Pharm Exam 2

The order reads, "Give metoprolol (Lopressor) 300 mg/day PO in 2 divided doses." The tablets are available in 50-mg strength. How many tablets will the patient receive per dose?

(150 mg per dose)

The nurse is assessing a patient who has been taking quinidine and asks about adverse effects. An adverse effect associated with the use of this drug includes: a. muscle pain. b. tinnitus. c. chest pain. d. excessive thirst.

...

The medication order for a 5-year-old child reads: "Give digoxin elixir, 15 mcg/kg, PO now." The child weighs 20 kg. How many milligrams will this child receive?

0.3 mg

The order reads: "Give tacrolimus IV 0.03 mg/kg/day as a continuous IV infusion." The patient weighs 110 lb. How many milligrams per day will this dose provide?

1.5 mg/day

The order for enoxaparin (Lovenox) reads: Give 1 mg/kg subcut every 12 hours. The patient weighs 242 lb, and the medication is available in an injection form of 120 mg/0.8 mL. How many milligrams will this patient receive? How many milliliters will the nurse draw up for the injection? (Round to hundredths.)

110 mg; 0.73 mL

The order reads: "Infuse 1000 mL of normal saline over the next 8 hours." The IV tubing has a drop factor of 15 gtt/mL. Calculate the mL/hour rate, and calculate the drops/minute setting for the IV tubing with this gravity infusion.

125 mL/hr; 31 gtt/min

The order reads: "Give vancomycin, 1250 mg in 250 mL NS, IVPB, every 12 hours. Infuse over 90 minutes." The nurse will set the infusion pump to what setting for mL/hour?

167 mL/hour

The medication order reads: niacin, 500 mg PO, every evening. The medication is available in 250-mg tablets. How many tablets will the patient receive per dose?

2 tablets

The order for chemotherapy reads: "Give asparaginase (Elspar) IV 200 units/kg/day." The patient weighs 297 lb. The pharmacy department will prepare the medication for intravenous infusion. How much drug will be given per dose? Is this a safe dose?

27,000 units; yes

The order for a child reads: "Give cefoxitin (Mefoxin) 160 mg/kg/day, IVPB, divided into doses given every 6 hours." The child weighs 55 lb. How much will the patient receive each day? For each dose?

4000 mg/day; 1000 mg/dose

The order reads, "Give nystatin (Mycostatin) suspension, 500,000 units by mouth (swish and swallow) 4 times a day for 1 week." The medication is available in a suspension of 100,000 units per mL. How many milliliters will the nurse give per dose?

5 mL

The order reads: Give hydralazine (Apresoline) 0.75 mg/kg/ day. The child weighs 16 pounds. How much hydralazine will be given? Round to hundredths.

5.45 mg/kg/day

The order for isoniazid (INH) reads: "Give 5 mg/kg PO daily." The patient weighs 275 pounds. What is the amount per dose? Is this a safe dose?

625 mg/dose; no, maximum

The nurse is assessing a patient who is about to receive antifungal drug therapy. Which condition, if found in the patient, would be of most concern? A. Pulmonary disease B. Diabetes mellitus C. Liver disease D. Bleeding disorders

C. Liver disease

_______ is the most significant protozoal disease in terms of morbidity and mortality.

Malaria **The most significant protozoal disease in terms of morbidity and mortality is malaria. Worldwide, it is estimated that 350 to 500 million people are infected, with an annual death rate of 1 million to 2 million people. Malaria can be prevented if medication is taken before and during travel in countries with known possible exposure during travel.

Assessment of a patient receiving a positive inotropic drug would include reviewing which values? (Select all that apply.) a. Lung sounds b. Daily weights c. Apical pulse d. Serum electrolytes e. Complete blood count

a. Lung sounds b. Daily weights c. Apical pulse d. Serum electrolytes

The anthrax vaccine is recommended for which groups of people? (Select all that apply.) a. Military personnel b. Veterinarians c. Workers who process imported animal hair d. Emergency department health care providers

a. Military personnel b. Veterinarians c. Workers who process imported animal hair

Cefoperazone has been prescribed at discharge for a patient with pelvic inflammatory disease. Due to the possibility of a disulfiram-like reaction, the nurse should teach the patient to avoid consuming what? a. alcohol b. antacids c. aspirin d. aged cheese

a. alcohol

The nurse will question the use of a floroquinolone antibiotic in a patient already prescribed which medication? a. amiodarone b. metoprolol c. furosemide d. omeprazole

a. amiodarone ***Dangerous cardiac dysrhythmias are more likely to occur when quinolones are taken by patients receiving class IA and class III antiarrhythmic drugs such as disopyramide and amiodarone. For this reason, such drug combinations should be avoided.

In the emergency department, several patients have possibly been exposed to anthrax. The nurse will prepare to administer prophylactic doses of a. ciprofloxacin. b. cidofovir. c. immunoglobulin. d. antitoxin.

a. ciprofloxacin.

Which medication has antiplatelet properties? a. clopidogrel b. enoxaparin c. heparin d. alteplase

a. clopidogrel **Clopidogrel (Plavix) is an antiplatelet drug indicated for thrombus prevention associated with strokes and myocardial infarction. Enoxaparin and heparin are anticoagulants. Alteplase is a thrombolytic drug.

Which of these laboratory tests would be a priority for the nurse to assess when a patient is receiving an aminoglycoside? a. creatinine b. fasting glucose c. hemoglobin and hematocrit d. INR

a. creatinine

When planning care for a patient who is receiving interferon therapy, the nurse must keep in mind that the major doselimiting factor is a. fatigue. b. bone marrow suppression. c. fever. d. nausea and vomiting

a. fatigue.

When administering a nonsteroidal antiinflammatory drug (NSAID) and penicillin concurrently, displacement of the penicillin antibiotic from the protein-binding sites results in a. increased free drug in blood. b. decreased free drug in blood. c. no change in free drug in blood. d. synergistic effect of drug.

a. increased free drug in blood. ***Drugs that are not bound to protein are free and thus active to exert their therapeutic (or toxic, if too much free) effect.

What is the most common drug used to treat oropharyngeal candidiasis? a. nystatin (Mycostatin) b. oseltamivir (Tamiflu) c. amantadine (Symmetrel) d. griseofulvin (Fulvicin P/G)

a. nystatin (Mycostatin) **Nystatin is an antifungal ointment that is used for a variety of candidal infections. It is applied topically as a cream, ointment, or powder. It is also available as a troche and an oral liquid or tablet.

When providing health promotion teaching at a senior citizen center, the nurse would include information about which medication used to decrease the duration of influenza A and B? a. oseltamivir (Tamiflu) b. ganciclovir (Cytovene) c. enfuvirtide (Fuzeon) d. indinavir (Crixivan)

a. oseltamivir (Tamiflu) **Oseltamivir (Tamiflu) and zanamivir (Relenza) are active against influenza virus types A and B and have been shown to reduce the duration of influenza infection by several days.

The nurse would question an order for voriconazole (Vfend) if the patient was taking which medication? a. quinidine b. prednisone c. captopril (Capoten) d. clindamycin (Cleocin)

a. quinidine **The nurse would question an order for quinidine, since both voriconazole and quinidine are metabolized by the cytochrome P-450 enzyme system. The drugs will compete for the limited number of enzymes, and one of the drugs will end up accumulating.

The nurse would expect to administer which diuretic to treat a patient diagnosed with primary hyperaldosteronism? a. spironolactone (Aldactone) b. hydrochlorothiazide (HydroDIURIL) c. acetazolamide (Diamox) d. furosemide (Lasix)

a. spironolactone (Aldactone) **Spironolactone is the direct antagonist for aldosterone.

While preparing a patient with acute chest pain for an emergency angioplasty, the nurse would anticipate administering which medication to prevent platelet aggregation? a. tirofiban (Aggrastat) b. protamine sulfate c. warfarin (Coumadin) d. aminocaproic acid (Amicar)

a. tirofiban (Aggrastat) **Tirofiban is a glycoprotein IIb/IIIa inhibitor that blocks the enzyme essential for platelet aggregation. This is given to prevent the formation of further clots and is faster acting than warfarin. Protamine sulfate is the antagonist for heparin, not an anticoagulant. Aminocaproic acid is an antifibrinolytic, the opposite of what is needed in this situation.

When teaching a patient who is taking nystatin lozenges for oral candidiasis, which instruction by the nurse is correct? a "Chew the lozenge carefully before swallowing." b "Dissolve the lozenge slowly and completely in your mouth." c "Dissolve the lozenge until it is half the original size, and then swallow it." d "These lozenges need to be swallowed whole with a glass of water."

b "Dissolve the lozenge slowly and completely in your mouth.

During antitubercular therapy with isoniazid, the patient received another prescription for pyridoxine. Which statement by the nurse best explains the rationale for this second medication? a "This vitamin will help to improve your energy levels." b "This vitamin helps to prevent neurologic adverse effects." c "This vitamin works to protect your heart from toxic effects." d "This vitamin helps to reduce gastrointestinal adverse effects."

b "This vitamin helps to prevent neurologic adverse effects."

A patient is currently taking a statin. The nurse considers that the patient may have a higher risk of developing rhabdomyolysis when also taking which product? a NSAIDs b A fibric acid derivative c Orange juice d Fat soluble vitamins

b A fibric acid derivative

The nurse is assessing a patient who is about to receive antifungal drug therapy. Which problem would be of most concern? a Endocrine disease b Hepatic disease c Cardiac disease d Pulmonary disease

b Hepatic disease

The nurse is reviewing the use of multidrug therapy for HIV with a patient. Which statements are correct regarding the reason for using multiple drugs to treat HIV? (Select all that apply.) a The combination of drugs has fewer associated toxicities. b The use of multiple drugs is more effective against resistant strains of HIV. c Effective treatment results in reduced T-cell counts. d The goal of this treatment is to reduce the viral load. e This type of therapy reduces the incidence of opportunistic infections.

b The use of multiple drugs is more effective against resistant strains of HIV. d The goal of this treatment is to reduce the viral load. e This type of therapy reduces the incidence of opportunistic infections.

Which teaching point would be appropriate to include when the nurse is informing a patient about the adverse effects of antimalarials? a The skin may turn blotchy while these medications are taken. b These medications may cause anorexia and abdominal distress. c These medications may cause increased urinary output. d The patient may experience periods of diaphoresis and chills.

b These medications may cause anorexia and abdominal distress.

When teaching a patient about the potential drug interactions with antiprotozoal drugs, the nurse will include information about a acetaminophen. b warfarin. c decongestants. d antibiotics.

b warfarin.

When the nurse is teaching a patient about taking an antidysrhythmic drug, which statements by the nurse are correct? (Select all that apply.) a. "Take the medication with an antacid if stomach upset occurs." b. "Do not chew sustained-release capsules." c. "If weight gain of 5 pounds within 1 week occurs, notify your physician at the next office visit." d. "If you experience severe adverse effects, stop the drug and notify your physician." e. "You may take the medication with food if stomach upset occurs."

b. "Do not chew sustained-release capsules." c. "If weight gain of 5 pounds within 1 week occurs, notify your physician at the next office visit."

A patient is started on oral anticoagulant therapy while still receiving intravenous heparin. The patient is concerned about risk for bleeding. What is the nurse's best response? a. "Your concern is valid in that you are at an increased risk for bleeding, so I will call the doctor to discontinue the heparin." b. "It usually takes 4 to 5 days to achieve a full therapeutic effect for warfarin, so the heparin is continued to help prevent blood clots until the warfarin is working up to speed." c. "Because of your valve replacement, it is especially important for you to be fully anticoagulated, and the heparin and warfarin together are more effective than one alone." d. "Because you are now up and walking, you have a higher risk of blood clots and therefore need to be on both medications."

b. "It usually takes 4 to 5 days to achieve a full therapeutic effect for warfarin, so the heparin is continued to help prevent blood clots until the warfarin is working up to speed." **Warfarin works by decreasing the production of clotting factors. However, it takes 4 to 5 days for the body to use up present clotting factors and thus achieve a full therapeutic anticoagulant effect. Because of this, heparin is continued until this is achieved.

A patient prescribed azithromycin (Zithromax) expresses concern regarding gastrointestinal upset that he experienced when previously taking erythromycin. What is the nurse's best response? a. "I will call the doctor and ask for a different antibiotic." b. "This drug is like erythromycin with less severe gastrointestinal side effects." c. "You need this medication and will just have to deal with the nausea." d. "I will ask the doctor for a prescription for an antiemetic in case this drug makes you sick as well."

b. "This drug is like erythromycin with less severe gastrointestinal side effects." ***Azithromycin is a newer macrolide antibiotic. It has a longer duration of action, as well as fewer and less severe gastrointestinal side effects than erythromycin.

The current immunization for tetanus and diphtheria toxoids and pertussis, Tdap, is administered to people in which age range? a. Under 6 years of age b. 11 years of age and older c. Any age range d. In the first two years of life

b. 11 years of age and older ***Currently DTaP is the preferred preparation for primary and booster immunization against these diseases in children from 6 weeks to 6 years of age, unless use of the pertussis component is contraindicated. Tdap is the recommended vaccine for adolescents and adults, those over the age of 11.

