cancer about the drug tamoxifen. The nurse should tell the client that which of the following conditions is a contraindication for taking tamoxifen? A Deep-vein thrombosis B COPD C Diabetes mellitus D Alcohol use disorder

A Deep-vein thrombosis Tamoxifen, an estrogen receptor blocker, can cause thromboembolism. Its use requires cautious use with clients who have deep-vein thrombosis.

A nurse is caring for a client who is prescribed zidovudine. Which of the following laboratory values should the nurse report to the provider? A Hemoglobin 7.1 g/dL B RBC count 5.2/mm3 C Neutrophil 57% D Triglycerides 125 mg/dL

A Hemoglobin 7.1 g/dL The provider might consider dose reduction, discontinuation of therapy, or blood transfusions if the client's hemoglobin is less than 7.5 g/dL or has a reduction of greater than 25% from baseline.

A nurse is planning care for a client who has acute myelogenous leukemia and a platelet count of 48,000/mm ^3. Which of the following interventions should the nurse include? A. Avoid IM injections B. Assess the client for ecchymosis once per shift C. Do not allow the client to have visitors D. Encourage daily flossing between teeth

A. Avoid IM injections This client's platelet count of 48,000/mm^3 indicates thrombocytopenia; therefore, the nurse should avoid invasive procedures such as an IM injection which can increase the client's risk of bleeding.

A nurse is caring for a client who recently had chemotherapy and now has myelosuppression. Which of the following interventions should the nurse initiate? (Select all that apply.) A. Prohibit visitors from bringing fresh flowers and plants into the client's room. B. Encourage frequent visits from family and friends. C. Ensure thorough cleaning of the client's room and bathroom daily. D. Replace wound dressings every other day. E. Use dedicated equipment such as stethoscopes.

A. Prohibit visitors from bringing fresh flowers and plants into the client's room. C. Ensure thorough cleaning of the client's room and bathroom daily. E. Use dedicated equipment such as stethoscopes. Myelosuppression is bone-marrow depression, which puts the client at a high risk of infection after chemotherapy. Fresh flowers and potted plants can introduce microorganisms into the client's immediate environment. Due to the client's high risk of infection, the nurse should make sure the housekeeping staff clean and sanitize the client's environment daily. In addition, the nurse should utilize single-use equipment as much as possible and keep reusable equipment (e.g. stethoscopes and blood pressure cuffs) in the client's room for dedicated use by that client only.

A nurse is caring for a client who has tuberculosis and is taking rifampin. The nurse should monitor the client for which of the following adverse effects of rifampin? A. Red-tinged urine B. Tinnitus C. Blurred vision D. Dry mouth

A. Red-tinged urine The nurse should identify that red-tinged urine, saliva, and tears are adverse effects of rifampin.

You are caring for a client who is pregnant and HIV positive. Which of the following drugs helps prevent the transfer of HIV to the fetus? A Anastrozole B Zidovudine C Tamoxifen D Trastuzumab

B Zidovudine Zidovudine prevents the transmission of HIV to the fetus. The client should take the drug orally five times daily from 14 weeks of gestation until delivery. During delivery, the client should receive the drug via IV infusion until the birth attendant clamps the newborn's cord. Anastrozole (Arimidex), an aromatase inhibitor and a pregnancy risk teratogenic drug, treats early or advanced estrogen-receptor-positive breast cancer in postmenopausal women. Tamoxifen, an estrogen receptor blocker and a pregnancy risk teratogenic drug, treats metastatic estrogen-receptor-positive breast cancer and prevents it in high- risk women. Trastuzumab, a monoclonal antibody and a pregnancy risk teratogenic drug, treats metastatic breast cancer with tumors that overexpress human epidural growth factor receptor 2 (HER2)

A nurse is providing teaching about antiretroviral medication therapy to a client who has a new diagnosis of AIDS. Which of the following statements should the nurse include in the teaching? A. "Your provider will prescribe a single antiretroviral medication at a time." B. "You should take antiretroviral medications on a routine schedule." C. "You should increase your intake of raw fruits and vegetables while taking antiretroviral medications." D. "Your provider will prescribe antiretroviral therapy to kill the HIV."

