Pharm Exam 2

A client is prescribed isoniazid (INH) for a diagnosis of tuberculosis (TB). Which adverse effect may result in discontinuation of the medication? Group of answer choices weight gain jaundice fever arthralgia

jaundice

A nursing student is assessing a client who has COVID-19 and is taking hydroxychloroquine. The nurse should report which of the following adverse effects to the provider immediately? palpitations diarrhea blurred vision fatigue

palpitations

A client is taking a xanthine derivative as part of treatment for chronic obstructive pulmonary disease (COPD). The nurse demonstrates good understanding of this medication by monitoring for which adverse effect of this medication? Diarrhea Drowsiness Palpitations Bradycardia

Palpitations

-stigmine

anticholinesterase inhibitor

-lukast

Leukotriene Receptor Blockers

J. M., a 79 year old patient with a serum creatinine of 1.9 mg/dL, has atrial fibrulation. A resident has prescribed digoxin for J.M. The target concentration of digoxin for the treatment of atrial fibrilation is 0.5 ng/mL to 0.9 ng/mL, but JM's cuurent level is high at 2 ng/ mL. Assuming no more doses of digoxin are given and the drug has a half life of 36 hours, how long will it take JM to achieve a therapeutic level? A. 108 hours B. 72 hours C. 144 hours D. 36 hours

72 hours

A client is being assessed by the home care nurse on the appropriate use of her metered-dose inhalers. Instructions concerning which intervention will assist a client in the proper administration of a metered-dose inhaler? use of a spacer pushing fluids exhaling immediately after administration administration of a corticosteroid first

use of a spacer The client should be instructed to use a spacer to increase compliance and accuracy of administration. An asthma spacer is an add-on device used to increase the ease of administering aerosolized medication from a metered-dose inhaler (MDI). The corticosteroid should be administered after the bronchodilator. The increase in fluids will not affect the administration of the inhaler. The client should hold his or her breath for several seconds after administration of the inhaler.

A nurse is caring for a client who has a new diagnosis of asthma. The client was prescribed an ipratropium inhaler. Which of the following questions should the nurse ask the client about their past medical history? Select all that apply "Do you have any heart conditions?" "Have you ever been diagnosed with glaucoma?" "Have you experienced any hair loss recently?" "Do you have any problems with your prostate"

"Do you have any heart conditions?" "Have you ever been diagnosed with glaucoma?" "Do you have any problems with your prostate"

Which health education topic is most important to share with a client diagnosed with asthma? "Do not become fatigued. It will trigger asthma attacks." "Do not consume foods high in sodium." "Prolonged exposure to direct sunlight will trigger asthma." "Exposure to cold temperatures can trigger asthma."

"Exposure to cold temperatures can trigger asthma." Exposure to cold air can exacerbate asthma symptoms due to the bronchoconstriction of airways. Neither fatigue, consumption of dietary sodium nor direct sunlight is a known trigger of an asthma attack.

A patient was discharged from the hospital with instructions to take an antibiotic for 7 days to treat a bladder infection. Twelve days later, a home care nurse visits the patient and finds that the symptoms have not resolved. What is the most important question for the nurse to ask? "Do you think you have another bladder infection?" "How much water have you been drinking each day?" "Have you taken all of the antibiotics as directed?" "What antibiotic do you usually take to treat an infection?"

"Have you taken all of the antibiotics as directed?" The failure to take medications as directed is a common cause of persistent infection.

A patient is about to begin therapy with ethambutol. The nurse knows that, before initiating treatment with this drug, it is important to obtain which test(s) A. Color vision and visual acuity B. Complete blood cell (CBC) count C. Hearing testing and a tympanogram D. Hepatic function tests

A. Color vision and visual acuity

A nurse is teaching a client who has a new prescription for beclomethasone. Which of the following instructions should the nurse include? "Increase your intake of vitamin B12 while taking this medication." Correct! "Rinse your mouth after each use of this medication." "You can take the medication as needed." "Limit fluid intake while taking this medication."

"Rinse your mouth after each use of this medication."

A client has prescriptions for two inhalers. One inhaler is a bronchodilator, and the other is a corticosteroid. Which instruction regarding these inhalers will the nurse give to the client? "Take these two drugs at least 2 hours apart." "Take the corticosteroid inhaler first." "Take the bronchodilator inhaler first." "It does not matter which inhaler you use first."

"Take the bronchodilator inhaler first."

When teaching a person how to use their inhalers, the nurse would know to include the following information in their plan... When using the same inhaler you should wait approximately ______ minutes between puffs. 2-5 1-3 1-2 3-5

1-2

What are the four key principles of antibiotic therapy?

1. Patients should be monitored for signs and symptoms of Super Infection. 2. Patients should be assessed for allergies. 3. Patients should be monitored for notable drug to drug interactions. 4. Patients should always finish their entire antibiotic therapy even if they feel better.

We are going to work through the nursing process (ADPIE). This question will deal with planning. When teaching a person how to use their inhalers, the nurse would know to include the following information in their plan... When using different inhalers you should wait approximately ______ minutes between puffs. 2-5 3-5 1-2 1-3

2-5

Your patient is on vancomycin 1gm IV every 12 hours. The last dose of vancomycin was at 0900 this morning. Assuming steady state, the provider orders a vancomycin trough to be drawn. What time would you expect the trough to be ordered? 21:30 this evening 09:30 this morning 21:00 this evening 20:30 this evening

20:30 this evening

For how long after you give an antibiotic should you observe your patient for signs and symptoms of an allergic reaction? 30 minutes 15 minutes 45 minutes 60 minutes

30 minutes

What are our Unintended Outcomes on anticoagulants? (Meaning what are our adverse effects?) A patient has ringing in their ears A patient develops a sudden headache that is extremely painful A patient notes reddish pink urine A patient has become fatigued and gets tired easily A patient has been constipated for 48 hours

A patient develops a sudden headache that is extremely painful A patient notes reddish pink urine A patient has become fatigued and gets tired easily Rationale: The primary unintended outcome is bleeding! There are many signs and symptoms. Lab Values: We can measure the Hemoglobin, Hematocrit and Platelets to see a trend. If they are falling, it may suggest bleeding. We can also visually observe our patients. Patients may develop GI bleeds and may report blood in the urine or bowel movement (could be bright red or black and tarry in appearance). They may also develop a severe stomach ache or even vomit up blood or what looks like coffee grounds. An extremely dangerous outcome would be an intracranial bleed. This can be spontaneous (although extremely rare) or could be caused by head trauma (falling and hitting their head at home). If a patient falls at home, they need to come to the hospital to be evaluated. If the patient develops a sudden, severe headache, they should be evaluated immediately. If a patient is bleeding, they will have signs and symptoms of anemia. They are losing Hemoglobin, which carries Oxygen. As a result, they may have symptoms of inadequate oxygen such as fatigue or even confusion.