When preparing to administer furosemide (Lasix) intravenously to a patient with renal dysfunction, the nurse plans implementation based on knowledge that the medication should be administered no faster than which rate? a. 2 mg/min b. 4 mg/min c. 6 mg/min d. 8 mg/min

b. 4 mg/min **Furosemide infusion rates should not exceed 4 mg/min in patients with renal dysfunction. Otherwise, furosemide may be administered at 20 mg/min, but that is not an option in this question.

The nurse would question the use of milrinone (Primacor) in a patient with which disorder? a. Systolic heart failure b. Aortic regurgitation c. Acute renal failure d. Mitral valve prolapse

b. Aortic regurgitation **Milrinone (Primacor), a phosphodiesterase inhibitor, is contraindicated in severe aortic or pulmonic valvular disease and in diastolic heart failure.

The nurse would question an order for colesevelam (Welchol) in a patient with which condition? a. Renal disease b. Complete bowel obstruction c. Glaucoma d. Hepatic disease

b. Complete bowel obstruction **Colesevelam (Welchol) binds with bile in the intestinal tract to form an insoluble complex. It can also bind to other substances and lead to intestinal obstruction.

The patient has been prescribed ibutilide (Corvert), a class III antiarrhythmic drug. The nurse is aware that this drug has been prescribed for which reason? a. Treatment of PSVT b. Conversion of recent-onset atrial fibrillation and flutter c. Conversion of life-threatening ventricular arrhythmias d. Treatment of dysrhythmias in patients with acute renal failure

b. Conversion of recent-onset atrial fibrillation and flutter **Ibutilide is specifically indicated only for treatment of recent-onset atrial fibrillation and flutter.

What side effect of angiotensin-converting enzyme (ACE) inhibitors most often results in the provider changing the treatment plan to an angiotensin receptor blocker? a. Orthostatic hypotension b. Dry, nonproductive cough c. Fatigue d. Hypokalemia

b. Dry, nonproductive cough **ACE inhibitors prevent the breakdown of bradykinin, frequently causing a nonproductive cough. Angiotensin receptor blockers do not block this breakdown, thus minimizing this annoying side effect.

The nurse is assessing a patient who has experienced severe neutropenia after chemotherapy and will monitor for which possible signs of infection? (Select all that apply.) a. Elevated WBC count b. Fever c. Nausea d. Sore throat e. Chills

b. Fever d. Sore throat e. Chills

While assessing a patient who is to receive muromonab-CD3, the nurse knows that which condition would be a contraindication for this drug? a. Acute myalgia b. Fluid overload c. Polycythemia d. Diabetes mellitus

b. Fluid overload

Which laboratory value might indicate an adverse response to hydrochlorothiazide (HydroDIURIL)? a. Sodium levels b. Glucose levels c. Calcium levels d. Chloride levels

b. Glucose levels **Hydrochlorothiazide can cause hyperglycemia; therefore, glucose levels can indicate this adverse response.

When a patient is receiving cyclophosphamide (Cytoxan), he or she should be advised to drink plenty of water/fluids to prevent which condition? a. Renal failure b. Hemorrhagic cystitis c. Liver dysfunction d. Red blood cell count

b. Hemorrhagic cystitis **Patients receiving cyclophosphamide should drink at least 2 to 3 L of fluid before, during, and after administration to prevent hemorrhagic cystitis.

A new vaccination, Zostavax, has been approved to prevent the development of what condition in adults over the age of 50? a. Herpes simplex b. Herpes zoster c. Influenza A d. Avian influenza

b. Herpes zoster **Zostavax is a new vaccination developed and approved for use in adults over the age of 50 to prevent the onset or outbreak of herpes zoster (shingles).

When administering nitroprusside (Nipride) intravenously, the nurse would monitor for which sign of toxicity? a. Fever b. Hypotension c. Extreme fatigue d. Hyperglycemia

b. Hypotension **The main symptom of sodium nitroprusside overdose or toxicity is excessive hypotension.

When teaching a patient about signs and symptoms of hypokalemia, the nurse will instruct the patient to notify the health care provider if which occurs? a. Diaphoresis b. Leg cramps c. Constipation d. Blurred vision

b. Leg cramps **Leg cramps are a common clinical manifestation of hypokalemia. The other answers are incorrect.

What disorders are considered contradictions for use of antifungal medications? (Select all that apply.) a. Heart failure b. Liver failure c. Kidney failure d. Pancreatic failure e. Respiratory failure

b. Liver failure d. Pancreatic failure

Which test will the nurse use to assess for adverse reactions to HMG-CoA reductase inhibitors? a. Serum cholesterol levels b. Liver function tests c. Serum electrolytes d. Complete blood count

b. Liver function tests **HMG-CoA reductase inhibitors can cause hepatic toxicity; thus it is necessary to monitor liver function tests every 3 months for the first year of treatment.

When caring for a patient with serum potassium of 2.8 mEq/L, which is a priority nursing intervention when administering intravenous replacement therapy? a. Administer potassium as a bolus over 10 minutes. b. Maintain infusion rate at no greater than 20 mEq/hr. c. Apply ice packs to site of intravenous administration. d. Teach the patient and family the signs and symptoms of hypokalemia.

b. Maintain infusion rate at no greater than 20 mEq/hr. **Too rapid an infusion of potassium can cause cardiac arrhythmias. Therefore intravenous potassium infusion rates should not exceed 20 mEq/hr.

Which vaccination is marketed and recommended in the prevention of a virus that is known to cause cervical cancer? a. Herpes zoster vaccine (Zostavax) b. Papillomavirus vaccine (Gardasil) c. Pneumococcal vaccine (Prevnar 13) d. Hepatitis B virus vaccine (Recombivax HB)

b. Papillomavirus vaccine (Gardasil) ***Human papillomavirus virus (HPV) is a common cause of genital warts and cervical cancer. The papillomavirus vaccine (Gardasil, Cervarix) is the first and only vaccine known to prevent cancer.

When assessing a patient who will be receiving a measles vaccine, the nurse will consider which condition to be a possible contraindication? a. Anemia b. Pregnancy c. Ear infection d. Common cold

b. Pregnancy

The nurse is caring for a patient who becomes severely nauseated during chemotherapy. Which intervention is most appropriate? a. Encourage light activity during chemotherapy as a distraction. b. Provide antiemetic medications 30 to 60 minutes before chemotherapy begins. c. Provide antiemetic medications only upon the request of the patient. d. Hold fluids during chemotherapy to avoid vomiting.

b. Provide antiemetic medications 30 to 60 minutes before chemotherapy begins.

The nurse is receiving shift report on her patients. One patient, per report, had a new IV bag of normal saline (NS) hung, which is to be infused at a rate of 100 mL per hour. The nurse discovers that the bag is almost empty and the pump was mistakenly set at 1000 mL per hour. What is the most immediate concern for any patient in this situation? a. Edema of hands and feet b. Pulmonary edema c. Increased urination d. Phlebitis

b. Pulmonary edema **Crystalloids are a very safe and effective means of replacing needed fluid, when administered at the correct dosage. Because they contain no large particles, such as proteins, they do not stay within the blood vessels and can leak out of the plasma into the tissues and cells. This may result in edema anywhere in the body. Peripheral edema and pulmonary edema are two common examples. Pulmonary edema is the most concerning issue at this point due to the complications that can arise from fluid in the lungs. The nurse needs to stop the infusion and notify the provider immediately.

A patient receiving chemotherapy is experiencing severe bone marrow suppression. Which nursing diagnosis is most appropriate at this time? a. Activity intolerance b. Risk for infection c. Disturbed body image d. Impaired physical mobility

b. Risk for infection

The nurse interprets a patient's international normalized ratio (INR) value of 2.5. What is the meaning of this reported value? a. The patient is not receiving enough warfarin for a therapeutic effect. b. The patient's warfarin dose is therapeutic. c. The patient is not receiving enough subcutaneous heparin for a therapeutic effect. d. The patient is receiving a dangerously high amount of heparin.

b. The patient's warfarin dose is therapeutic. **INR determination is a routine test to evaluate coagulation while patients are taking warfarin, not heparin. A therapeutic INR is 2 to 3.

Which are general adverse effects of chemotherapy? (Select all that apply.) a. Leukocytosis b. Thrombocytopenia c. Alopecia d. Urinary retention e. Hypertension

b. Thrombocytopenia c. Alopecia

A patient with a rapid, irregular heart rhythm is being treated in the emergency department with adenosine. During administration of this drug, the nurse will be prepared to monitor the patient for which effect? a. Nausea and vomiting b. Transitory asystole c. Muscle tetany d. Hypertension

b. Transitory asystole

Phosphodiesterase inhibitors have an added advantage in treating heart failure. The drugs cause a positive inotropic effect and what other effect? a. Vasoconstriction b. Vasodilation c. Platelet inhibition d. Bronchodilation

b. Vasodilation **Phosphodiesterase inhibitors are also called inodilators because they have both positive inotropic and vasodilator effects.

A patient has been prescribed lidocaine (Xylocaine). What does the nurse understand as the reason for this medication order? a. Bradycardia b. Ventricular arrhythmias c. Atrial arrhythmias d. Heart block

b. Ventricular arrhythmias **Lidocaine is a sodium channel-blocking drug used specifically to treat ventricular arrhythmias.

The nurse anticipates an order for vitamin supplementation for a patient who is receiving INH therapy. What vitamin supplement is usually used with INH? a. Folate b. Vitamin B6 c. Vitamin E d. Calcium

b. Vitamin B6 **Pyridoxine (vitamin B6) is typically ordered to assist in prevention of the neurologic side effects of the INH.

A patient who is allergic to penicillin is at increased risk for an allergy to which drug? a. tetracycline b. cefazolin sodium (Ancef) c. gentamicin (Garamycin) d. erythromycin

b. cefazolin sodium (Ancef) ***Patients who are allergic to penicillins have a fourfold to sixfold increased risk of allergy to other beta-lactam antibiotics. The incidence of cross-reactivity between cephalosporins and penicillins is reported to be between 1% and 4%.

The dose-limiting toxicity of ganciclovir treatment is assessed by monitoring a. liver function tests (LFTs). b. complete blood count (CBC). c. blood urea nitrogen (BUN). d. creatine phosphokinase (CPK).

b. complete blood count (CBC). ***Bone marrow suppression is a dose-limiting toxicity of ganciclovir; therefore, CBC should be monitored.

Which statement, if made by a patient with HIV infection, demonstrates a need for continued patient teaching? a. "I will change my position slowly to prevent dizziness and potential injury." b. "I must take these medications exactly as prescribed for the rest of my life." c. "I don't need to use condoms as long as I take my medication as prescribed." d. "I should remain upright for 30 minutes after taking my zidovudine."

c. "I don't need to use condoms as long as I take my medication as prescribed." **Antiretroviral drugs do not stop the transmission of HIV, and patients need to continue standard precautions.

During a teaching session for a patient receiving an immunosuppressant drug, the nurse will include which statement? a. "It is better to use oral forms of these drugs to prevent the occurrence of thrush." b. "You will remain on antibiotics to prevent infections." c. "It is important to use some form of contraception during treatment and for up to 12 weeks after the end of therapy." d. "Be sure to take your medications with grapefruit juice toincrease absorption."

c. "It is important to use some form of contraception during treatment and for up to 12 weeks after the end of therapy."

When reviewing a patient's medication regimen before discharge, the patient asks why he is taking pyridoxine when he is already taking isoniazid (INH) to treat tuberculosis. What is the nurse's best response? a. "Pyridoxine is another antitubercular drug that will work synergistically with the isoniazid." b. "You really should not be on that drug. I will check with the doctor." c. "Pyridoxine will help prevent numbness and tingling that can occur secondary to the isoniazid." d. "Multidrug therapy is necessary to prevent the occurrence of resistant bacteria."

c. "Pyridoxine will help prevent numbness and tingling that can occur secondary to the isoniazid." ***INH can cause neurotoxicity. Pyridoxine, vitamin B6, is the drug of choice to prevent this adverse reaction. It is not an antiinfective drug and thus will not work to destroy the mycobacterium or prevent drug resistance.

A patient who is taking sublingual nitroglycerin is complaining of flushing and headaches. What is the nurse's best response? a. "This is a normal response to your chest pain." b. "Stop taking the nitroglycerin because you are probably allergic to it." c. "These are the most common side effects of nitroglycerin. They should subside with continued use of nitroglycerin." d. "These symptoms are not related to your sublingual nitroglycerin. You should notify your doctor for diagnostic testing."

c. "These are the most common side effects of nitroglycerin. They should subside with continued use of nitroglycerin." ***Headache and flushing are the most common side effects of nitroglycerin and will subside with continued use.