B. "You should take antiretroviral medications on a routine schedule." The nurse should inform the client of the need to take antiretroviral therapy exactly as prescribed and to avoid delaying or skipping any doses, which can result in medication resistance.

A nurse is caring for a client who has a new prescription for ritonavir and zidovudine therapy to treat HIV-1. The nurse should inform the client that zidovudine is prescribed with ritonavir for which of the following reasons? A To prevent an infusion reaction B To increase platelet production C To protect healthy cells from the toxic effects of ritonavir D To prevent drug resistance

D To prevent drug resistance The nurse should explain that zidovudine, a nucleoside reverse transcriptase inhibitor, is administered along with ritonavir, a protease inhibitor, to reduce the risk for drug resistance and to increase drug effectiveness.Monotherapy with zidovudine quickly results in drug resistance, as is also the case with monotherapy with ritonavir.

You should give the client which of the following instructions about chemotherapy with doxorubicin? (Select all that apply) A report vaginal itching B expect red-tinged tears C use effective contraception D expect regrowth after hair loss E increase intake of calcium and vitamin D

A B C D Doxorubicin, an antitumor antibiotic, can cause a superinfection, often manifested as fungal overgrowth in the mouth, vagina, or intestines. The health care professional should instruct the client to watch for and report a black hairy tongue, pain in the mouth, diarrhea, and vaginal itching or discharge. Doxorubicin can cause a reddish discoloration of tears and urine, typically 1 to 2 days after therapy. Doxorubicin is a pregnancy risk teratogenic drug, so female clients who are sexually active should use reliable contraceh-tive methods and report any suspicion of pregnancy. The health care professional should tell the client to expect complete but reversible alopecia. Bone loss is not likely with doxorubicin therapy. Increasing calcium and vitamin D intake is essential with anastrozole, an aromatase inhibitor that causes bone loss.

A client is starting to take ritonavir to treat HIV-1 infection. Which of the following instructions should you include when talking with the client about taking this drug? (select all that apply) A Expect periodic blood glucose monitoring B Take it on an empty stomach. C Watch for and report jaundice. D Increase weight-bearing activity. E Expect periodic cholesterol testing.

A C D E Ritonavir, a protease inhibitor, can cause hyperglycemia and diabetes mellitus. Tell the client to expect periodic blood glucose checks. Clients who already have diabetes should check their blood glucose levels frequently and report elevations as well as increased hunger, thirst, or urination. Tell the client to take the drug with food to maximize absorption and minimize gastrointestinal upset. Ritonavir can cause liver toxicity, so tell the client to watch for and report indications of liver toxicity, such as yellowed sclera and skin. Ritonavir can reduce bone density, so instruct the client to increase weight-bearing activity and calcium and vitamin D intake. Tell the client to expect periodic cholesterol checks.

A nurse is assessing a client who has AIDS and is taking zidovudine. Which of the following findings is the priority for the nurse to report to the provider? A. Nausea and vomiting B. Decreased hemoglobin C. Decreased appetite D. Anxiety

B. Decreased hemoglobin The nurse should apply the safety and risk-reduction priority-setting framework, which assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one posing the greatest threat is the highest priority. The nurse should use Maslow's hierarchy of needs, the ABC priority setting framework, and/or nursing knowledge to identify which risk poses the greatest threat to the client. Therefore, the priority finding for the nurse to report to the provider is a decreased hemoglobin level. Zidovudine can cause severe anemia and neutropenia from bone marrow suppression, resulting in hematologic toxicity.