What are our Intended Outcomes in Anticoagulant therapy? (Meaning what are the goals of therapy?) A patient on heparin has an AST of 24 units/L A patient on IV heparin has a PTT of 68 seconds A patient on warfarin has a potassium of 4.5 mEq/L A patient with a DVT in their right leg reports decreased pain,swelling and redness in their leg A patient with a hip replacement did not develop a DVT/PE post-operatively

A patient on IV heparin has a PTT of 68 seconds A patient with a DVT in their right leg reports decreased pain,swelling and redness in their leg A patient with a hip replacement did not develop a DVT/PE post-operatively Rationale: The intended outcomes of anticoagulants are to prevent or treat blood clots (PEs/DVTs). We can subjectively listen to signs and symptoms of our patients, meaning have they develop any signs of a DVT? If they have a DVT, have their symptoms improved? What about lab markers? How do you know that the drug was dosed appropriately? Warfarin: Warfarin can be assessed by looking at the INR or the PT. Warfarin goal Prothrombin Time is typically 18 to 24 seconds. Warfarin INR goal is 2-3, except in patients with mechanical heart valves. Mechanical Heart Valves have a higher risk of forming a clot, so general recommendations are an INR of 2.5-3.5 for these patients. Heparin IV: Heparin can be assessed by looking at the activated Partial Thromboplastin Time (aPTT). The ATI goal is 60 to 80 seconds. Many facilities may use higher or lower ranges depending on the condition (stroke vs PE, etc.). Some facilities now measure what is called an Anti-Xa level, but you will not need to know these levels. Heparin SQ: We do not routinely check levels Enoxaparin SQ: We do not routinely check levels Apixaban: There is not an established lab value to measure Rivaroxaban: There is not an established lab value to measure

Which patients would be candidates for heparin usage? Select All That Apply: A patient who is Post Op Hip/Knee Replacement A patient with a Pulmonary Embolism A patient who has developed an Acute Kidney Injury A patient with Diabetes A patient with new onset trial Fibrillation

A patient who is Post Op Hip/Knee Replacement A patient with a Pulmonary Embolism A patient with new onset trial Fibrillation

Which patient would be an appropriate candidate to receive emergent alteplase therapy? A patient with a massive Pulmonary Embolism A patient who had an ischemic stroke 8 hours ago A patient with an ischemic stroke who is taking warfarin therapy A patient with a hemorrhagic stroke

A patient with a massive Pulmonary Embolism

Which of the following persons would NOT be a good candidate for the use metronidazole to treat a protozoan reaction? A person who overuses alcohol and has no intentions of quitting. A person who overuses nicotine and has no intentions of quitting. A person who overuses opioids and has no intentions of quitting. A person who overuses benzos and has no intentions of quitting.

A person who overuses alcohol and has no intentions of quitting.

Mr. D has a new diagnosis of asthma and was prescribed ipratropium (Atrovent) to take via an inhaler. When teaching the patient about the medication, which of the following questions is important to ask before he starts taking the medication? Select all that apply. A. Do you have a penicillin allergy? B. Have you experienced hair loss recently? C. Do you have problems with your prostate? D. Have you ever been diagnosed with glaucoma?

A. Do you have a penicillin allergy? C. Do you have problems with your prostate? D. Have you ever been diagnosed with glaucoma?

When educating a patient about the use of multiple inhalers, which of the following actions are correct? A. Hold the inhaled dose for 10 seconds to allow the drug to be deposited in the lungs B. Spacer use is contra- indicated in children C. Use the steroid inhaler first, followed by the bronchodilater inhaler D. Wait at least 10 min between different inhalers E. Wait 1 - 2 minutes between puffs of the same inhaler

A. Hold the inhaled dose for 5- 10 seconds to allow the drug to be deposited in the lungs E. Wait 1 - 2 minutes between puffs of the same inhaler

When assessing a client who is to receive a decongestant, the nurse will recognize that a potential contraindication to the drug would be which conditions? Select all that apply. A. Hypertension B. Peptic Ulcer disease C. Glaucoma D. Fever E. Allergic rhinitis

A. Hypertension C. Glaucoma

You are a new nursing resident giving a discussion on Cross Sensitivity of antibiotics. Which of the following antibiotics may have a cross sensitivity in a patient who reports a Piperacillin-Tazobactam allergy? Select all that apply. A. Methicillin B. Cefazolin C. Ertapenem D. Doxycycline E. Vancomycin

A. Methicillin B. Cefazolin C. Ertapenem

A nursing student is preparing to administer medication to a patient who has gout flare ups. The nursing student discovers that a medical error was made during the previous shift and the patient received atenolol instead of allopurinol. Which of the following actions should the nurse take first? A. Obtain the client's blood pressure. B. Contact the client's provider. C. Inform the charge nurse. D. Complete an incident report.

A. Obtain the client's blood pressure.

You are leading a nursing school discussion on acyclovir medication administration. Which of the following are correct statements? Select All That Apply: Group of answer choices Topical acyclovir will prevent the transmission of the virus between partners Patients can discontinue their medication early if their lesions heal Acyclovir can be used to stop the replication of the Herpes Virus (HSV) as well as the Varicella Zoster Virus (VZV) Patients receiving IV acyclovir should receive IV fluids during therapy and for at least 2 hours after the end of the infusion Acyclovir should be administered as a rapid IV push

Acyclovir can be used to stop the replication of the Herpes Virus (HSV) as well as the Varicella Zoster Virus (VZV) Patients receiving IV acyclovir should receive IV fluids during therapy and for at least 2 hours after the end of the infusion

Everyone with a diagnosis of asthma should have a rescue inhaler. As an astute nurse, you know that the following inhalers can be used as rescue inhalers. Select all that apply. ICS Albuterol Formoterol Formoterol + ICS Theophylline

Albuterol Formoterol + ICS Formoterol + ICS is a NEWLY accepted rescue inhaler, however ATI/NCLEX may not yet be updated to reflect this. The ATI/NCLEX answer for a rescue inhaler is always ALBUTEROL!

Your patient is taking diphenhydramine. You know that this co-administration of this medication should be avoided with which of the following? select all that apply. Alcohol Pseudophedrine Morphine Acetaminophen Ibuprofen Cyclobenzaprine Diazepam Aspirin Phenobarbital

Alcohol Morphine Cyclobenzaprine Diazepam Phenobarbital You can remember the drugs to avoid with 1st generation antihistamines as the B-Drugs.