A patient calls the family practice office to report that he has seen his pills in his stools when he has a bowel movement. How will the nurse respond? a. "The pills are not being digested properly. You need to take them on an empty stomach." b. "The pills are not being digested properly. You need to take them with food." c. "What you are seeing is the waxy matrix that contained the medication, but the drug has been absorbed." d. "This indicates that you are not tolerating this medication and will need to switch to a different form."

c. "What you are seeing is the waxy matrix that contained the medication, but the drug has been absorbed."

When planning care for a patient receiving once-daily intravenous gentamicin therapy, the nurse schedules a trough drug level to be drawn a. 30 minutes after beginning the antibiotic infusion. b. 60 minutes after beginning the antibiotic infusion. c. 12 hours after completing the antibiotic infusion. d 18 hours after completing the antibiotic infusion.

c. 12 hours after completing the antibiotic infusion. ***Trough serum drug levels should be drawn at least 8 to 12 hours after the medication is infused.

Which condition is not an anticipated side effect of azathioprine (Imuran)? a. Leukopenia b. Thrombocytopenia c. Alopecia d. Hepatotoxicity

c. Alopecia ***Common side effects of azathioprine include leukopenia, thrombocytopenia, and hepatotoxicity. Alopecia (hair loss) is not an expected side effect.

What is included in the priority assessment before administering isosorbide mononitrate (Imdur)? a. Serum electrolytes b. Blood urea nitrogen (BUN) and creatinine c. Blood pressure d. Level of consciousness

c. Blood pressure **Mononitrate is a vasodilator and thus can cause hypotension. It is important to assess blood pressure before administering.

Patients receiving filgrastim (Neupogen) should be taught to expect which side effect? a. Hypotension b. Constipation c. Bone pain d. Insomnia

c. Bone pain ***Filgrastim increases the production of white blood cells in the bone marrow, triggering the common side effect of bone pain.

The nurse will suspect which type of cancer in a patient receiving tamoxifen (Soltamox)? a. Lung cancer b. Renal cancer c. Breast cancer d. Colon cancer

c. Breast cancer ***Tamoxifen is an antiestrogen drug useful in treating malignancies that require estrogen for growth, such as breast cancer.

When caring for a patient with angina, the nurse would question an order for a noncardioselective beta blocker in a patient with what coexisting medical diagnosis? a. Hypertension b. Atrial fibrillation c. Bronchial asthma d. Myocardial infarction

c. Bronchial asthma **Noncardioselective beta blockers should be used with caution in patients with bronchial asthma since any level of blockade of beta2-receptors can promote bronchoconstriction through unopposed parasympathetic (vagal) tone.

The drug mycophenolate (CellCept) has a black box warning because of which potential adverse effect? a. Hypertension b. Suicidal ideations c. Congenital malformations d. Abnormal high number of adverse effects

c. Congenital malformations ***Mycophenolate (CellCept) is an antimetabolite and suppresses T cell proliferation. It is indicated for the prevention of organ rejection as well as the treatment of organ rejection. Mycophenolate has a black box warning from the Food and Drug Administration stating that it is associated with an increased risk of congenital malformations and spontaneous abortions when used during pregnancy.

In an effort to prevent superinfections of the gastrointestinal tract (e.g., from Clostridium difficile), the nurse will instruct patients to eat which foods? a. Multigrain foods b. Raw fruits and vegetables c. Cultured dairy products such as yogurt d. Low-fat meats such as chicken and pork

c. Cultured dairy products such as yogurt ***The natural flora in the gastrointestinal tract may be killed off by antibiotics, leaving other bacteria such as C. difficile to overgrow. This process may be prevented through consumption of probiotics (e.g., yogurt, buttermilk, kefir).

Carvedilol (Coreg) is classified as a a. beta blocker. b. alpha1 blocker. c. Dual-action alpha1 and beta receptor blocker. d. Calcium channel blocker.

c. Dual-action alpha1 and beta receptor blocker. **Carvedilol blocks both the alpha1 and beta receptors of the adrenergic nervous system.

When planning care for a patient receiving a sulfonamide antibiotic, it is important for the nurse to perform which action? a. Advise the patient to report any tinnitus. b. Encourage a diet that causes an alkaline ash. c. Encourage fluid intake of 2000 to 3000 mL/day. d. Insert an indwelling catheter for accurate input and output.

c. Encourage fluid intake of 2000 to 3000 mL/day. ***Patients should be encouraged to drink plenty of fluids (2000 to 3000 mL/24 hours) to prevent drug-related crystalluria associated with sulfonamide antibiotics.

The nurse would question an order for simvastatin (Zocor) in a patient with which condition? a. Leukemia b. Diabetes c. Hepatic disease d. Chronic obstructive pulmonary disease (COPD)

c. Hepatic disease **Simvastatin (Zocor) can cause an increase in liver enzymes and thus should not be used in patients with preexisting liver disease.

Current research has lead to discovery of cancer-causing viruses. Which virus that is linked to cancer can be prevented by vaccination in humans? a. Rous sarcoma virus b. Shope papillomavirus c. Human papillomavirus Correct d. Leukemia viruses

c. Human papillomavirus Extensive research has indicated that there are cancer-causing viruses that can affect most mammalian species. Examples include human papillomavirus (HPV in humans), the various cat leukemia viruses, the Rous sarcoma virus in chickens, and the Shope papillomavirus in rabbits. The HPV now has a vaccination on market which is likely to decrease the chance of getting the virus which can lead to several different types of cancers.

When assessing a patient taking triamterene (Dyrenium), the nurse would specifically monitor for which adverse effect? a. Hypokalemia b. Hypoglycemia c. Hyperkalemia d. Hypernatremia

c. Hyperkalemia **Triamterene is a potassium-sparing diuretic, and therefore hyperkalemia is a possible adverse effect.

Which laboratory value depicts a known side effect of furosemide (Lasix)? a. Hyperchloremia b. Hypernatremia c. Hypokalemia d. Hypophosphatemia

c. Hypokalemia **Furosemide is a potent loop diuretic, resulting in the loss of potassium as well as water, sodium, and chloride.

In caring for a patient receiving therapy with a myelosuppressive antineoplastic drug, the nurse notes an order to begin filgrastim after the chemotherapy is completed. Which statement correctly describes when the nurse will begin the filgrastim therapy? a. It can be started during the chemotherapy. b. It will begin immediately after the chemotherapy is completed. c. It will be initiated 24 hours after the chemotherapy is completed. d. It will not be started until at least 72 hours after the chemotherapy is completed.

c. It will be initiated 24 hours after the chemotherapy is completed.

The nurse is providing teaching after an adult receives a booster immunization. Which adverse reactions should be reported immediately to the health care provider? (Select all that apply.) a. Swelling and redness at the injection site b. Fever of 100° F (37.8° C) c. Joint pain d. Heat over the injection site e. Rash over the arms, back, and chest f. Shortness of breath

c. Joint pain e. Rash over the arms, back, and chest f. Shortness of breath

A patient has been admitted for treatment of an infected leg ulcer and will be started on intravenous linezolid. The nurse is reviewing the list of the patient's current medications. Which type of medication, if listed, would be of most concern if taken with the linezolid? a. Beta blocker b. Oral anticoagulant c. Selective serotonin reuptake inhibitor antidepressant d. Thyroid replacement hormone

c. Selective serotonin reuptake inhibitor antidepressant

When giving a vaccination to an infant, the nurse should tell the mother to expect which adverse effect? a. Fever over 101° F (38.3° C) b. Rash c. Soreness at the injection site d. Chills

c. Soreness at the injection site

A 28-year-old is in the urgent care center after stepping on a rusty tent nail. The nurse evaluates the patient's immunity status and notes that the patient thinks she had her last tetanus booster about 10 years ago, just before starting college. Which immunization would be most appropriate at this time? a. Immunoglobulin intravenous (Gammar-P IV) b. DTaP (Daptacel) (diphtheria, tetanus, and acellular pertussis) c. Tdap (Adacel) (diphtheria, tetanus, and acellular pertussis) d. No immunizations are necessary at this time.

c. Tdap (Adacel) (diphtheria, tetanus, and acellular pertussis)

A teenage patient is taking a tetracycline drug as part of treatment for severe acne. When the nurse teaches this patient about drug-related precautions, which is the most important information to convey? a. When the acne clears up, the medication may be discontinued. b. This medication needs to be taken with antacids to reduce GI upset. c. The patient needs to use sunscreen or avoid exposure to sunlight, because this drug may cause photosensitivity. d. The teeth should be observed closely for signs of mottling or other color changes.

c. The patient needs to use sunscreen or avoid exposure to sunlight, because this drug may cause photosensitivity.

A patient has a new prescription for transdermal nitroglycerin patches. The nurse teaches the patient that these patches are most appropriately used for which reason? a. To relieve exertional angina b. To prevent palpitations c. To prevent the occurrence of angina d. To stop an episode of angina

c. To prevent the occurrence of angina

A woman who has been taking an antibiotic for a UTI calls the nurse practitioner to complain of severe vaginal itching. She has also noticed a thick, whitish vaginal discharge. The nurse practitioner suspects that a. this is an expected response to antibiotic therapy. b. the UTI has become worse instead of better. c. a superinfection has developed. d. the UTI is resistant to the antibiotic.

c. a superinfection has developed.

A priority assessment of a patient on antibiotic therapy includes questioning the patient about a. history of seizure activity. b. cardiac history. c. allergies. d. immunizations.

c. allergies. ***Antibiotic allergy is one of the most common drug allergies. An allergic reaction that occurs after administration of an antibiotic has the potential to cause severe anaphylaxis and possible death.

Medications used to treat HIV infections are more specifically classified as a. antifungal drugs. b. antiviral drugs. c. antiretroviral drugs. d. antiparasitic drugs.

c. antiretroviral drugs. ***HIV is a member of the retrovirus family; therefore drugs used to treat this virus are classified as antiretroviral drugs. Although antiretroviral drugs also fall under the broader category of antiviral drugs in general, their mechanisms of action are unique to the AIDS virus. So, they are more commonly referred to by their subclassification as antiretroviral drugs.

The nurse should assess a patient for nephrotoxicity and ototoxicity when administering which antimicrobial? a. cefazolin b. clindamycin c. gentamicin d. erythromycin

c. gentamicin ***Aminoglycoside antibiotics, including gentamicin, have a high risk for nephrotoxicity and ototoxicity.

The nurse would plan to administer which calcium channel blocker to a patient with cerebral artery spasms following a subarachnoid hemorrhage? a. amlodipine (Norvasc) b. diltiazem (Cardizem) c. nimodipine (Nimotop) d. verapamil (Calan)

c. nimodipine (Nimotop) **Nimodipine crosses the blood-brain barrier and has a greater effect on the cerebral arteries than on other arteries in the body; thus, it is indicated for the treatment of cerebral artery spasm following subarachnoid hemorrhage.

A patient is prescribed a Tetracycline antibiotic. Which patient information is a reason for the medication to be withheld by the nurse and the prescriber consulted? a. patient has an allergy to penicillin b. patient is a 12 year old child c. pregnancy status of the patient is unknown d. Theophylline is also prescribed

c. pregnancy status of the patient is unknown

During therapy with the cytotoxic antibiotic bleomycin, the nurse will assess for a potentially serious adverse effect by monitoring a. blood urea nitrogen and creatinine levels. b. cardiac ejection fraction. c. respiratory function. d. cranial nerve function.

c. respiratory function.

A patient who has been newly diagnosed with HIV has many questions about the effectiveness of drug therapy. After a teaching session, which statement by the patient reflects a need for more education? a "I will be monitored for side effects and improvements while I'm taking this medicine." b "These drugs do not eliminate the HIV, but hopefully the amount of virus in my body will be reduced." c "There is no cure for HIV." d "These drugs will eventually eliminate the virus from my body."

d "These drugs will eventually eliminate the virus from my body."

While assessing a patient with angina who is to start beta blocker therapy, the nurse is aware that the presence of which condition may be a problem if these drugs are used? a Hypertension b Essential tremors c Exertional angina d Asthma

d Asthma

During treatment with zidovudine, the nurse needs to monitor for which potential adverse effect? a Retinitis b Deep vein thromboses c Kaposi's sarcoma d Bone marrow suppression

d Bone marrow suppression

Which adverse effect can result if tetracycline is administered to children under 8 years of age? a. Delayed achievement of developmental milestones b. Neurotoxicity c. Gastrointestinal bleeding d. Permanent discoloration of the teeth

d. Permanent discoloration of the teeth ***Tetracycline is contraindicated in children under 8 years of age because it can cause permanent discoloration of the adult teeth, which are still forming in the child.

A patient has a new order for glatiramer acetate. The patient has not had an organ transplant. The nurse knows that the patient is receiving this drug for which condition? a. Psoriasis b. Rheumatoid arthritis c. Irritable bowel syndrome d. Relapse-remitting multiple sclerosis

d. Relapse-remitting multiple sclerosis

The nurse is administering lidocaine and considers which condition, if resent in the patient, a caution for the use of this drug? a. Tachycardia b. Hypertension c. Ventricular dysrhythmias d. Renal dysfunction

d. Renal dysfunction

During therapy with an intravenous aminoglycoside, the patient calls the nurse and says, "I'm hearing some odd sounds, like ringing, in my ears." What is the nurse's priority action at this time? a. Reassure the patient that these are expected adverse effects. b. Reduce the rate of the intravenous infusion. c. Increase the rate of the intravenous infusion. d. Stop the infusion immediately.

d. Stop the infusion immediately.