A community health nurse is caring for a client who was exposed to human immunodeficiency virus (HIV) 2 days ago. The client asks the nurse what she should do. Which of the following responses should the nurse provide? A. "I will administer an HIV vaccine today, and it will need to be repeated in 3 months." B. "I will administer an HIV test today, and you will need to return in 48 hours to have me read the results." C. "You will need to have an HIV test every other week for 6 months." D. "You will need to take prophylactic medications for 4 weeks."

D. "You will need to take prophylactic medications for 4 weeks." The client will need to take prophylactic medications for 4 weeks to prevent the virus from replicating within the body.

A nurse is caring for a client who is receiving radiation therapy for mouth cancer and reports a dry mouth. Which of the following dietary recommendations should the nurse provide? A. Offer graham crackers as a snack B. Avoid foods containing citrus C. Rinse the mouth with an alcohol-based mouthwash before eating D. Use gravies or sauces to soften food

D. Use gravies or sauces to soften food The nurse should instruct the client to use gravies or sauces to soften foods and make them easier to eat.

You should instruct a client who is taking tamoxifen to treat breast cancer to watch for and report which of the following serious adverse effects of this drug? A Abnormal menstrual bleeding B Muscle pain and weakness C Yellowing of skin and eyes D Peripheral edema

A Abnormal menstrual bleeding

A nurse is caring for a client who has a new prescription for tamoxifen. The nurse should recognize that tamoxifen has which of the following therapeutic effects? A Anti-estrogenic B Antimicrobial C Androgenic D Anti-inflammatory

A Anti-estrogenic Tamoxifen is an anti-estrogen medication used to treat cancer of the breast in both pre- and postmenopausal women. It is also used to prevent breast cancer in women who are at an increased risk.

A nurse is caring for a client who is about to begin taking isoniazid to treat tuberculosis. The nurse should instruct the client to report which of the following adverse effects of the drug? (Select all that apply.) A. Jaundice B. Numbness of the hands C. Dizziness D. Hearing loss E. Oral ulcers

A B C Jaundice is correct. Isoniazid, an antimycobacterial drug, can cause liver toxicity, especially in clients who abuse alcohol. The nurse should monitor liver enzymes during therapy and instruct the client to report indications of liver damage, such as jaundice, abdominal pain, and fatigue. Numbness of the hands is correct. Isoniazid can cause peripheral neuropathy. The nurse should instruct the client to report numbness, pain, or tingling in the hands or feet. Administering pyridoxine (vitamin Bs) can help minimize these effects. Dizziness is correct. Isoniazid can cause dizziness, ataxia, and seizures. The nurse should instruct the client to report these CNS effects. Hearing loss is incorrect. Isoniazid is more likely to cause visual disturbances than hearing loss. Oral ulcers is incorrect. Isoniazid is unlikely to cause a superinfection and oral ulcers, but it can cause dry mouth

A nurse is caring for a client who has tuberculosis and is taking rifampin. Which of the following client statements should indicate to the nurse that the client is experiencing an adverse effect of the medication? A. "I have noticed my urine is orange in color." B. "I sleep more than I used to." C. "My tongue and mouth are sore." D. "My voice seems hoarse."

A. "I have noticed my urine is orange in color." The nurse should identify that an adverse effect of rifampin can be red-orange colored urine, saliva, sweat, and tears as the medication is excreted from the body. The nurse should also inform the client that permanent staining of contact lenses can occur. However, this adverse effect is harmless. The client should inform the provider if urine becomes dark in color since this can be an indication of hepatotoxicity.

A nurse is preparing to change the bed linens of a client who has AIDS and is incontinent of stool. Which of the following personal protective equipment (PPE) items should the nurse don prior to providing client care? (Select all that apply.) A. Gown B. Gloves C. Mask D. Hair cover E. Goggles

A. Gown B. Gloves The nurse should follow standard precautions when caring for a client who has AIDS. Because the bed linens might be soiled, the nurse should don a gown. Because the nurse's hands will come in contact with the soiled bed linens, the nurse should don clean gloves in addition to other necessary PPE.