What types of conditions can anticoagulants be used to treat? Group of answer choices An 18 year old patient with COVID-19 who developed a Pulmonary Embolism A 56 year old patient with Type 2 diabetes and retinopathy A 58 year old patient with narrow angle glaucoma A 55 year old patient with Atrial Fibrillation A 32 year old patient with hypertension A 72 year old patient who just had their knee replaced

An 18 year old patient with COVID-19 who developed a Pulmonary Embolism A 55 year old patient with Atrial Fibrillation A 72 year old patient who just had their knee replaced Rationale: Anticoagulants are used for a wide variety of conditions. They primarily work by stopping clotting cascade. This means that they can prevent blood clot creation or stop blood clot growth. Common uses include stroke prevention in Atrial Fibrillation, DVT/PE prevention and TREATMENT (meaning it stops the growth of these clots and allows the body to break them down). Anticoagulants are commonly used in hospitalized patients who are immobile or are high risk to prevent a DVT/PE from forming. COVID-19 patients have been found to develop hyper-coagulable states. Often times, you may see hospitalized COVID-19 patients receiving higher doses of anticoagulants than normal (mainly heparin subcutaneous).

A nursing student is caring for a client who has HIV-1 infection and is prescribed zidovudine as part of antiretroviral therapy. The nursing student should monitor the patient for which of the following adverse effects of this medication? Anemia Metabolic alkalosis Cardiac dysrhythmia Renal failure

Anemia

Which information should the nurse include when teaching a patient about rifampin therapy? A. Oral contraceptives are safe to use with rifampin therapy. B. Contact your healthcare provider immediately if the color of your body fluids changes to reddish orange. C. Rifampin is safe to use in patients who have hepatic disease. D. Rifampin may be administered intravenously.

Answer D. Rifampin may be administered intravenously. Rationale: Rifampin may be administered intravenously. Women taking oral contraceptives should consider a nonhormonal form of birth control while taking rifampin. Rifampin frequently imparts a red-orange color to urine, sweat, saliva, and tears; patients should be informed of this harmless effect. Permanent staining of soft contact lenses occasionally has occurred, so the patient should consult an ophthalmologist about contact lens use. Rifampin is toxic to the liver, posing a risk of jaundice and even hepatitis. Asymptomatic elevation of liver enzymes occurs in about 14% of patients. However, the incidence of overt hepatitis is less than 1%. Hepatotoxicity is most likely in alcohol abusers and patients with pre-existing liver disease. These individuals should be monitored closely for signs of liver dysfunction.

Which information should the nurse include when teaching a patient about isoniazid (INH) therapy? A. Tubercle bacilli cannot develop resistance to isoniazid during treatment. B. Isoniazid can be used as monotherapy for treatment of TB. C. An adverse effect of isoniazid therapy is peripheral neuropathy, which can be reversed with pyridoxine. D. The dose of isoniazid should be lowered if the patient is also taking phenytoin.

Answer: C An adverse effect of isoniazid therapy is peripheral neuropathy, which can be reversed with pyridoxine. Rationale: If peripheral neuropathy develops, it can be reversed by administering pyridoxine (50 to 200 mg daily). Tubercle bacilli can develop resistance to isoniazid during treatment Plasma levels of phenytoin should be monitored, and the phenytoin dosage should be reduced as appropriate; the dosage of isoniazid should not be changed. Isoniazid can raise levels of other drugs, including phenytoin.

A nurse is preparing to administer nafcillin IM to an adult client who has an infection. Which of the following actions should the nurse plan to take? (Select all that apply.) Ask the client about an allergy to penicillin before administering the medication. Select a 25‑gauge, ½‑inch needle for the injection Monitor the client for 30 min following the injection Administer the medication deeply into the ventrogluteal muscle Tell the client to expect a temporary rash to develop following the injection.

Ask the client about an allergy to penicillin before administering the medication. Monitor the client for 30 min following the injection Administer the medication deeply into the ventrogluteal muscle A. A 25‑gauge, ½‑inch needle is too small and short for an IM injection of nafcillin to an adult client. Choose the needle size and length that is best for each specific client. A needle for an adult client's IM injection should be 19‑ to 22‑gauge and 1½ inches long. B. CORRECT: It is important to administer nafcillin IM into a deep muscle mass (the ventrogluteal site). C. CORRECT: It is important to ask the client about an allergy to penicillin or other antibiotics before administering nafcillin. An allergy to another penicillin or to a cephalosporin is a contraindication for administering nafcillin. D. CORRECT: When administering a penicillin or other antibiotic parenterally, it is important to monitor the client for 30 min for an allergic reaction. E. A rash is not an expected reaction after nafcillin administration. A rash can be a manifestation of an allergy to the medication.

When completing an admission assessment, the patient states that she is allergic to sulfa drugs. What will the nurse do next? Notify the physician about the patient's allergy. Ask the patient for more information about the allergic reaction she had. Mark the allergy on her medical record. Place an "allergy" armband on the patient.

Ask the patient for more information about the allergic reaction she had. Some patients say they are "allergic" to drugs when in fact what they experienced was a common and mild adverse effect. The nurse should clarify the patient's statements with open-ended questions.

Your patient has been prescribed Azithromycin to treat a COVID-19 bacterial pneumonia. Which of the following comments from your patient would be of the highest priority? A. I have a metallic taste in my mouth. B. I feel like my heart is fluttering. C. I feel a fullness in my ears. D. I have a productive cough.

B. I feel like my heart is fluttering.

In a patient receiving Gentamicin therapy, which of the following comments from the patient would suggest the patient is experiencing toxicity due to Gentamicin? Select all that apply. A. I've lost my sense of smell. B. I hear a faint ringing in my ears. C. I haven't peed all day. D. I get dizzy every time I stand upright. E. I have a fever and night sweats.

B. I hear a faint ringing in my ears. C. I haven't peed all day. D. I get dizzy every time I stand upright.

A patient is beginning treatment for active tuberculosis (TB) in a region with little drug-resistant TB. Which treatment regimen will be used initially? A. Rifampin, pyrazinamide, and ethambutol B. Isoniazid, rifampin, pyrazinamide, and ethambutol C. Isoniazid, pyrazinamide, and ethambutol D. Isoniazid and pyrazinamide

B. Isoniazid, rifampin, pyrazinamide, and ethambutol

In a patient receiving anticoagulant or antiplatelet medications. Which of the following would be a potential contra-indication? Select all that apply: Bleeding GI ulcer Epidural Active hemorrhagic Stroke Asthma Atrial Fibrillation

Bleeding GI ulcer Epidural Active hemorrhagic Stroke

A nurse is performing a physical assessment on a patient with tuberculosis who takes rifampin [Rifadin]. What would be an expected finding? A. Crystalluria B. Red-Orange Tinged Urine C. Myopathy D. Peripheral neuropathy

B. Red-Orange Tinged Urine

Which of the following are signs/ symptoms that a superinfection has developed? Select all that apply. A. A patient has not had a bowel movement in a week. B. The patient has severe, smelly diarrhea. C. A patient has white, thick discharge from the vagina. D. A patient has a white film developed in their mouth. E. A patient reports sudden hearing loss in both ears.