Which laboratory test result would cause the nurse to question administration of hydroxyurea (Hydrea)? a. White blood cell count of 8000/mm3 b. Platelet count of 450,000/mm3 c. Hemoglobin of 15 g/dL d. Thrombocyte count of 8000/mm3

d. Thrombocyte count of 8000/mm3 ***Hydroxyurea causes bone marrow suppression, which is evidenced by a decrease in red blood cells, white blood cells, and platelets. A thrombocyte count of 8000/mm3 is significantly lower than normal. All the other options are within normal limits.

During therapy with azathioprine (Imuran), the nurse must monitor for which common adverse effect? a. Bradycardia b. Diarrhea c. Vomiting d. Thrombocytopenia

d. Thrombocytopenia

How is the effectiveness of antiviral drugs administered to treat HIV infection assessed and evaluated? a. Megakaryocytes b. Red blood cell counts c. Lymphocyte counts d. Viral load

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

The nurse reviews a patient's laboratory values and finds a digoxin level of 10 ng/mL and a serum potassium level of 6.2 mEq/L. The nurse would notify the health care provider and anticipate administering a. sodium polystyrene sulfonate. b. atropine. c. epinephrine. d. digoxin immune Fab.

d. digoxin immune Fab. **Digoxin immune Fab is indicated for severe digoxin toxicity as evidenced in this question by a digoxin level of 10 ng/mL and hyperkalemia.

The nurse prepares to administer which diuretic to treat a patient with acute pulmonary edema? a. spironolactone (Aldactone) b. amiloride (Midamor) c. triamterene (Dyrenium) d. furosemide (Lasix)

d. furosemide (Lasix) **Furosemide is a potent, rapid-acting diuretic that would be the drug of choice to treat acute pulmonary edema. The other medications are not potent enough to cause the strong diuresis necessary to treat this acute situation.

ACE inhibitors and angiotensin receptor blockers both work to decrease blood pressure by a. preventing the formation of angiotensin II. b. enhancing sodium and water resorption. c. increasing the breakdown of bradykinin. d. preventing aldosterone secretion.

d. preventing aldosterone secretion. **ACE inhibitors block the formation of angiotensin II, whereas angiotensin receptor blockers allow the formation of angiotensin II but block its effect at the receptors. Without the receptors stimulated (because of either drug), aldosterone is not produced, diminishing the reabsorption of sodium and water.

The nurse is assessing a patient who is scheduled to receive a dose of gentamicin. In the last 12 hours, fluid intake has been 900 mL and urine output has been 200 mL. The patient's bladder is not distended. What should the nurse do? a. administer the drug b. administer the drug and notify the prescriber of the output c. instruct the patient t drink a full glass of water each time the medication is administered d. withhold the medication and notify the prescriber of the output.

d. withhold the medication and notify the prescriber of the output.

A patient is to receive filgrastim (Neupogen) after therapy with carmustine and radiation therapy for treatment of a brain tumor. The patient weighs 132 pounds. The protocol that the oncologist has written states that the filgrastim will be dosed at 5 mcg/kg. Filgrastim comes in a 300-mcg/mL vial. What dose will the patient receive? How many milliliters will the patient be given?

300 mcg; 1 mL

The order reads: Give mannitol 0.5 g/kg IV now, over 2 hours. The patient weighs 165 lb, and you have a 100-mL vial of 20% mannitol. How many grams will the patient receive? How many milliliters of mannitol will you prepare for this infusion?

37.5 g, 187.5 mL

The order for an adult who needs passive hepatitis B prophylaxis reads: "Give hepatitis B immunoglobulin (Bay-Hep B), 0.06 mg/kg IM now, and then again in 30 days."The patient weighs 176 pounds. How many milligrams will this patient receive per dose?

4.8 mg per dose

A 5-year-old patient has been diagnosed with malaria after returning from a trip. The patient is to receive one dose of mefloquine (Lariam), 25 mg/kg PO. The child weighs 44 lb. How much mefloquine will this child receive? Is this a safe dose?

500 mg; yes

The nurse is preparing to add a dose of bevacizumab (Avastin) to a patient's intravenous infusion. The dose is 70 mg of bevacizumab in 100 mL of normal saline, and it is to infuse over 90 minutes. The nurse will set the infusion pump to what rate for this dose?

67 mL/hour (66.66 rounds to 67)

The order for an 11-year-old child who has chickenpox reads: "Give acyclovir (Zovirax) 20 mg/kg PO daily × 5 days. The child weighs 99 pounds. How much is each dose? Is this dose safe for this child?

900 mg; no, the dose exceeds

The nurse is reviewing antimalarial drug therapy with a patient and instructs the patient to watch for and report which potential adverse reactions? A. Visual disturbances B. Drowsiness C. Constipation D. Insomnia

A. Visual disturbances

If a patient is taking fluconazole (Diflucan) with an oral anticoagulant, the nurse will monitor for which possible interaction? A. Increased effects of oral anticoagulants, resulting in increased PT/INR B. Decreased effectiveness of the antifungal drug C. Increased change in renal impairment caused by the antifungal drug D. Reduced action of oral anticoagulants, resulting in decreased prothrombin time/international normalized ratio (PT/INR)

A. increased effects of oral anticoagulants, resulting in PT/INR

It is a priority to teach patients who are prescribed quinine for malaria to report which effect? A. palpitations B. pallor C. headache D. fatigue

A. palpitations

A patient who has been prescribed metronidazole asks why he should not drink alcohol. The nurse's response is based on the fact that alcohol combined with metronidazole can cause: A. psychotic reaction B. dysrhythmias C. CNS depression D. bradycardia

B. dysrhythmias

It would be a priority to report which diagnostic test result to the prescriber treating a patient for intestinal roundworms? A. AST 5 IU/L B. hCG 3400 IU/L C. BUN 15 mg/dL D. INR 1

B. hCG 3400 IU/L

The nurse teaches a patient who is prescribed metronidazole that it is very important to report which possible adverse effect of the drug to the prescriber? A. mouth ulcers B. paresthesias C. metallic taste D. darkening of the urine

B. paresthesias

A patient who has been taking isoniazid (INH) has a new prescription for pyridoxine. She is wondering why she needs this medication. The nurse explains that pyridoxine is often given concurrently with the isoniazid to prevent which condition? A. Hair loss B. Heart failure C. Peripheral neuropathy D. Renal failure

C. Peripheral neuropathy

An infant has been hospitalized with a severe lung infection caused by the respiratory syncytial virus (RSV) and will be receiving medication via the inhalation route. The nurse expects which drug to be used? A. amantadine B. acyclovir C. ribavirin D. ganciclovir

C. Ribavirin

A patient who is HIV-positive has been receiving medication therapy that includes zidovudine (Retrovir). However, the prescriber has decided to stop the zidovudine because of its dose-limiting adverse effect. Which of these conditions is the dose-limiting adverse effect of zidovudine therapy? A. hepatotoxicity B. renal toxicity C. bone marrow suppression D. retinitis

C. bone marrow suppression

The nurse is counseling a woman who will be starting rifampin (Rifadin) as part of antitubercular therapy. The patient is currently taking oral contraceptives. Which statement is true regarding rifampin therapy for this patient? A. Women have an increased risk of thrombophlebitis while on this medication combination. B. Oral contraceptives are contraindicated during rifampin therapy. C. Oral contraceptives will be less effective during Rifampin therapy. D. A higher dose of the rifampin will be required due to concurrent use of oral contraceptives.

C. oral contraceptives will be less effective during Rifampin

A college student who has been diagnosed with her first genital herpes infection outbreak is discussing the disorder and the prescribed topical acyclovir treatment with the college health center nurse. Which statement would suggest the patient needs teaching about this disorder and drug therapy? A. "I should not have sex when sores are present." B. "I should use gloves when applying the ointment, immediately dispose of them and wash my hands to prevent spreading the infection to other parts of my body." C. "I can get a different infection in the sores if I am not careful about cleaning after having a bowel movement." D. "Using the ointment as soon as I get a sore will stop the outbreak."

D. "Using the ointment as soon as I get a sore will stop the outbreak."

At what point is the patient most likely to experience fever, chills, rigors, nausea, and headache when receiving amphotericin B? A. immediately after the infusion begins B. 20-30 minutes after the infusion begins C. 3-6 hours after the infusion begins D. 1-3 hours after the infusion begins

D. 1- 3 hours after the infusion begins

The nurse is administering albendazole to an older adult patient who has been diagnosed with the larval form of the pork tapeworm. Which lab result would warrant consultation with the prescriber regarding administration of the medication? A. Creatinine 1.4 mg/dL B. BUN 25 mg/dL C. Potassium 3.8 mg/dL D. ALT 175 IU/L

D. ALT 175 IU/L

The nurse is reviewing laboratory results before preparing to administer a dose of amphotericin B. Before administering the drug, it is a priority to review which lab result? A. Liver function tests B. ECG C. WBC counts D. Creatinine

D. Creatinine

Which instruction should be included in the discharge teaching for a patient with a transdermal nitroglycerin patch? a "Apply the patch to a nonhairy, nonirritated area of the upper torso or arms." b. "Apply the patch to the same site each day to maintain consistent drug absorption." c. "If you get a headache, remove the patch for 4 hours and then reapply." d. "If you get chest pain, apply a second patch right next to the first patch."

a "Apply the patch to a nonhairy, nonirritated area of the upper torso or arms." **A nitroglycerin patch should be applied to a nonhairy, nonirritated area for the best and most consistent absorption rates. Sites should be rotated to prevent skin irritation, and the drug should be continued if headache occurs because tolerance will develop. Sublingual nitroglycerin should be used to treat chest pain.

An elderly patient has been discharged following treatment for a mild case of heart failure. He will be taking a loop diuretic. Which instruction(s) from the nurse are appropriate? (Select all that apply.) a "Take the diuretic at the same time each morning." b "Take the diuretic only if you notice swelling in your feet." c "Be sure to stand up slowly because the medicine may make you feel dizzy if you stand up quickly." d "Drink at least 8 glasses of water each day." e "Here is a list of foods that are high in potassium—you need to avoid these." f "Please call your doctor immediately if you notice muscle weakness or increased dizziness."

a "Take the diuretic at the same time each morning." c "Be sure to stand up slowly because the medicine may make you feel dizzy if you stand up quickly." f "Please call your doctor immediately if you notice muscle weakness or increased dizziness."

When the nurse is teaching a patient who is taking acyclovir for genital herpes, which statement by the nurse is accurate? a "This drug will help the lesions to dry and crust over." b "Acyclovir will eradicate the herpes virus." c "This drug will prevent the spread of this virus to others." d "Be sure to give this drug to your partner, too."

a "This drug will help the lesions to dry and crust over."

The nurse is counseling a woman who is beginning antitubercular therapy with rifampin. The patient also takes an oral contraceptive. Which statement by the nurse is most accurate regarding potential drug interactions? a "You will need to switch to another form of birth control while you are taking the rifampin." b "Your birth control pills will remain effective while you are taking the rifampin." c "You will need to take a stronger dose of birth control pills while you are on the rifampin." d "You will need to abstain from sexual intercourse while on the rifampin to avoid pregnancy."

a "You will need to switch to another form of birth control while you are taking the rifampin."

The nurse is reviewing drug interactions with a male patient who has a prescription for isosorbide dinitrate (Isordil) as treatment for angina symptoms. Which substances listed below could potentially result in a drug interaction? (Select all that apply.) a A glass of wine b Thyroid replacement hormone c tadalafil (Cialis), an erectile dysfunction drug d metformin (Glucophage), an antidiabetic drug e carvedilol (Coreg), a beta blocker

a A glass of wine c tadalafil (Cialis), an erectile dysfunction drug e carvedilol (Coreg), a beta blocker

When giving antihypertensive drugs, the nurse will consider giving the first dose at bedtime for which class of drugs? a Alpha blockers such as doxazosin (Cardura) b Diuretics such as furosemide (Lasix) c ACE inhibitors such as captopril (Capoten) d Vasodilators such as hydralazine (Apresoline)

a Alpha blockers such as doxazosin (Cardura)

When monitoring a patient who is receiving caspofungin, the nurse will look for which serious adverse effects? (Select all that apply.) a Blood dyscrasias b Hypotension c Pulmonary infiltrates d Tinnitus e Hepatotoxicity

a Blood dyscrasias b Hypotension e Hepatotoxicity

Before administering antiprotozoal drugs, the nurse will review which baseline assessment? a Complete blood count b Serum magnesium level c Creatinine clearance d Arterial blood gas concentrations

a Complete blood count

When administering niacin, the nurse needs to monitor for which adverse effect? a Cutaneous flushing b Muscle pain c Headache d Constipation

a Cutaneous flushing

When monitoring a patient who is receiving an intravenous infusion of nesiritide (Natrecor), the nurse will look for which adverse effect? a Dysrhythmia b Proteinuria c Hyperglycemia d Hypertensio

a Dysrhythmia

Which action by the nurse is most appropriate for the patient receiving an infusion of packed red blood cells? a. Flush the IV line with normal saline before the blood is added to the infusion. b. Flush the IV line with dextrose before the blood is added to the infusion. c. Check the patient's vital signs once the infusion is completed. d. Anticipate that flushed skin and fever are expected reactions to a blood transfusion.

a Flush the IV line with normal saline before the blood is added to the infusion.