A client is prescribed rifampin for treatment of tuberculosis. The healthcare provider should instruct the client to monitor and report which of the following, which may indicate a serious adverse effect of the rifampin? A. Jaundice B. Tremor C. Sweating D. Insomnia

A. Jaundice Rifampin can cause liver toxicity and hepatitis. Monitor liver enzymes during therapy. Instruct client to monitor and report abdominal pain, nausea, and jaundice. Rifampin can cause lethargy, drowsiness, and confusion. It is unlikely to cause insomnia. Rifampin can impart a red- orange color to urine, saliva, tears, and sweat. It is unlikely to cause sweating. Rifampin can cause ataxia. It is unlikely to cause a tremor.

A nurse in a community health clinic is assessing a new client who has prescriptions for isoniazid and rifampin. Which of the following disorders should the nurse expect the client to have? A. Tuberculosis B. Hypertension C. Diabetes D. Cirrhosis

A. Tuberculosis Isoniazid and rifampin are first-line antitubercular medications used to treat active tuberculosis. The medications are used in combination therapy.

A nurse is caring for a client who has been taking isoniazid and rifampin for 3 weeks for the treatment of active pulmonary tuberculosis (TB). The client reports his urine is orange in color. Which of the following statements should the nurse make? A "Stop taking the isoniazid for 3 days and the discoloration should go away." B "Rifampin can turn body fluids orange." C "I'll make an appointment for you to see the provider this afternoon." D "Isoniazid can cause bladder irritation."

B "Rifampin can turn body fluids orange." Rifampin can cause body fluids, such as tears, sweat, saliva, and urine to turn a reddish-orange color. The nurse should inform the client that this effect does not cause harm.

A nurse is reviewing the laboratory results for a client who has a prescription for filgrastim. The nurse should recognize that an increase in which of the following values indicates a therapeutic effect of the medications? A Erythrocyte count B Neutrophil count C Lymphocyte count D Thrombocyte count

B Neutrophil count Filgrastim increases neutrophil production. It is given to treat neutropenia and reduce the risk of infection for clients who are receiving chemotherapy for cancer or who have undergone bone marrow transplant.

A nurse is conducting dietary teaching for a client who has AIDS. Which of the following instructions should the nurse include in the teaching? A. Discard leftovers after 8 hr B. Use a separate cutting board for poultry C. Thaw frozen foods at room temperature D. Store cold foods at 10°C (50°F) or less

B. Use a separate cutting board for poultry The nurse should instruct the client to use a separate cutting board for raw poultry. Raw poultry can contain bacteria such as salmonella, which may contaminate other foods or work surfaces. Using a separate cutting board prevents cross-contamination of work surfaces when preparing food.

During IV administrations of Doxorubicin, the infusion site becomes swollen, red, and painful. Which of the following actions should you take? A slow the infusion rate B Apply pressure to the site C Stop the IV infusion D Apply ice and continue the infusion

C stop the infusion Doxorubicin, an antitumor antibiotic, can cause tissue damage from extravasation. The health care professional should stop the IV infusion immediately and contact the primary care provider. Continuing the infusion, even at a slower rate, can cause further tissue damage, as can applying ice or pressure to the site. After stopping the infusion, the health care professional should monitor the client's skin for ulceration, which can occur 1 to 4 weeks after extravasation.

A nurse in the emergency department is caring for an inmate who has a laceration and is bleeding. The client was brought to the facility by a guard who asks the nurse about the client's HIV infection status. Which of the following actions should the nurse take? A. Inform the guard that the warden must request this information B. Ask the guard to sign a release of information form C. Instruct the guard to ask the inmate D. Complete an incident report

C. Instruct the guard to ask the inmate The nurse is not able to supply this information to the guard. In order for the guard to obtain this information, the client must offer the information freely. Therefore, the nurse should instruct the guard to ask the client for this information.