B. The patient has severe, smelly diarrhea. C. A patient has white, thick discharge from the vagina. D. A patient has a white film developed in their mouth.

A patient who is taking ketoconazole tells the nurse that her periods have become irregular. What will the nurse tell her? A. This is a sign of hepatic toxicity, and the drug dose should be lowered. B. This is caused by a reversible effect on estradiol synthesis. C. This is a serious side effect that warrants discontinuation of the drug. D. This indicates that she should begin taking oral contraceptives.

B. This is caused by a reversible effect on estradiol synthesis. Rationale: Ketoconazole inhibits steroid synthesis in humans, and in females it reduces estradiol synthesis, causing menstrual irregularities. It is not an indication that oral contraceptive pills (OCPs) are needed. Because it is reversible, there is no indication for withdrawing the drug until treatment is complete. Menstrual irregularities are not a sign associated with hepatotoxicity

A nurse is assessing a client who has received atropine eye drops during an eye examination. Which of the following findings should the nurse expect as an effect of the medication? Difficulty seeing in the dark Blurred vision Excessive tearing Pinpoint pupils

Blurred vision I think you can argue that both cholinergic and anticholinergic eye drops could cause blurred vision! The other answers are clearly wrong

Regular monitoring and evaluation of the following for patient's taking PrEP is necessary for safe and effective therapy. ( Select all that apply) (Note: This question has answer options A through H) Group of answer choices Bone Mineral Density Renal Function Liver Function Hyperventilation Regimen Adherence HIV Status PT/INR Blood Glucose

Bone Mineral Density Renal Function Liver Function Hyperventilation Regimen Adherence HIV Status

Which assessment finding should prompt the nurse to suspect that the resident is experiencing an anticholinergic effect of diphenhydramine? A. Wheezing on expiration B. Tinnitus C. Dry eyes E. Urticaria

C. Dry eyes

The nurse is reviewing a client's medication orders for an as needed medication that can be given to a client who has bronchitis and a productive cough. Which of the following medications will the nurse anticipate administering? A. Codeine B. Psuedoephedrine C. Guaifenesin D. Diphenhydramine

C. Guaifenesin

CD is a patient just starting doxycycline therapy. Which of the following statements suggest the patient needs re-education? A. I should not lie down after taking this medication. B. If I develop diarrhea, I should report this to my provider. C. I should take this medication with a full glass of milk. D. I should wear sunscreen or clothes to appropriately cover my skin due to sunburn risk.

C. I should take this medication with a full glass of milk.

A nurse is providing teaching to a client who is to start treatment for asthma with beclomethasone and albuterol inhalers. Which of the following instructions should the nurse include in the teaching? A. Limit your calcium and Vitamin D intake B. Use beclomethasone 5 min before using albuterol C. Rinse your mouth after inhaling the beclomethasone D. Beclomethasone should be used as your rescue inhaler during asthma attacks

C. Rinse your mouth after inhaling the beclomethasone

Clients taking methylxanthines should be instructed to avoid which of the following? Select all that apply. Beta Blockers Fish Oil Energy drinks Chocolate Peanuts Coffee

Energy drinks Chocolate Coffee

What antibiotics should be used cautiously in patients with a history of seizures?

Ciprofloxacin

When teaching patients about treatment of viral infection with Acyclovir (Zovirax), which of the following statements will the nurse include? A. The drug is used mainly to suppress the replication of HSV-1, HSV-2, and VZV. B. Acyclovir (Zovirax) is only effective for initial viral infections. C. Acyclovir (Zovirax) is available in topical form only. D. Acyclovir (Zovirax) is taken once daily.

Correct answer: A The drug is used mainly to suppress the replication of HSV-1, HSV-2, and VZV. • Rationale: Acyclovir (Zovirax) is a synthetic nucleoside analogue that is used mainly to suppress the replication of HSV-1, HSV-2, and VZV. Acyclovir is considered the drug of choice for the treatment of both initial and recurrent episodes of these viral infections. Acyclovir is available in oral, topical, and injectable formulations. Acyclovir (Zovirax) is taken five times daily.

A patient with active HIV has been taking zidovudine (Retrovir). Which potential adverse effect may limit the length of time this medication can be taken? A. Lactic acidosis B. Bone marrow suppression C. Hepatomegaly D. Fatigue

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

A patient is receiving amphotericin B lipid complex. The nurse knows that an advantage of the lipid formulations of this drug is that they: A. have a lower cost. B. can be administered quickly. C. take longer to be absorbed. D. cause fewer adverse effects.

Correct answer: D cause fewer adverse effects. Rationale: Lipid formulations of amphotericin B have been developed in an attempt to decrease the incidence of its adverse effects and increase its efficacy. There are currently three lipid preparations of amphotericin B: (1) amphotericin B lipid complex (Abelcet), (2) amphotericin B cholesteryl complex (Amphotec), and (3) liposomal amphotericin B (AmBisome). These lipid dosage forms have a much higher cost than conventional amphotericin B and for this reason are often used only when patients are intolerant of or have an infection refractory to nonlipid amphotericin B.

A nurse is planning to teach about inhalant medications to a client who has a new diagnosis of exercise-induced asthma. Which of the following medications should the nurse plan to instruct the client to use prior to physical activity? Tiotropium Beclomethasone Budesonide Cromolyn

Cromolyn More recent guidelines do allow use of PRN steroid inhalers, but ATI/NCLEX usually take a few years to catch up to recent practice guidelines.

A nurse is caring for a client who has a gynecologic infection and a history of alcohol use disorder. The nurse should identify that which of the following drugs can cause a reaction similar to disulfiram if the client drinks alcohol while taking it? A. Amoxicillin B. Vancomycin C. Neomycin D. Cefotetan

D. Cefotetan

Sulfamethoxazole/trimethoprim is commonly used to treat UTIs. Which of the following conditions can this antibiotic cause? A. Tendon rupture B. Tinnitus C. QT prolongation D. Kericterus in newborns

D. Kericterus in newborns

JM has just been diagnosed with Anthrax and was prescribed Ciprofloxacin. Which of the following conditions is associated with a fluoroquinolone usage? A. Blood dycrasias B. Constipation C. Tinnitus D. Tendon rupture

D. Tendon rupture

A nurse is providing discharge instructions to a client who has COPD and a new prescription for roflumilast. The nurse should instruct the client to report which of the following adverse effects to the provider? Depression Palpitations Constipation Blurred vision

Depression

Which of the following are TRUE concerning a patient taking diphenhydramine? Select all that apply. It is safe to take diphenhydramine with Codeine to help suppress a cough Diphenhydramine may cause urinary retention Diphenhydramine can be used off label to treat glaucoma Patients taking diphenhydramine should not operate any machinery Diphenhydramine is known to cause diarrhea

Diphenhydramine may cause urinary retention Patients taking diphenhydramine should not operate any machinery

Which of the following are essential counseling points on a patient starting doxycycline therapy? Select all that apply: Doxycycline may decrease effectiveness of your oral contraceptive so you should use an alternative form of contraception You can stop taking the medication once your fever improves Wear protective clothing and use sucreen with an SPF of 30 or higher while in sunlight Take your doxycyline with a full glass off milk or yogurt to increase absorption Mouth sores are a common adverse effect of this medication, but will resolve on their own

Doxycycline may decrease effectiveness of your oral contraceptive so you should use an alternative form of contraception Wear protective clothing and use sucreen with an SPF of 30 or higher while in sunlight

One of the most common pathogens of Urinary Tract Infections is: Mycobacterium Avium Complex Streptococcus pyogenes Correct! Escherichia coli Staphylococcus aureus

Escherichia coli

True/False: It is unsafe to use both a MOAI and decongestant (such as pseudophedrine) because they can lower blood pressure to dangerously low levels.