When giving metronidazole, the nurse implements appropriate administration techniques, including which of these? (Select all that apply.) a Giving oral forms with food b Giving oral forms on an empty stomach with a full glass of water c Infusing intravenous doses over 30 to 60 minutes d Administering intravenous doses by bolus over 5 minutes e Obtaining ordered specimens before starting the medication

a Giving oral forms with food c Infusing intravenous doses over 30 to 60 minutes e Obtaining ordered specimens before starting the medication

The nurse knows that antimalarial drugs are used to treat patients with infections caused by which microorganism? a Plasmodium spp. b Candida albicans c Pneumocystis jirovecii d Mycobacterium

a Plasmodium spp.

The nurse is administering an intravenous infusion of a phosphodiesterase inhibitor to a patient who has heart failure. The nurse will evaluate the patient for which therapeutic effects? (Select all that apply.) a Positive inotropic effects b Vasodilation c Decreased heart rate d Increased blood pressure e Positive chronotropic effects

a Positive inotropic effects b Vasodilation e Positive chronotropic effects

When monitoring laboratory test results for patients receiving loop and thiazide diuretics, the nurse knows to look for a decreased serum levels of potassium. b increased serum levels of calcium. c decreased serum levels of glucose. d increased serum levels of sodium.

a decreased serum levels of potassium.

Which statement by the patient reflects the need for additional patient education about the calcium channel blocker diltiazem (Cardizem)? a. "I can take this drug to stop an attack of angina." b. "I understand that food and antacids alter the absorption of this oral drug." c. "When the long-acting forms are taken, the drug cannot be crushed." d. "This drug may cause my blood pressure to drop, so I need to be careful when getting up."

a. "I can take this drug to stop an attack of angina."

Which statement, if made by your patient, signifies that additional patient teaching regarding antihypertensive treatment is required? a. "I will check my blood pressure every day and take my medication when it is over 140/90." b. "I will include rest periods during the day to help me tolerate the fatigue my medicine may cause." c. "I will change my position slowly to prevent feeling dizzy." d. "I will not mow my lawn until I see how this medication makes me feel."

a. "I will check my blood pressure every day and take my medication when it is over 140/90." **Antihypertensive medications need to be taken routinely in order to maintain a normotensive state and prevent occurrence of complications. Many patients do not adhere to this regimen because hypertension itself does not cause symptoms, whereas the medication can cause some untoward effects. Patient teaching is essential.

When educating patients on immunosuprressants, what information would the nurse include in the teaching? (Select all that apply.) a. "Never stop taking these medications without being instructed by the prescribing provider." b. "Over-the-counter medication are OK to take as needed." c. "You must take all medications exactly as prescribed." d. "Medications must be taken at the correct time every time to avoid interactions."

a. "Never stop taking these medications without being instructed by the prescribing provider." c. "You must take all medications exactly as prescribed." d. "Medications must be taken at the correct time every time to avoid interactions."

The patient weighs 44 pounds and is to receive a loading dose of digoxin. The loading dose is to be 0.03 mg/kg in three divided doses. How much will the nurse administer per dose? a. 0.2 mg b. 0.3 mg c. 0.4 mg d. 0.6 mg

a. 0.2 mg **44 pounds is converted to kilograms by dividing 44 by 2.2 = 20 kg. 0.03 mg/kg × 20 kg = 0.6 mg. 0.6 mg ÷ 3 doses = 0.2 mg/dose.

What information must be provided to a patient receiving rifampin? a. A nonharmful side effect of the drug is red-orange discoloration of urine, sweat, and tears. b. Oral contraception is the preferred method of birth control when using rifampin. c. Peripheral neuropathy is an expected side effect, and the patient should report any numbness or tingling of the extremities. d. The patient will only need to take this medication for the prescribed 14-day period.

a. A nonharmful side effect of the drug is red-orange discoloration of urine, sweat, and tears **Red-orange discoloration of body fluids is a common side effect of rifampin, but it is not harmful. Rifampin does not cause peripheral neuropathies (INH does), but it does interfere with the effectiveness of oral contraceptives. All antitubercular drugs need to be taken long term in order to eradicate the slow-growing mycobacterium lying deep within the tissues.

The patient's culture has grown gram-positive cocci, and the patient is prescribed two different antibiotics, one of which is gentamicin. To treat this type of infection, which type of drug is typically prescribed with gentamicin? a. A penicillin b. A cephalosporin c. A fluoroquinolone d. An aminoglycoside

a. A penicillin *** In gram-positive cocci, gentamicin is usually given in combination with a penicillin. The other antibiotics are not typically prescribed with gentamicin for this culture result.

A patient has been prescribed monoclonal antibody therapy for the treatment of rheumatoid arthritis. What known disorder or disease is a contraindication and would alert the nurse to question the order for this class of drugs? a. AIDS b. Hypertensive crisis c. Chronic obstructive pulmonary disease d. Nephrotic syndrome

a. AIDS ***Monoclonal antibodies are usually contraindicated in patients with known active infectious processes due to their immunosuppressive qualities. Use of alemtuzumab is also contraindicated in patients with active systemic infections and immunodeficiency conditions, including AIDS.

Quinolones are a class of antibiotics known for several significant complications. Which are possible adverse effects with these drugs? (Select all that apply.) a. Abnormal cartilage development in children b. Prolongation of the QT interval c. Nephrotoxicity d. Tendon rupture e. Ototoxicity

a. Abnormal cartilage development in children b. Prolongation of the QT interval d. Tendon rupture

Which assessment is of greatest priority for the nurse to complete before administering a penicillin antibiotic? a. Allergy history b. BUN c. Temperature d. Wound drainage

a. Allergy history

The nurse is reviewing the orders for wound care, which include use of an antiseptic. Which statements best describe the use of antiseptics? (Select all that apply.) a. Antiseptics are appropriate for use on living tissue. b. Antiseptics work by sterilizing the surface of the wound. c. Antiseptics are applied to nonliving objects to kill microorganisms. d. The patient's allergies must be assessed before using the antiseptic. e. Antiseptics are used to inhibit the growth of microorganisms on the wound surface.

a. Antiseptics are appropriate for use on living tissue. d. The patient's allergies must be assessed before using the antiseptic. e. Antiseptics are used to inhibit the growth of microorganisms on the wound surface.

What cells are the functional cells of the humoral immune system that mature into immunoglobulins? a. B cells b. Granulocytes c. T cells d. Red blood cells

a. B cells ***The functional cells of the humoral immune system are the B lymphocytes. When an antigen binds to receptors located on the B cells, a biochemical signal is sent to the B lymphocytes. These B cells then mature into plasma cells, which in turn produce antibodies.

The patient has a serum digoxin level drawn and it comes back 0.4 ng/mL. How does the nurse interpret this lab value result? a. Below the therapeutic level b. A therapeutic level c. Above the therapeutic level d. A toxic level

a. Below the therapeutic level **Therapeutic serum digoxin levels are 0.5 to 2 ng/mL.

When titrating intravenous nitroglycerin, which assessment findings does the nurse monitor? (Select all that apply.) a. Blood pressure b. Heart rate c. Chest pain d. Respiratory rate

a. Blood pressure b. Heart rate c. Chest pain

While administering bevacizumab (Avastin), what will the nurse assess to look for drug-related toxicities? (Select all that apply.) a. Blood pressure b. Color of the skin and sclera of the eye (for jaundice) c. Blood glucose level d. Urine protein level e. Hearing

a. Blood pressure d. Urine protein level

Before administering an immunosuppressant drug, the nurse should perform which assessments? (Select all that apply.) a. Blood urea nitrogen and creatinine levels b. Level of consciousness c. Blood pressure and pulse d. Hepatic enzymes

a. Blood urea nitrogen and creatinine levels b. Level of consciousness c. Blood pressure and pulse d. Hepatic enzymes

For which potential adverse effects would the nurse monitor patients prescribed amiodarone? (Select all that apply.) a. Bluish skin discoloration b. Diarrhea c. Hypothyroidism d. Photosensitivity e. Hypertension

a. Bluish skin discoloration c. Hypothyroidism d. Photosensitivity

A newly admitted patient reports a penicillin allergy. The prescriber has ordered a second-generation cephalosporin as part of the therapy. Which nursing action is appropriate? a. Call the prescriber to clarify the order because of the patient's allergy. b. Give the medication, and monitor for adverse effects. c. Ask the pharmacy to change the order to a first-generation cephalosporin. d. Administer the drug with a nonsteroidal antiinflammatory drug to reduce adverse effects.

a. Call the prescriber to clarify the order because of the patient's allergy.

Sodium channel blockers are considered which class of antidyshythmic drugs? a. Class I b. Class II c. Class III d. Class IV

a. Class I **Sodium channel blockers are classified as class I drugs.

A patient is experiencing stomatitis after a round of chemotherapy. Which intervention by the nurse is correct? a. Clean the mouth with a soft-bristle toothbrush and warm saline solution. b. Rinse the mouth with commercial mouthwash twice a day. c. Use lemon-glycerin swabs to keep the mouth moist. d. Keep dentures in the mouth between meals.

a. Clean the mouth with a soft-bristle toothbrush and warm saline solution.

When providing instructions to patients on use of antibiotics, which instructions would the nurse include in the teaching? (Select all that apply.) a. Complete the entire course of therapy. b. Notify the provider of any possible reactions that occur. c. Save any leftover medication in a cool dry place for later use. d. Wash hands before and after preparing food. e. Increase fluid intake.

a. Complete the entire course of therapy. b. Notify the provider of any possible reactions that occur. d. Wash hands before and after preparing food. e. Increase fluid intake.

Which is most important for the nurse to monitor in a patient receiving an antifungal medication? (Select all that apply.) a. Daily weights b. Mental status c. Intake and output d. Blood urea nitrogen (BUN)Correct e. Creatinine

a. Daily weights c. Intake and output e. Creatinine

A patient taking an anthelmintic drug should be instructed to notify the physician immediately if he or she experiences which side effect? a. Darkened urine b. Light-colored stools c. Anal irritation d. Gastrointestinal discomfort

a. Darkened urine **Darkened urine may be a sign of hemolysis, a serious side effect of anthelmintic drugs.

When evaluating for therapeutic effects of mannitol, what does the nurse anticipate? a. Decreased intracranial pressure b. Decreased excretion of therapeutic medications c. Increased urine osmolality d. Decreased serum osmolality

a. Decreased intracranial pressure **Mannitol is an osmotic diuretic that pulls fluid from extravascular spaces into the bloodstream to be excreted in urine. This will decrease intracranial pressure, increase excretion of medications, decrease urine osmolality, and increase serum osmolality.

Acetazolamide (Diamox) is used to treat which disorders? (Select all that apply.) a. Edema associated with heart failure b. Metabolic acidosis c. High-altitude sickness d. Open-angle glaucoma

a. Edema associated with heart failure c. High-altitude sickness d. Open-angle glaucoma

A patient is taking digoxin (Lanoxin) 0.25 mg and furosemide (Lasix) 40 mg. When the nurse enters the room, the patient states, "I think I need to take a nap. Everything is starting to look a little yellow." Which action will the nurse take? a. Evaluate the patient for other symptoms of digoxin toxicity. b. Withhold the furosemide. c. Administer the medication as ordered. d. Document the findings and reassess in 1 hour.

a. Evaluate the patient for other symptoms of digoxin toxicity. **Yellow or green halos around objects is a red flag symptom of digoxin toxicity.

The nurse is caring for a patient with an acute renal insufficiency and thrombocytopenia. Along with platelet transfusions, the nurse would expect to administer which substance to increase deficient clotting factors in this patient? a. Fresh frozen plasma b. Albumin c. Plasma protein factors d. Whole blood

a. Fresh frozen plasma **Fresh frozen plasma is indicated to increase clotting factors in patients with a known deficiency. Albumin and plasma protein factors do not contain clotting factors. Although whole blood does contain the same ingredients as fresh frozen plasma, the amount of volume that must be administered to give the patient the necessary clotting factors may be prohibitive in a patient with renal insufficiency.

The nurse recognizes that patient teaching regarding warfarin (Coumadin) has been successful when the patient acknowledges an increased risk of bleeding with concurrent use of which herbal product? (Select all that apply.) a. Garlic b. Ginkgo c. Dong quai d. Glucosamine e. St. John's wort

a. Garlic b. Ginkgo c. Dong quai e. St. John's wort

The nurse is reviewing emergency protocols and administration of adenosine (Adenocard). What is a vitally important task to remember when administering adenosine? a. Give it as a rapid intravenous push. b. Give it at the highest port in the IV tubing. c. Offer it with food or milk. d. Prepare to set up for an intravenous drip infusion.

a. Give it as a rapid intravenous push. **Adenosine must be given as rapidly as possible, followed by a 50-mL normal saline flush in order to get all of the medication into the circulation quickly since the half-life of adenosine is less than 10 seconds.