A nurse is caring for a client who has a prescription for rifampin to treat tuberculosis. The nurse should expect the provider to prescribe which of the following drugs to the client to prevent possible resistance to rifampin? A. Gentamicin B. Vancomycin C. Isoniazid D. Metronidazole

C. Isoniazid Isoniazid is used to treat tuberculosis and reduces the possibility of resistance to rifampin when combined with the drug. Drug resistance can develop quickly if the client only takes rifampin.

A nurse is caring for a client who is in the terminal stage of cancer. Which of the following actions should the nurse take when she observes the client crying? A. Contact the family and ask someone to stay with the client B. Offer to call the client's minister C. Sit and hold the client's hand D. Leave the room and allow the client to cry privately

C. Sit and hold the client's hand This action uses the therapeutic communication techniques of silence, touch, and offering of self to the client.

A nurse is providing teaching to a client with tuberculosis who has prescriptions for rifampin and ethambutol. Which of the following findings is an adverse effect of these medications that the client should report to the provider? A. Red-orange discoloration of urine B. Unexpected weight gain C. Ringing in the ears D. Decreased visual acuity

D. Decreased visual acuity The nurse should identify optic neuritis as an adverse effect of ethambutol. The nurse should instruct the client to monitor for changes in visual acuity or color identification as indications of optic neuritis to report to the provider. This adverse effect necessitates termination of ethambutol therapy because irreversible blindness can result.

When talking to the client about chemotherapy wtih doxorubicin, you explain the need for periodic diagnostic tests. The result of which of the following diagnostic tests or procedures requires monitoring? A. Lumbar Puncture B. IV pyelogram C. Bone density Scan D. ECG

D. ECG Doxorubicin, an antitumor antibiotic, can cause cardiotoxicity. Cardiac symptoms can develop years after treatment, so it is essential to monitor cardiac function before, during, and after doxorubicin therapy. The health care professional should instruct the client to watch for and report palpitations, shortness of breath, or chest pain. Doxorubicin therapy does not require cerebrospinal fluid analysis unless the client shows indications of neurologic system infection. This drug is unlikely to cause kidney damage or kidney stones, so an IV pyelogram is unnecessary. It is unlikely to cause bone loss, so a bone density scan is unnecessary.

A nurse is assessing a client who has multidrug-resistant tuberculosis and takes ethambutol. The nurse should identify which of the following findings as an adverse effect of this medication? A. Mottling of the extremities B. Orange-red urine and bodily secretions C. Yellowing of the sclera D. Loss of red/green color discrimination

D. Loss of red/green color discrimination Ethambutol is an antitubercular medication that impairs ribonucleic acid synthesis. A common adverse reaction is the loss of red/green color discrimination due to optic neuritis. The nurse should notify the provider of this finding and expect to discontinue the medication.

A nurse is providing teaching for a client who takes an oral contraceptive and is about to begin rifampin therapy to treat tuberculosis. Which of the following instructions should the nurse include? A. Increase the rifampin dose. B. Increase the oral contraceptive dose. C. Allow 2 hr between taking the two drugs. D. Use a non-hormonal form of contraception.

D. Use a non-hormonal form of contraception. Rifampin, an antimycobacterial drug, can increase the metabolism of oral contraceptives, reducing their effectiveness. Clients who are taking oral contraceptives and rifampin should use additional, non-hormonal contraceptive methods to prevent an unwanted pregnancy.

A nurse is caring for a client who just received a diagnosis of cancer. The client states, "I just don't know what I'm going to do now." Which of the following responses should the nurse make? A. "In time you'll know the right thing to do." B. "I am sorry. Would you like me to call someone for you?" C. "There are multiple treatment options for you to consider." D. "Can you explain the concerns you're having right now?"

D. "Can you explain the concerns you're having right now?" This response uses the therapeutic communication technique of asking a relevant question. By using an open-ended question to ask the client to explain any present concerns, the nurse is encouraging the client to respond and provide additional information.