False The use of a MAOI and decongestant will RAISE bp. MAO-Is are one of the oldest groups of anti-depressants. Our prototype MAO-I is phenelzine. This drug increases levels of Norepinephrine. MAO-I (elevated levels of Norepinephrine) + A decongestant (Alpha-1 agonist), will result in potentially a dangerously high Blood Pressure! This is why patients with underlying hypertension/cardiac disease are contra-indicated in taking a decongestant. In Summary: MAO-Is + Decongestants=DANGEROUS

Which of the following are signs and symptoms of the "shake and bake" reaction associated with amphotericin B infusions? select all that apply Fever Profuse sweating Chills Rigors Hypokalemia Muscle pain Seizures Headache Nausea Fruity breath

Fever Rigors Muscle pain Headache Nausea

Which of the following is arguable the most important point when evaluating antimicrobial therapy? Finishing the entire treatment Side effects from the treatment Evaluating trough levels Evaluating kidney functioning

Finishing the entire treatment

A patient who is planning to become pregnant should ensure that she receives adequate levels of which supplement to reduce the risk for fetal neural tube defects? Folic acid Vitamin B12 Vitamin D Iron

Folic acid

A client with a tracheostomy has difficulty removing excessive, thick mucus from the respiratory tract. The nurse expects that which drug will be ordered to aid in the removal of mucus? Guaifenesin Diphenhydramine Pseudoephedrine Dextromethorphan

Guaifenesin

When monitoring for therapeutic effectiveness of Warfarin, which of the following lab values are monitored? Select all that apply: International Normalized Ratio (INR) Activated Partial Thromboplastin Time (aPTT) Prothrombin Time (PT) Aspartate AminoTransferase (AST) Blood Urea Nitrogen (BUN)

International Normalized Ratio (INR) Prothrombin Time (PT)

You have a patient on IV Vancomycin and you recently drew a Vancomycin trough. Lab calls you and reports a vancomycin trough of 21 mcg/ml. What are your next steps?

Hold the next dose and notify the provider

Which of the following statements from a patient receiving warfarin is correct? I should avoid all Vitamin K containing foods If I have pain, I should use NSAIDS like ibuprofen to treat minor aches and pains I need to have my INR checked periodically with a target INR between 2 to 3 It is completely normal to notice a little blood in my stool on occasion

I need to have my INR checked periodically with a target INR between 2 to 3

If a patient is taking fluconazole (Diflucan) with an oral anticoagulant, the nurse will monitor for which possible interaction? Reduced action of oral anticoagulants Hypokalemia Decreased effectiveness of the antifungal drug Increased effects of oral anticoagulants

Increased effects of oral anticoagulants

When preparing the drug Enfuvirtide, what are some important administration components? Select all that apply: Inject Sterile Water into the Vial Shake the vial Vigorously to reconstitute the vial The solution should look Cloudy when it is ready to administer Make sure the drug is room temperature before injecting

Inject Sterile Water into the Vial Make sure the drug is room temperature before injecting

The nurse is administering liquid oral iron supplements. Which intervention is appropriate when administering this medication? Have the patient take the liquid iron with milk. Have the patient drink the medication, undiluted, from the unit-dose cup. Instruct the patient to take the medication through a plastic straw. Have the patient sip the medication slowly.

Instruct the patient to take the medication through a plastic straw.

A patient is to receive iron dextran injections. Which technique is appropriate when the nurse is administering this medication? Intramuscular injection in the upper arm Subcutaneous injection into the abdomen Intravenous administration mixed with 5% dextrose Intramuscular injection using the Z-track method

Intramuscular injection using the Z-track method

A patient is receiving Augmentin (amoxicillin and clavulanic acid) liquid solution through a percutaneous endoscopic gastrostomy tube. What is the purpose of the clavulanic acid? It works synergistically with the antibiotic to improve potency. It inhibits the action of the enzymes produced by beta-lactamase-producing bacteria. It protects the antibiotic from the harmful gastric acid secretions in the stomach. It enhances the absorption of the antibiotic in the small intestine

It inhibits the action of the enzymes produced by beta-lactamase-producing bacteria. Rationale: The clavulanic acid works to inhibit the action of the enzymes produced by the bacteria, which would normally inactivate the antibiotic.

An athlete presents to the emergency department complaining of Achilles tendon pain. After assessing the patient, you discover they were taking an antibiotic that may have been the cause for this tendon pain. Which antibiotic is associated with tendon rupture? Phenazopyridine Azithromycin Levofloxacin Nafcillin

Levofloxacin

Penicillin allergies are a major concern during antibiotic therapy. Which of the following medications may have cross-sensitivity with a penicllin allergy? (select all that apply) Trimethoprim Meropenem Cefotetan Vancomycin Dicloxacillin Doxycycline Nitrofurantoin

Meropenem Cefotetan Dicloxacillin

A nursing student is teaching a patient who is taking metronidazole. Which of the following sense alterations should the nursing student include as an adverse effect of metronidazole? Metallic taste Olfactory changes Visual acuity changes Hearing loss

Metallic taste

A 10-year-old child is brought to the emergency department while having an asthma attack. She is given a nebulizer treatment with albuterol. What is the nurse's immediate assessment priority? Monitor Spo2 with a pulse oximeter. Provide education on asthma management Monitor the child's temperature. Determine the time of the child's last meal

Monitor Spo2 with a pulse oximeter. During administration of albuterol, a fast-acting beta2 agonist, the nurse should monitor the patient's respiratory status, including Spo2 (with a pulse oximeter), respiratory rate, and breath sounds, to ensure that the medication is having a therapeutic effect. The other items can be handled after her respiratory status is stable.