Before administration of any antiviral medication, what nursing care would be performed? (Select all that apply.) a. Head-to-toe physical assessment b. Documentation of known allergies c. History of medication use d. Monitoring for adverse effects e. Baseline vital signs

a. Head-to-toe physical assessment b. Documentation of known allergies c. History of medication use e. Baseline vital signs

When chemotherapy with alkylating drugs is planned, the nurse expects to implement which intervention to prevent nephrotoxicity? a. Hydrating the patient with intravenous fluids before chemotherapy b. Limiting fluids before chemotherapy c. Monitoring drug levels during chemotherapy d. Assessing creatinine clearance during chemotherapy

a. Hydrating the patient with intravenous fluids before chemotherapy

Potassium-sparing diuretics may cause which adverse reactions? (Select all that apply.) a. Hyperkalemia b. Dizziness c. Headache d. Hypermagnesemia e. Muscle cramps

a. Hyperkalemia b. Dizziness c. Headache

Which is a priority nursing diagnosis for a patient taking an antihypertensive medication? a. Ineffective cerebral tissue perfusion related to disease process and/or medication b. Deficient knowledge related to medication regimen c. Fatigue related to side effects of medication d. Risk for injury to mucous membranes related to medication side effects

a. Ineffective cerebral tissue perfusion related to disease process and/or medication **Ineffective cerebral tissue perfusion is always a priority over fatigue, risk for injury, and/or knowledge deficit. Patients taking antihypertensive medication are also at risk for ineffective renal and cardiac perfusion.

The nurse is aware that viruses can enter the body through various routes. By which methods can viruses enter the body? (Select all that apply.) a. Inhalation through the respiratory tract b. Ingestion via the gastrointestinal (GI) tract c. Transplacentally from mother to infant d. Through an animal bite

a. Inhalation through the respiratory tract b. Ingestion via the gastrointestinal (GI) tract c. Transplacentally from mother to infant d. Through an animal bite

What is the mechanism of action of ezetimibe (Zetia)? a. Inhibiting absorption of dietary and biliary cholesterol in the small intestine b. Inhibiting the biosynthesis of cholesterol in the liver c. Binding to bile in the intestinal tract, inhibiting its absorption and thus causing the liver to produce bile from cholesterol d. Decreasing the adhesion of cholesterol on the arterial walls

a. Inhibiting absorption of dietary and biliary cholesterol in the small intestine **Ezetimibe works by inhibiting the absorption of cholesterol in the small intestine.

Nitrates relieve angina pain by reducing preload. How would the nurse explain the term preload to a patient? a. It is the blood volume within the heart. b. It is the pressure within the superior vena cava. c. It is the pressure against which the heart must pump. d. It is the oxygen demand of the heart.

a. It is the blood volume within the heart. **Preload is determined by the amount of blood in the ventricle just before contraction.

A patient taking spironolactone (Aldactone) requests assistance with dietary choices. The nurse would recommend which food choices? (Select all that apply.) a. Lean meat b. Bananas c. Apples d. Squash

a. Lean meat c. Apples d. Squash

When assessing for adverse reactions to Rifamate (combination isoniazid and rifampin), the nurse would monitor which laboratory values? (Select all that apply.) a. Liver function tests b. CBC c. Sputum cultures d. Uric acid levels e. Cholesterol

a. Liver function tests b. CBC

What are the major adverse effects specific to the cytotoxic antibiotics? a. Liver toxicity b. Cardiovascular toxicity c. Pneumonitis d. Neurotoxicity e. Nephrotoxicity

a. Liver toxicity b. Cardiovascular toxicity c. PneumonitisCorrecte. Nephrotoxicity

Enoxaparin sodium (Lovenox) is an anticoagulant used to prevent and treat deep vein thrombosis and pulmonary embolism. This drug is in which drug group? a. Low-molecular-weight heparin b. Oral anticoagulant c. Glycoprotein IIb/IIIa inhibitor d. Thrombolytic drug

a. Low-molecular-weight heparin **Enoxaparin is a low-molecular-weight heparin.

Discharge teaching for a patient receiving simvastatin (Zocor) would include the importance of reporting which symptoms that might indicate a serious adverse reaction to the medication? a. Muscle pain b. Headache c. Weight loss d. Fatigue

a. Muscle pain **Muscle pain must be reported because it could signify an uncommon but serious side effect of rhabdomyolysis associated with statin drugs.

Which are common side effects of fenofibrate (Tricor), a fibric acid derivative? (Select all that apply.) a. Nausea, vomiting, and abdominal pain b. Increase in gallstone formation c. Impotence d. Constipation e. Rash

a. Nausea, vomiting, and abdominal pain b. Increase in gallstone formation c. Impotence e. Rash

Which are known adverse effects of alkylating agents? (Select all that apply.) a. Nephrotoxicity b. Neurotoxicity c. Ototoxicity d. Bone marrow suppression e. Cardiotoxicity

a. Nephrotoxicity b. Neurotoxicity c. Ototoxicity d. Bone marrow suppression

When assessing a patient for adverse effects related to cisplatin (Platinol), the nurse will monitor for which adverse effects? (Select all that apply.) a. Nephrotoxicity b. Peripheral neuropathy c. Pulmonary toxicity d. Severe nausea/vomiting e. Ototoxicity

a. Nephrotoxicity b. Peripheral neuropathy d. Severe nausea/vomiting e. Ototoxicity

Which types of antiviral drugs are used to treat HIV infection? (Select all that apply.) a. Nonnucleoside reverse transcriptase inhibitors b. Protease inhibitors c. Reverse transcriptase inhibitors d. Fusion inhibitors e. Neuraminidase inhibitors

a. Nonnucleoside reverse transcriptase inhibitors b. Protease inhibitors c. Reverse transcriptase inhibitors d. Fusion inhibitors

Bacterial resistance to antibiotics can occur with which situations? (Select all that apply.) a. Patients stop taking an antibiotic once they feel better. b. New organisms arrive from foreign countries. c. Antibiotics are prescribed according to culture and sensitivity reports. d. Antibiotics are prescribed to treat a viral infection.

a. Patients stop taking an antibiotic once they feel better. d. Antibiotics are prescribed to treat a viral infection.

Which are therapeutic effects of digoxin? a. Positive inotropic, negative chronotropic, and negative dromotropic b. Positive inotropic, positive chronotropic, and negative dromotropic c. Negative inotropic, negative chronotropic, and negative dromotropic d. Positive inotropic, negative chronotropic, and positive dromotropic

a. Positive inotropic, negative chronotropic, and negative dromotropic **Digoxin increases cardiac contractility (positive inotropic effect), decreases heart rate (negative chronotropic effect), and decreases conductivity (negative dromotropic effect).

When assessing a patient who is to begin therapy with an immunosuppressant drug, the nurse recognizes that such drugs should be used cautiously in patients with which condition(s)? (Select all that apply.) a. Pregnancy b. Glaucoma c. Anemia d. Myalgia e.. Renal dysfunction f. Hepatic dysfunction

a. Pregnancy d. Myalgia f. Hepatic dysfunction

Combinations of chemotherapeutic drugs are frequently used for which purpose? (Select all that apply.) a. Preventing drug resistance b. Providing a synergistic action c. Decreasing cost of treatment d. Decreasing the severity of adverse effects e. Decreasing drug tolerance

a. Preventing drug resistance b. Providing a synergistic action d. Decreasing the severity of adverse effects

Nursing care for a patient receiving alteplase (Activase) would include which action? (Select all that apply.) a. Record vital signs and report changes. b. Observe for signs and symptoms of bleeding. c. Monitor liver enzymes. d. Assess for cardiac dysrhythmias. e. Administer injections intramuscularly to prevent bleeding.

a. Record vital signs and report changes. b. Observe for signs and symptoms of bleeding. d. Assess for cardiac dysrhythmias.

When teaching a patient about carvedilol (Coreg), the nurse explains that this medication reduces blood pressure by which actions? (Select all that apply.) a. Reducing heart rate b. Vasodilation c. Decreasing stress d. Increasing urine output

a. Reducing heart rate b. Vasodilation

When administering vancomycin, the nurse knows that which of these is most important to assess before giving the medication? a. Renal function b. WBC count c. Liver function d. Platelet count

a. Renal function

Which would be a priority assessment prior to administering eplerenone (Inspra)? a. Serum electrolytes b. Level of consciousness c. Patient's knowledge level d. Thiocyanate levels

a. Serum electrolytes **Eplerenone (Inspra) is contraindicated in patients with an elevated serum potassium level (greater than 5.5 mEq/L) or severe renal impairment, Therefore, it is imperative that the nurse assess the patient's most recent serum electrolytes before administering this medication.

When providing education to a patient undergoing antineoplastic drug therapy, the nurse would teach the patient that which signs and symptoms indicate an oncologic emergency that requires immediate notification of the health care provider? (Select all that apply.) a. Swollen tongue b. Bleeding gums c. Difficulty sleeping d. New and persistent cough e. Nausea on the day of treatment f. Blood in urine

a. Swollen tongue b. Bleeding gums d. New and persistent cough f. Blood in urine

Which cells are activated by aldesleukin (interleukin-2)? a. T-cells b. Red blood cells c. Undifferentiated cells d. Neutrophils

a. T-cells Correct ***Aldesleukin enhances the immune system by stimulating the production and activity of T-cells.

The nurse is reviewing the medical history of a patient who is about to receive therapy with etanercept (Enbrel). Which conditions, if present, would be a contraindication or caution for therapy with this drug? (Select all that apply.) a. Urinary tract infection b. Psoriasis c. Heart failure d. Glaucoma e. Latex allergy

a. Urinary tract infection c. Heart failure e. Latex allergy

Which statement most accurately describes the pharmacodynamics of vaccines? a. Vaccines work by stimulating the humoral immune system. b. Vaccines provide passive immunity. c. Vaccines work by suppressing immunoglobulins. d. Vaccines prevent the formation of antibodies against a specific antigen.

a. Vaccines work by stimulating the humoral immune system. ***Vaccines work by stimulating the humoral immune system, which synthesizes immunoglobulins. They also stimulate the formation of antibodies against their specific antigen, providing active immunity.

A patient is seen in the clinic for signs and symptoms of malaria after a trip to South America. What drug would the nurse expect to be prescribed? a. chloroquine (Aralen) b. penicillin c. metronidazole (Flagyl) d. pentamidine (Pentam)

a. chloroquine (Aralen) **Chloroquine is a standard drug used for the treatment of malaria in an acute stage.

During drug therapy with basiliximab, the nurse monitors for signs of cytokine release syndrome, which results in a. fever, dyspnea, and general malaise. b. neurotoxicity and peripheral neuropathy. c. hepatotoxicity with jaundice. d. thrombocytopenia with increased bleeding tendencies.

a. fever, dyspnea, and general malaise.

A patient with elevated triglyceride levels unresponsive to HMG-CoA reductase inhibitors will most likely be prescribed which drug? a. gemfibrozil (Lopid) b. cholestyramine (Questran) c. colestipol (Colestid) d. simvastatin (Zocor)

a. gemfibrozil (Lopid) **Gemfibrozil, a fibric acid derivative, promotes catabolism of triglyceride-rich lipoproteins.

Before administering intravenous basiliximab (Simulect), the nurse would anticipate giving which medication? a. methylprednisolone sodium (Solu-Medrol) b. diphenhydramine (Benadryl) c. acetaminophen (Tylenol) d. meperidine (Demerol)

a. methylprednisolone sodium (Solu-Medrol) ***Methylprednisolone sodium is administered 30 minutes before basiliximab injection to prevent or minimize acute allergic-type reactions associated with this medication.

A patient with low platelets is prescribed a drug to stimulate platelet production. Which drug would the nurse anticipate being prescribed? a. oprelvekin (Neumega) b. epoetin (Epogen) c. aldesleukin (Proleukin) d. interferon beta-1a (Avonex)

a. oprelvekin (Neumega) ***Oprelvekin stimulates the production of platelets. Epoetin stimulates the production of red blood cells in the bone marrow. Interleukins (aldesleukin) and interferons activate the immune system but do not increase production of white blood cells.

Tetracycline can cause esophageal ulceration. What can the nurse teach to minimize the risk of this adverse effect? a. stay upright for at least 30 minutes after taking the medication. b. take the medication at bedtime c. take the medication with milk d. take the medication with antacid

a. stay upright for at least 30 minutes after taking the medication.