-ium

Muscarinic Antagonist Inhalers

Which of the following are results of an adverse drug reaction to vancomycin? Ototoxicity Seizures Histamine Flush Nephrotoxicity Neutropenia Electrolyte Imbalances

Ototoxicity Histamine Flush Nephrotoxicity

What are your planning goals? Do you need to educate the patient about anything with anticoagulants? Patients on heparin should have a target Partial Thromboplastin Time The primary goal will be to prevent a blood clot or to help the body break down the blood clot Patients on warfarin should have a goal PTT Patients on warfarin should have a goal INR Patients should be instructed of signs and symptoms of bleeding Patients on heparin should have a target Prothrombin Time Patients on heparin should learn about the Vitamin K diet

Patients on heparin should have a target Partial Thromboplastin Time Patients on warfarin should have a goal INR Patients should be instructed of signs and symptoms of bleeding Rationale: Patients on IV heparin should routinely have their aPTT measured. This stands for activated Partial Thromboplastin Time (PTT) Patients on warfarin should routinely have a PT /INR measured. This stands for Prothrombin Time (PT) and International Normalized Ratio (INR). The primary goal should be either A) Clot prevention or B) Prevent the clot from growing and allow the body to breakdown the clot Patients should be educated about the risks of anticoagulants which includes major bleeding. Patients should be aware of signs and symptoms of bleeding! What might a patient see?

Your patient is receiving IV ertapenem therapy. Which of the following responses are true about ertapenem therapy? Select all that apply: Patients should be monitored for 30 minutes after parenteral ertapenem administration Ertapenem is known to cause electrolyte abnormalities including hyperkalemia Rashes are an expected adverse effect of Ertapenem usage and do not need to be reported Ertapenem is known to increase clotting risk in the body Patients should report diarrhea to the nurse or provider Ertapenem is known to decrease levels of valproic acid

Patients should be monitored for 30 minutes after parenteral ertapenem administration Patients should report diarrhea to the nurse or provider Ertapenem is known to decrease levels of valproic acid

Your patient, AH, has been receiving IV heparin for 2 weeks and has begun to develop petechiae. The provider suspects that AH has develop HIT. Which of the following lab values would help confirm the suspicion of HIT? Platelet count of 75,000 mm3 Hemoglobin of 9 g/dL INR of 2 aPTT of 90 seconds

Platelet count of 75,000 mm3

A nurse is caring for a client who has a new prescription for acyclovir to treat a herpes simplex infection. Which of the following laboratory values should the nurse monitor for this client? Serum Creatinine (SCr) Hematocrit (Hct) Protrombin Time (PT) Aspartate Aminotransferase (AST)

Serum Creatinine (SCr)

What should you assess prior to giving any anticoagulant? Heart Rate Platelets Potassium Hemoglobin Serum Creatinine Hematocrit

Platelets Hemoglobin Hematocrit Rationale: Anticoagulants are HIGH risk drugs. They have a high risk of causing a bleed. The primary lab values that help identify a bleed include the Hemoglobin, Hematocrit and Platelets. These 3 labs are part of the Complete Blood Count (CBC) lab panel. If we see a drop in these values, it can suggest bleeding. A drop in these values can always suggest many other diseases/conditions. Sometimes students select Heart Rate. While a heart rate may provide loose evidence of a bleed, the H/H and platelets are much better indicators. Not only that, but anticoagulants are commonly prescribed to patients who have Atrial Fibrillation and may have abnormal heart rates. Therefore, Heart Rate is not required to be checked before giving an anticoagulant.

Your patient is receiving Amphotericin B for a severe, systemic fungal infection. Which of the following is a manifestation of Amphotericin B toxicity? Group of answer choices Potassium of 5.6 mEq/ Aspartate AminoTransferase of 23 units/L Magnesium of 4.5 mg/dL Potassium of 2.8 mEq/L WBC count of 6 ,000 cells/μL Magnesium of 2 mg/d

Potassium of 2.8 mEq/L

Azithromycin was commonly prescribed to COVID-19 patients during the initial understanding of potential treatment regimens. What are some potential complications of Azithromycin therapy? (Select all that apply) Pseudomembranous Colitis (C.diff) Tinnitus Renal Impairment Yellow Vision Discoloration QT prolongation

Pseudomembranous Colitis (C.diff) Tinnitus QT prolongation

Which of the following assessment finding(s) or lab value(s) would be suggestive of active bleeding in a patient on warfarin? Select all that apply: Pulse of 110 beats per minute Hgb of 7 g/dL Hct of 25% Plts 200,000 mm3 SCr of 2 mg/dL Blood Pressure 140/80

Pulse of 110 beats per minute Hgb of 7 g/dL Hct of 25%

Which of the following antimicrobials are used to treat TB? select all that apply Acyclovir Rifampin Darunavir Isoniazid Pyrazinamide Ketoconazole Ethambutol Metronidazole

Rifampin Isoniazid Pyrazinamide Ethambutol

Which of the following agents may be used during treatment of active tuberculosis? Select all that apply: Ethambutol Rifampin Isoniazid Pyrazinamide Azithromycin Doxycycline Metronidazole Hydroxycholoroquine Ketoconazole

Rifampin Isoniazid Pyrazinamide

Select All That Apply: Which of the following are suggestive signs/symptoms of ototoxicity? Ringing in the ears Dizziness Visual disturbances Red discoloration of the chest and neck Tinnitus Itching

Ringing in the ears Dizziness Tinnitus

True or false. Parenteral drugs bypass the first pass effect.

True

Which of the following statements about Sulfamethoxazole-Trimethoprim is true? Sulfamethoxazole-Trimethoprim can impair renal reabsoprtion of potassium resulting in hypokalemia Sulfamethoxazole-Trimethoprim usage can increase the risk for a DVT Sulfamethoxazole-Trimethoprim is a liver enzyme inhibitor ulfamethoxazole-Trimethoprim can cause kernicterus in newborns

Sulfamethoxazole-Trimethoprim can cause kernicterus in newborns

A client prescribed albuterol should be educated on identifying and managing which adverse reaction?

Tachycardia

Which of the following are known side effects of albuterol? Select all that apply. Tachycardia Bradycardia Angina Hypokalemia Hyperkalemia Tremors Paraesthesia Hoarsness

Tachycardia Angina Hypokalemia Tremors

During intravenous (IV) quinolone therapy in an 88-year-old patient, which potential problem is of most concern when assessing for adverse effects? Nephrotoxicity Hepatotoxicity Rhabdomyolysis Tendon rupture

Tendon rupture A black box warning is required by the U.S. Food and Drug Administration for all quinolones because of the increased risk of tendonitis and tendon rupture with use of these drugs. This effect is more common in older patients, patients with renal failure, and patients receiving concurrent glucocorticoid therapy (e.g., prednisone).

Which of the following does the nurse identify as being a concern for patients receiving tetracycline? Tetracycline has no impact on the effectiveness of oral contraceptives. Tetracycline used with warfarin decreases its effectiveness and enhances clot formation. Tetracycline should not be administered to anyone older than age 65 years. Tetracyclines should not be administered with dairy products.

Tetracyclines should not be administered with dairy products. Assess for significant drug interactions, including simultaneous use of antacids, antidiarrheal drugs, dairy products, calcium, enteral feedings, and iron preparations. There is concern regarding the use of these drugs in patients younger than 8 years of age because of the problem of permanent mottling and discoloration of the teeth. Tetracyclines may also decrease the effectiveness of oral contraceptives. Assess the patient taking oral anticoagulants more closely because of possible potentiation of bleeding.

A client with chronic bronchitis calls the office for a refill of their albuterol inhaler. The client just had the prescription filled 2 weeks ago, but he says it is empty. When asked, the client tells the nurse, "I use it whenever I need it, but now when I use it, I feel so sick. I've been needing to use it more often." What is the most appropriate action by the nurse? The nurse should consult the prescriber for a different inhaler prescription. The nurse should tell the client not to use this drug too often. The nurse should confirm the pharmacy location for the needed refill.​ The nurse should ask the client to come to the office for an evaluation of his respiratory status.

The nurse should ask the client to come to the office for an evaluation of his respiratory status. Although it is true that the patient should be reminded about the correct use of this inhaler, it is evident that he has used it too often and that his respiratory status should be evaluated to see if an adjustment in the prescription should be made.

The nurse is reviewing the medical record of a patient before giving a new order for iron sucrose. Which statement regarding the administration of iron sucrose is correct? Iron sucrose is contraindicated if the patient has renal disease. The nurse will monitor the patient for hypotension during the infusion. A test dose will be administered before the full dose is given. Patients should take this on an empty stomach for best absorption

The nurse will monitor the patient for hypotension during the infusion.

Your patient is taking sulfamethoxazole-trimethoprim when they report developing a fever and a rash, which is now starting to blister and peel. What do you suspect is occurring? The patient's infection is worsening The patient is experiencing a Type I Hypersensitivity The patient has developed SJS/TEN The patient is experiencing hepatotoxicity

The patient has developed SJS/TEN

A nurse is planning to teach about the use of a spacer to a child who has a new prescription for a fluticasone inhaler to treat chronic asthma. What should the nurse tell the child the spacer is used for?

The space helps the medication go straight to your lungs.

A nurse student is leading a student group on discussions of pharmacology definitions. The student states that the duration of action of a drug is defined as:

The time period at which a drug's concentration is sufficient to cause a therapeutic response.

A client is prescribed rifampin. What information should the nurse include in the client's medication education? Group of answer choices When taking it with warfarin, an increased anticoagulant effect occurs. It decreases hepatic enzymes and decreases metabolism of drugs. It can be taken as monotherapy to treat active tuberculosis. The urine, tears, sweat, and other body fluids will be a discolored red-orange.

The urine, tears, sweat, and other body fluids will be a discolored red-orange.

Your patient has not been able to achieve a therapeutic INR with their warfarin. You are assessing their medication list and identify which of the following asthma drugs as likely causing issues with their warfarin levels... Albuterol Theophylline Fluticasone Ipratropium

Theophylline Theophylline is an old, narrow therapeutic index drugs, that also messes with the metabolism of many medications.

When planning the timing/duration of a vancomycin infusion, which lab value helps us to plan antibiotic therapy and maintain steady state?

Trough

Which of the following are known side effects of SAMAs? select all that apply. Urinary hesitancy Diarrhea Urinary Incontinence Constipation Xerostomia Hoarsness Bradycardia Palpitations

Urinary hesitancy Constipation Xerostomia Hoarsness Palpitations

You are caring for a patient taking Tobramycin to treat a severe pneumonia. Which of the following lab values would suggest toxicity caused by Tobramycin? SCr of 0.9 mg/dL AST of 21 units/mL WBC of 3000 cells/mm3 Temperature of 99.5 F K of 4.4 mEq/L Urine Output of 29 ml/hr

Urine Output of 29 ml/hr

Your patient has been diagnosed with MRSA. Which of the following antimicrobials is indicated for treating MRSA? You do NOT need to know these, there is only ONE that you should know from our lecture.

Vancomycin

A patient is receiving isoniazid (INH) for the treatment of TB. Which vitamin does the nurse anticipate administering with the isoniazid to prevent INH-precipitated peripheral neuropathies? Vitamin B6 Vitamin D Vitamin B12 Vitamin C

Vitamin B6

Which of the following lab values are indicative of an infection? WBC 5,000 WBC 15,000 Temp 100.0 Temp 100.8 HR 78 HR 120 BP 120/80 BP 90/60

WBC 15,000 Temp 100.8 HR 120 BP 90/60

Are there any general or unique administration components on anticoagulants? SELECT ALL THAT APPLY: Patients on heparin should be educated about the protamine diet Patients receiving subcutaneous heparin should receive injections within 1 inch of the umbilicus When educating a patient for home usage of enoxparin, it should be emphasized to not expel any air bubbles from the syringe When educating a patient for home usage of enoxparin, it should be emphasized to not aspirate the needle Patients on apixaban should be educated about the Vitamin K diet

When educating a patient for home usage of enoxparin, it should be emphasized to not expel any air bubbles from the syringe When educating a patient for home usage of enoxparin, it should be emphasized to not aspirate the needle Rationale: The Vitamin K diet is ONLY for warfarin. What does the Vitamin K diet mean? Generally, we tell patients to limit their vitamin K and remain consistent with their Vitamin K consumption. It would be inappropriate to tell a patient to avoid Vitamin K. Vitamin K is the antidote to warfarin, so it makes sense to be consistent with it in your diet. Patients on other anticoagulants (like apixaban) do NOT need to worry about Vitamin K. Heparin and Enoxaparin subcutaneous administration has several key techniques 1) always make sure to rotate and record injection sites. You should never inject over the same site that was used for the previous dose. 2) Inject these in a 90 degree manner, you can pinch up the abdominal skin before injecting 3) Make sure to stay at least 2 inches away from the umbilicus 4) Do NOT aspirate 5) Do NOT expel any air bubbles from the syringe. We don't want to accidentally waste any of the drug 6) Apply gentle pressure for 1-2 minutes after the injection. DON'T RUB THE SITE.

A nurse is preparing to administer an IM dose of penicillin to a client who has a new prescription. The client states when they took penicillin 3 years ago, they developed a rash. Which of the following actions should the nurse take? Withhold the medication. Ask the provider to change the prescription to an oral form. Administer an oral antihistamine at the same time. Administer the prescribed dose.

Withhold the medication. A.Administering the intramuscular penicillin in the prescribed dosage could cause a severe reaction and is not the appropriate action. B. CORRECT: Withhold the medication and notify the provider of the client's previous reaction to penicillin so that an alternative antibiotic can be prescribed. Allergic reactions to penicillin can range from mild to severe anaphylaxis, and prior sensitization should be reported to the provider. C. Administering the penicillin orally rather than intramuscularly would not prevent a reaction and is not the appropriate nursing action. D. Giving the penicillin along with an oral antihistamine would not prevent a reaction from occurring and is not the appropriate nursing action.