A patient visits the health care provider for treatment of tinea pedis (athlete's foot). Which medication would the nurse most likely instruct the patient on to treat this condition? a. terbinafine (Lamisil) b. voriconazole (Vfend) c. caspofungin (Cancidas) d. amphotericin B

a. terbinafine (Lamisil) **Terbinafine (Lamisil) is classified as an allylamine antifungal drug and is currently the only drug in its class. It is available in a topical cream, gel, and spray for treating superficial dermatologic infections, including tinea pedis (athlete's foot), tinea cruris (jock itch), and tinea corporis (ringworm).

The nurse would question an order for chloroquine in a patient also prescribed which medication? a. valproic acid b. doxycycline (Doryx) c. clindamycin (Cleocin) d. diazepam (Valium)

a. valproic acid **Concurrent use of chloroquine with valproic acid may reduce serum drug levels of valproic acid and thus increase the risk of seizure activity. Chloroquine may be given concurrently with clindamycin or doxycycline for synergistic actions.

Which statement needs to be included when the nurse provides patient education for a patient with heart failure who is taking daily doses of spironolactone (Aldactone)? a "Be sure to eat foods that are high in potassium." b "Avoid foods that are high in potassium." c "Avoid grapefruit juice while taking this medication." d "A low-fiber diet will help prevent adverse effects of this medication."

b "Avoid foods that are high in potassium."

A 56-year-old man started antihypertensive drug therapy 3 months earlier and is in the office for a follow-up visit. While the nurse is taking his blood pressure, he informs the nurse that he has had some problems with sexual intercourse. Which would be the most appropriate response by the nurse? a "Not to worry. Eventually, tolerance will develop." b "The physician can work with you on changing the dose and/or drugs." c "Sexual dysfunction happens with this therapy, and you will learn to accept it." d "This is an unusual occurrence, but it is important to stay on your medications."

b "The physician can work with you on changing the dose and/or drugs."

The nurse is teaching a patient about selfadministration of enoxaparin (Lovenox). Which statement should be included in this teaching session? a "We will need to teach a family member how to give this drug in your arm." b "This drug is given in the folds of your abdomen, but at least 2 inches away from your navel." c "This drug needs to be taken at the same time every day with a full glass of water." d "Be sure to massage the injection site thoroughly after giving the drug."

b "This drug is given in the folds of your abdomen, but at least 2 inches away from your navel."

A patient has a new prescription for an ACE inhibitor. During a review of the patient's list of current medications, which would cause concern for a possible interaction with this new prescription? (Select all that apply.) a A benzodiazepine taken as needed for allergies b A potassium supplement taken daily c An oral anticoagulant taken daily d An opioid used for occasional severe pain e An NSAID taken as needed for headaches

b A potassium supplement taken daily e An NSAID taken as needed for headaches

A patient is starting warfarin (Coumadin) therapy as part of treatment for atrial fibrillation. The nurse will follow which principles of warfarin therapy? (Select all that apply.) a Teach proper subcutaneous administration b Administer the oral dose at the same time every day c Assess carefully for excessive bruising or unusual bleeding d Monitor laboratory results for a target INR of 2 to 3 e Monitor laboratory results for a therapeutic aPTT value of 1.5 to 2.5 times the control value

b Administer the oral dose at the same time every day c Assess carefully for excessive bruising or unusual bleeding d Monitor laboratory results for a target INR of 2 to

The nurse is administering an IV solution that contains potassium chloride to a patient in the critical care unit who has a severely decreased serum potassium level. Which action(s) by the nurse are appropriate? (Select all that apply.) a Administer the potassium by slow IV bolus. b Administer the potassium at a rate no faster than 20 mEq/hr. c Monitor the patient's cardiac rhythm with a heart monitor. d Use an infusion pump for the administration of IV potassium chloride. e Administer the potassium IV push.

b Administer the potassium at a rate no faster than 20 mEq/hr. c Monitor the patient's cardiac rhythm with a heart monitor. d Use an infusion pump for the administration of IV potassium chloride.

The nurse is administering cholestyramine (Questran), a bile acid sequestrant. Which nursing intervention(s) is appropriate? (Select all that apply.) a Administering the drug on an empty stomach b Administering the drug with meals c Instructing the patient to follow a low-fiber diet while taking this drug d Instructing the patient to take a fiber supplement while taking this drug e Increasing fluid intake f Not administering this drug at the same time as other drugs

b Administering the drug with meals d Instructing the patient to take a fiber supplement while taking this drug e Increasing fluid intake f Not administering this drug at the same time as other drugs

The nurse is monitoring for liver toxicity in a patient who has been receiving long-term isoniazid therapy. Manifestations of liver toxicity include: (Select all that apply.) a Orange discoloration of sweat and tears b Darkened urine c Dizziness d Fatigue e Visual disturbances f Jaundice

b Darkened urine d Fatigue f Jaundice

The patient has received a double dose of heparin during surgery and is bleeding through the incision site. While the surgeons are working to stop the bleeding at the incision site, the nurse will prepare to take what action at this time? a Give IV vitamin K as an antidote b Give IV protamine sulfate as an antidote c Call the blood bank for an immediate platelet transfusion d Obtain an order for packed red blood cells

b Give IV protamine sulfate as an antidote

The nurse is administering antihypertensive drugs to older adult patients. The nurse knows that which adverse effect is of most concern for these patients? a Dry mouth b Hypotension c Restlessness d Constipation

b Hypotension

A patient is receiving dabigatran (Pradaxa), 150 mg twice daily, as part of treatment for atrial fibrillation. Which condition, if present, would be a concern if the patient were to receive this dose? a Asthma b Renal impairment c History of myocardial infarction d Elevated liver enzymes

b Renal impairment

When teaching the patient about the signs and symptoms of cardiac glycoside toxicity, the nurse should alert the patient to watch for a visual changes such as photophobia. b flickering lights or halos around lights. c dizziness when standing up. d increased urine output.

b flickering lights or halos around lights.

When assessing a patient who is about to receive an albumin infusion, the nurse knows that a contraindication for albumin would be a acute liver failure. b heart failure. c severe burns. d fluid-volume deficit

b heart failure.

A patient is taking a beta blocker as part of the treatment plan for heart failure. The nurse knows that the purpose of the beta blocker for this patient is to a increase urine output. b prevent stimulation of the heart by catecholamines. c increase the contractility of the heart muscle. d cause peripheral vasodilation

b prevent stimulation of the heart by catecholamines.

The patient asks what the difference is between dalteparin (Fragmin) and heparin. What is the nurse's best response? a. "There is really no difference, but dalteparin is preferred because it is less expensive." b. "Dalteparin is a low-molecular-weight heparin that has a more predictable anticoagulant effect." c. "I'm not really sure why some physicians choose dalteparin and some heparin, so you should ask your doctor." d. "The only difference is that heparin dosing is based on the patient's weight."

b. "Dalteparin is a low-molecular-weight heparin that has a more predictable anticoagulant effect." **A low-molecular-weight heparin is more predictable in its effect than regular heparin. Dalteparin is more expensive than heparin and is dosed based upon the patient's weight.

During a routine checkup, a 72-year-old patient is advised to receive an influenza vaccine injection. He questions this, saying, "I had one last year. Why do I need another one?" What is an appropriate response from the nurse? a. "The effectiveness of the vaccine wears off after 6 months." b. "Each year a new vaccine is developed based on the flu strains that are likely to be in circulation." c. "When you reach 65 years of age, you need boosters on an annual basis." d. "Taking the flu vaccine each year allows you to build your immunity to a higher level each time."

b. "Each year a new vaccine is developed based on the flu strains that are likely to be in circulation."

The nurse is providing education to a patient who is prescribed metronidazole (Flagyl) for trichomoniasis. What statement by the patient indicates the patient has understood the teaching? a. "I will stop taking the medication when the discharge stops." b. "I will have my partner evaluated and treated." c. "I can continue to have intercourse as long as we use condoms." d. "I won't get this again since I have had it once."

b. "I will have my partner evaluated and treated." **Inform the patient taking metronidazole for a sexually transmitted disease to avoid sexual intercourse until the prescriber states otherwise. The partner, any sexual partners possibly exposed, need to be evaluated and treated if positive. All other statements would require further teaching by the nurse.

Which statement will indicate to the nurse that the patient understands the discharge instructions regarding cholestyramine (Questran)? a. "I will take Questran 1 hour before my other medications." b. "I will increase fiber in my diet." c. "I will weigh myself weekly." d. "I will have my blood pressure checked weekly."

b. "I will increase fiber in my diet." **Cholestyramine can cause constipation; thus increasing fiber in diet is appropriate. All other drugs should be taken 1 hour before or 4 hours after cholestyramine to facilitate proper absorption.

Which statement indicates that the patient understands discharge teaching about nitroglycerin? a. "I will need to refill my prescription once a year in order to maintain potency." b. "I will need to keep the nitroglycerin stored in the bottle it comes in." c. "I will take a nitroglycerin tablet every 15 minutes until my chest pain is gone." d. "I should take a nitroglycerin tablet 2 hours before I want to engage in activity that will cause chest pain."

b. "I will need to keep the nitroglycerin stored in the bottle it comes in." **Nitroglycerin needs to be stored away from heat, humidity, and light, all of which can decrease its potency. Keeping it in the brown light-resistant bottle helps achieve this. It should be replaced every 3 to 6 months in order to maintain potency. Nitroglycerin is used every 5 minutes for pain relief or just before engaging in activity that is known to cause chest pain.

The patient asks how nitroglycerin should be stored while traveling. What is the nurse's best response? a. "You can protect it from heat by placing the bottle in an ice chest." b. "It's best to keep it in its original container away from heat and light." c. "You can put a few tablets in a resealable bag and carry in your pocket." d. "It's best to lock them in the glove compartment of your car to keep them away from heat and light."

b. "It's best to keep it in its original container away from heat and light." **Although nitroglycerin needs to be kept in a cool, dry place, it should not be placed in an ice chest where it could freeze. It should also not be locked up and needs to be kept away from light, not in a clear plastic bag.

What teaching would the nurse provide to a patient receiving tetanus toxoid? a. "Increase fluid and fiber in your diet to prevent constipation." b. "Soreness at the injection site is a common reaction." c. "You will have lifetime immunity from this injection." d. "This medication must be repeated weekly for four weeks."

b. "Soreness at the injection site is a common reaction." ***Myalgia at the injection site is a common side effect of tetanus toxoid.

A 68-year-old man has been taking the nitrate isosorbide dinitrate (Isordil) for 2 years for angina. He recently has been experiencing erectile dysfunction and wants a prescription for sildenafil (Viagra). Which response would the nurse most likely hear from the prescriber? a. "He will have to be switched to isosorbide mononitrate if he wants to take sildenafil." b. "Taking sildenafil with the nitrate may result in severe hypotension, so a contraindication exists." c. "I'll write a prescription, but if he uses it, he needs to stop taking the isosorbide for one dose." d. "These drugs are compatible with each other, and so I'll write a prescription."

b. "Taking sildenafil with the nitrate may result in severe hypotension, so a contraindication exists."

Which statement would be most appropriate during discharge teaching for a patient receiving transdermal clonidine (Catapres)? a. "Your blood pressure should be checked by a physician at least once a year." b. "The patch should be applied to a nonhairy site, and abrupt withdrawal should be avoided." c. "Excessive exercise or prolonged standing is not a problem with clonidine as it can be with other antihypertensive drugs." d. "If you are having difficulty with the common side effect of excessive drooling, notify your physician so your dosage can be adjusted."

b. "The patch should be applied to a nonhairy site, and abrupt withdrawal should be avoided." **Transdermal clonidine patches should be applied to nonhairy areas of the skin, and abrupt withdrawal should be avoided. The patient's blood pressure should be checked more frequently than once a year; prolonged standing can cause venous pooling and hypotension; and dry mouth, not drooling, is a common side effect of clonidine.

Which information will the nurse include in discharge teaching for a patient receiving doxycycline? a. "Take the medication until you feel better." b. "Use sunscreen and protective clothing when outdoors." c. "Keep the remainder of the medication in case of recurrence." d. "Take the medication with food and milk to minimize gastrointestinal upset."

b. "Use sunscreen and protective clothing when outdoors." ***Photosensitivity is a common side effect of doxycycline, a tetracycline antibiotic. The patient should avoid direct sun exposure while taking this medication. Exposure to the sun can cause severe burns.

Upon which patient finding would the nurse hold the ordered dose of filgrastim (Neupogen) and notify the provider? a. Fever of 99.5° F b. Absolute neutrophil count (ANC) count of 12,000 cells/mm3 c. White blood cell (WBC) count of 4.5/mm3 d. Blood pressure of 142/88 mm Hg

b. Absolute neutrophil count (ANC) count of 12,000 cells/mm3 ***Filgrastim (Neupogen) is usually discontinued when a patient's ANC rises above 10,000 cells/mm3. However, some prescribers will stop it when the ANC is between 1000 and 2000 cells/mm3.

The nurse would assess which laboratory value to determine the effectiveness of intravenous heparin? a. Complete blood count (CBC) b. Activated partial thromboplastin time (aPTT) c. Prothrombin time (PT) d. Blood urea nitrogen (BUN)

b. Activated partial thromboplastin time (aPTT) **Heparin dosing is based on aPTT results. The PT is reflective of warfarin's anticoagulant effect.