Which of the following agents can prevent pregnant person to baby transmission of HIV during delivery? Zidovudine Enfuvirtide Maraviroc Ritonavir

Zidovudine

What type of cough is best treated with dextromethorphan? a dry, nonproductive cough a cough that is associated with an allergy to ragweed an occasional, productive cough a cough that occurs when the client is exposed to airborne irritants

a dry, nonproductive cough The major clinical indication for use of dextromethorphan is a dry, hacking, nonproductive cough that interferes with rest and sleep. It is not desirable to suppress a productive cough because the secretions need to be removed. The character, not cause, of the cough is relevant to its treatment with dextromethorphan.

Your patient, AD, is on a therapeutic heparin drip for a DVT. Which of the following lab values would indicate therapeutic effectiveness of the heparin drip? aPTT of 65 seconds aPTT of 100 seconds PT of 12 seconds PT of 20 seconds INR of 1 INR of 2.8

aPTT of 65 seconds

One of the attendees expresses concern regarding her granddaughter's asthma. The attendee tells the nurse that she is afraid that she will not know which of her granddaughter's medications to give first in case of an asthma attack. Which medication should the nurse inform the attendee to administer first for an acute asthma attack? albuterol montelukast fluticasone ipratropium

albuterol

-terol

beta agonist; bronchodilator

What is the most common first-line therapy for relief of an acute asthma attack? beta2-adrenergic agonist leukotriene modifier xanthine derivative inhaled steroid

beta2-adrenergic agonist A client experiencing an acute asthma attack should be administered a beta2-adrenergic agonist. The client can receive an inhaled steroid, but it is not the first-line therapy. Leukotriene modifiers are used for maintenance in asthma, not during acute exacerbation. Xanthines are not the drug of choice in acute asthma attack.

When implementing HAART, which of the following medication combinations is appropriate?

darunavir/cobicistat/emtricitabine/tenofovir alafenamides The only correct combination above that has three active ingredients is darunavir/cobicistat/emtricitabine/tenofovir alafenamide (Symtuza). None of the others have three active ingredients. Remember, cobicistat is a PK booster and is NOT an active ingredient. A good resources is: https://www.poz.com/drug_charts/hiv-drug-chartLinks to an external site.

A client with a history of candidiasis is being closely monitored for signs of superinfection. Which signs or symptoms can indicate that superinfection has occurred? Select all that apply.

diarrhea inflammation of oral mucous membranes vaginal discharge Explanation:Signs of superinfection, also called opportunistic infection, include diarrhea, vaginal discharge, and inflammation of oral mucous membranes. These occur when nonpathogenic or remotely pathogenic microorganisms take advantage of favorable situations and overwhelm the host.

Which antibiotic should be avoided in teeth because it has the risk of staining and binding to teeth? doxycycline sulfamethoxazole-trimethoprim ciprofloxacin gentamicin

doxycycline

Which of the following lab values would require a dose-adjustment when administering antibiotic therapy? eGFR 78 eGFR 10 Serum Creatinine 0.8 Serum Creatinine 1.0

eGFR 10

A client has been diagnosed with chronic renal failure. Which agent will assist in raising the client's hemoglobin levels? epoetin alfa dextromethorphan hydrobromide pentoxifylline estazolam

epoetin alfa

An adult client has developed renal failure secondary to an overdose of a nephrotoxic drug. Which assessment finding would the nurse recognize as being most suggestive of impaired erythropoiesis? agitation and changes in cognition increased blood pressure and peripheral edema frequent infections and low neutrophil levels fatigue and increased heart rate

fatigue and increased heart rate Rationale: As RBCs decrease, conditions related to inadequate hematopoiesis develop. Clinical manifestations of inadequate erythropoiesis include anemia. This results in a decrease in the oxygen-carrying capacity of blood and consequently a decreased oxygen availability to the tissues. A compensatory increase in heart rate and cardiac output initially increases cardiac output, offsetting the lower oxygen-carrying capacity of the blood.

A client who is undergoing chemotherapy for the treatment of non-Hodgkin's lymphoma will soon begin treatment with epoetin alfa. The nurse should be aware that this drug may be administered by which route? Select all that apply. intravenous oral intramuscular buccal subcutaneous

intravenous subcutaneous Rationale: Epogen is administered by either IV or sub-Q routes. None of the other routes allow for the effective absorption of the medication.

A client is receiving epoetin alfa for anemia. Which adjunctive therapy is imperative with epoetin alfa? renal dialysis iron supplement sodium restriction potassium supplements

iron supplement Rationale: When administering darbepoetin and epoetin, an adequate intake of iron is required for drug effectiveness and an iron supplement is usually necessary. It is not necessary to provide the client with potassium supplements, restrict sodium, or place the client on renal dialysis.

Which medication classification is prescribed to decrease the nighttime episodes of bronchoconstriction and prevent asthma attacks? leukotriene modifiers anticholinergics beta2-adrenergic agonists

leukotriene modifiers The leukotriene modifiers improve symptoms and pulmonary function tests, decrease nighttime symptoms, and decrease the use of beta2-adrenergic drugs. Beta2-adrenergic agonists treat acute attacks but do not prevent asthma from occurring. Anticholinergics block the action of acetylcholine in bronchial smooth muscle when given by inhalation.

A client prescribed albuterol should be educated on identifying and managing which adverse reaction? tachycardia polydipsia hypotension diarrhea

tachycardia The symptoms of cardiac stimulation, including tachycardia, are noted with the administration of albuterol. The client will not experience polydipsia, hypotension, or diarrhea because of the effects of albuterol.

A 58-year-old man is receiving vancomycin as part of the treatment for a severe bone infection. After the infusion, he begins to experience some itching and flushing of the neck, face, and upper body. He reports no chills or difficulty breathing. The nurse should suspect the IV dose may have infused too quickly. an anaphylactic reaction is about to occur. the medication will not be effective for the bone infection. an allergic reaction has occurred.

the IV dose may have infused too quickly. These symptoms are know as red man syndrome and may occur during or after an infusion of vancomycin. This syndrome is characterized by flushing or itching of the head, face, neck, and upper trunk area. Symptoms can usually be alleviated by slowing the rate of infusion to at least 1 hour. Red man syndrome is bothersome but usually not harmful. Rapid infusions may also cause hypotension. NOTE: This is from our textbook. They use the term Red Man Syndrome and you will see this term thrown around quite a bit in pharmacology. As we discussed in class, this is NOT an appropriate term. There is no mutually agreed upon alternative, however, Histamine Flush Syndrome is an appropriate alternative.