A nurse administering niacin would implement which action to help to reduce adverse effects? a. Give the medication with grapefruit juice. b. Administer a small dose of aspirin or an NSAID 30 minutes before the niacin dose. c. Administer the medication on an empty stomach. d. Have the patient increase dietary fiber intake.

b. Administer a small dose of aspirin or an NSAID 30 minutes before the niacin dose.

The nurse plans which intervention to decrease the flushing reaction of niacin? a. Administer niacin with an antacid. b. Administer aspirin 30 minutes before nicotinic acid. c. Administer diphenhydramine hydrochloride (Benadryl) with the niacin. d. Apply cold compresses to the head and neck.

b. Administer aspirin 30 minutes before nicotinic acid. **Administration of an antiinflammatory drug such as aspirin has been shown to decrease the flushing reaction associated with niacin.

When applying nitroglycerin ointment, the nurse should perform which action? a. Use the fingers to spread the ointment evenly over a 3-inch area. b. Apply the ointment to a nonhairy part of the upper torso. c. Massage the ointment into the skin. d. Apply two thick lines of ointment over the prescribed measured area on the nitroglycerin paper.

b. Apply the ointment to a nonhairy part of the upper torso. **Absorption is best over a nonhairy portion of skin. The upper torso is the preferred site of application. The nurse should wear gloves when applying to prevent transdermal absorption by the applier. The ointment is measured as one straight line on the nitroglycerin patch and is gently spread over paper and applied, but not rubbed, into the skin. Rubbing would increase absorption and risks of side effects.

Which class of drugs is used to treat both hypertension and dysrhythmias? a. Sodium channel blockers b. Calcium channel blockers c. Angiotensin-converting enzyme (ACE) inhibitors d. Direct-acting vasodilators

b. Calcium channel blockers **Calcium channel blockers are effective in treating both hypertension and dysrhythmias secondary to their negative inotropic and chronotropic effects.

What is considered a major dose-limiting side effect of doxorubicin (Adriamycin)? a. Hemorrhagic cystitis b. Cardiomyopathy c. Hepatoxicity d. Nephrotoxicity

b. Cardiomyopathy ***Patients receiving doxorubicin need to be monitored for cardiac toxicity. There is a lifetime limited dose that patients are allowed to receive to minimize the occurrence of cardiomyopathy.

Calcium channel blockers have which pharmacodynamic effect? a. Positive inotropic effect b. Coronary vasodilation c. Positive chronotropic effect d. Shortened refractory period

b. Coronary vasodilation **Calcium channel blockers cause coronary vasodilation, a negative inotropic effect, a negative chronotropic effect, and a negative dromotropic effect.

A patient receiving intravenous nitroglycerin at 20 mcg/min complains of dizziness. Nursing assessment reveals a blood pressure of 85/40 mm Hg, heart rate of 110 beats/min, and respiratory rate of 16 breaths/min. What is the nurse's best action? a. Assess the patient's lung sounds. b. Decrease the intravenous nitroglycerin by 10 mcg/min. c. Increase the intravenous nitroglycerin by 10 mcg/min. d. Recheck the patient's vital signs in 1 hour.

b. Decrease the intravenous nitroglycerin by 10 mcg/min. **Nitroglycerin, as a vasodilator, causes a decrease in blood pressure. Because it is short-acting, decreasing the infusion rate will allow the blood pressure to rise. The patient should be monitored every 10 minutes while changing the rate of the intravenous nitroglycerin infusion.

Which is an expected outcome associated with the administration of digoxin? a. Increased heart rate b. Decreased heart rate c. Decreased urinary output d. Increased blood pressure

b. Decreased heart rate **Digoxin has a negative chronotropic effect (decreased heart rate).

Which are mechanisms of action of biologic response-modifying drugs? (Select all that apply.) a. Interruption of the cell lifecycle at the genetic level to interfere with growth of the cancer cell b. Direct toxic effect on tumor cells, causing them to rupture c. Adverse modification of a tumor's biology, making it harder for the tumor cells to survive and reproduce d. Enhancement or restoration of the host's immune system defenses against a tumor

b. Direct toxic effect on tumor cells, causing them to rupture c. Adverse modification of a tumor's biology, making it harder for the tumor cells to survive and reproduce d. Enhancement or restoration of the host's immune system defenses against a tumor

The nurse is conducting a community education program. When explaining different medication regimens to treat hypertension, it would be accurate to state that African Americans probably respond best to which combination of medications? a. ACE inhibitors and diuretics b. Diuretics and calcium channel blockers c. Diuretics and beta blockers d. ACE inhibitors and beta blockers

b. Diuretics and calcium channel blockers **Research has demonstrated that African Americans do not typically respond therapeutically to beta blockers or ACE inhibitors. They respond better to diuretics and calcium channel blockers.

Which are common side effects of nitroglycerin? (Select all that apply.) a. Blurred vision b. Flushing c. Headache d. Hypotension

b. Flushing c. Headache d. Hypotension

Which vaccination was developed to prevent bacterial meningitis caused by Haemophilus influenzae? a. Hepatitis B vaccine b. Hib conjugate vaccine c. Prevnar d. Gardasil

b. Hib conjugate vaccine ***H. influenzae type b (Hib) (HibTITER, ActHIB, Liquid PedvaxHIB) vaccine is a noninfectious, bacteria-derived vaccine. Before this vaccine was developed, infections caused by Hib were the leading cause of bacterial meningitis in children 3 months to 5 years of age.

Hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) are generally administered at which time? a. When the stomach is empty b. In the evening c. With breakfast d. With an antacid

b. In the evening **The liver produces the majority of cholesterol during the night. Thus statin drugs, which work to decrease this synthesis, are generally administered during the evening so that blood levels are highest coinciding with this production.

The nurse is conducting a class on drugs for malignant tumors for a group of new oncology staff members. Which best describes the action of interferons in the management of malignant tumors? a. Interferons increase the production of specific anticancer enzymes. b. Interferons have antiviral and antitumor properties and stengthen the immune system. c. Interferons stimulate the production and activation of T lymphocytes and cytotoxic T cells. d. Interferons help improve the cell-killing action of T cells because they are retrieved from healthy donors.

b. Interferons have antiviral and antitumor properties and stengthen the immune system.

How will the nurse explain to the patient the action of cholestyramine (Questran) and how it decreases lipid levels? a. It inhibits absorption of dietary cholesterol in the small intestine. b. It binds to bile in the intestinal tract, forming an insoluble complex that is excreted in the feces. c. It inhibits the biosynthesis of cholesterol in the liver. d. It stimulates the biliary system to increase excretion of dietary cholesterol.

b. It binds to bile in the intestinal tract, forming an insoluble complex that is excreted in the feces. **Cholestyramine is an anion exchange resin that binds to bile to form an insoluble complex that is excreted. The liver must then use cholesterol to synthesize more bile.

While observing a patient self-administer enoxaparin (Lovenox), the nurse identifies the need for further teaching when the patient completes which action? a. Does not aspirate prior to injecting the medication b. Massages the site after administration of the medication c. Administers the medication greater than 2 inches away from the umbilicus d. Injects the medication and then waits 10 seconds before withdrawing the needle

b. Massages the site after administration of the medication **It is not recommended to massage the area of injection of anticoagulants due to the increased risk of hematoma formation.

A patient prescribed prazosin (Minipress) does not have a history of hypertension. The nurse would assess for what disorder for which this medication is also used? a. Pulmonary emboli b. Obstructive benign prostatic hyperplasia c. Seizure disorder d. Subarachnoid hemorrhage

b. Obstructive benign prostatic hyperplasia **Alpha1 blockers have been useful in treating obstructive benign prostatic hyperplasia. The blocking of alpha-adrenergic receptors decreases the urine outflow obstruction related to benign prostatic hyperplasia by preventing smooth muscle contractions in the bladder neck and urethra.

What is the most important action for the nurse to complete before administration of intravenous amphotericin B? a. Administer the drug along with potassium aliquots to prevent hypokalemia. b. Premedicate the patient with an antipyretic, antihistamine, and antiemetic as prescribed. c. Administer insulin as prescribed to prevent severe hyperglycemia. d. Administer intravenous dextrose as prescribed to prevent severe hypoglycemia.

b. Premedicate the patient with an antipyretic, antihistamine, and antiemetic as prescribed. **Almost all patients given intravenous amphotericin B develop fever, chills, nausea and vomiting, and hypotension. Pretreatment with an antipyretic, antihistamine, and antiemetic can minimize or prevent these adverse reactions.

A patient who is taking an anticoagulant requests an aspirin for headache relief. What is the nurse's best action? a. Administer 650 mg of acetylsalicylic acid (ASA), and reassess pain in 30 minutes. b. Take advantage of a teachable moment to inform the patient of potential drug interactions with anticoagulants. c. Explain to the patient that ASA is contraindicated, and administer ibuprofen as ordered. d. Explain that the headache is an expected side effect and will subside shortly.

b. Take advantage of a teachable moment to inform the patient of potential drug interactions with anticoagulants. **Patients taking an anticoagulant should not use medications that would further increase the risk of bleeding.

How would the nurse define the term nadir to a patient? a. The average number of days it takes the bone marrow to recover from a dose of chemotherapy b. The average number of days it takes for chemotherapy to have its peak effect on the bone marrow c. The patient's tolerance to the chemotherapy's bone marrow suppressant effect d. The maximum dose for a chemotherapy drug in reference to bone marrow suppression

b. The average number of days it takes for chemotherapy to have its peak effect on the bone marrow. ***Nadir refers to the average number of days it takes for a chemotherapeutic drug to have its peak effect on the bone marrow, which would coincide with the patient's lowest blood count and highest risk for infection and/or bleeding.

The nurse is discussing the use of alkylating drugs with the patient. What is the best way to describe the mechanism of action of alkylating drugs on cancer cells? a. They interact with the cell through intercalation. b. They alter the chemical structure of the DNA. c. They change the structure of the RNA. d. They stop the meiosis of the cell.

b. They alter the chemical structure of the DNA. ***The alkylating drugs work by preventing cancer cells from reproducing. Specifically, they alter the chemical structure of the cells' DNA, which is essential to the reproduction of any cell. This stops the cancer from reproducing or spreading. Cytotoxic antibiotics interact with DNA through a process called intercalation, in which the drug molecule is inserted between the two strands of a DNA molecule, ultimately blocking DNA synthesis.

The nurse is providing education to a patient on why spironolactone (Aldactone) and furosemide (Lasix) are prescribed together. What information does the nurse provide to the patient? a. Moderate doses of two different types of diuretics are more effective than a large dose of one type. b. This combination promotes diuresis but decreases the risk of hypokalemia. c. This combination prevents dehydration and hypovolemia. d. Using two drugs increases osmolality of plasma and the glomerular filtration rate.

b. This combination promotes diuresis but decreases the risk of hypokalemia. **Spironolactone is a potassium-sparing diuretic; furosemide is a potassium-losing diuretic. Giving these together minimizes electrolyte imbalance.

When teaching a patient regarding the administration of digoxin, the nurse instructs the patient not to take this medication with which food? a. Bananas b. Wheat bran c. French toast d. Scrambled eggs

b. Wheat bran **Large amounts of bran taken with digoxin will decrease and negatively impact the drug's absorption.

The nurse would teach a patient receiving metronidazole (Flagyl) to avoid ingestion of which drink? a. Milk b. Wine c. Coffee d. Orange juice

b. Wine ***A disulfuram-like (Antabuse) reaction may occur with concurrent ingestion of metronidazole and alcohol, leading to flushing of the face, tachycardia, palpitations, nausea, and vomiting.

The nurse is obtaining a medication history from an 18-year-old female patient who has been diagnosed with genital herpes. Which drug would the nurse expect this patient to be prescribed? a. amantadine (Symmetrel) b. acyclovir (Zovirax) c. zidovudine (Retrovir) d. ribavirin (Virazole)

b. acyclovir (Zovirax) **Acyclovir is the drug of choice to treat herpes simplex infections. Ribavirin is effective against respiratory syncytial virus (RSV), zidovudine against human immunodeficiency virus (HIV), and amantadine against Haemophilus influenzae type A.

When teaching a patient being discharged on linezolid (Zyvox) to treat methicillin-resistant Staphylococcus aureus (MRSA), the nurse must emphasize the importance of a. reporting any occurrence of constipation. b. avoiding ingestion of foods containing tyramine. c. stopping the drug as soon as the patient feels better. d. taking the medication with an antacid to avoid gastrointestinal upset.

b. avoiding ingestion of foods containing tyramine. ***Acute hypertension may occur in patients consuming large amounts of tyramine while taking linezolid. Linezolid causes diarrhea, not constipation, and should be taken with food to decrease gastrointestinal distress. An antacid would interfere with absorption.

While teaching a patient who is about to receive cyclophosphamide (Cytoxan) chemotherapy, the nurse will instruct the patient to watch for potential adverse effects, such as a. cholinergic diarrhea. b. hemorrhagic cystitis. c. peripheral neuropathy. d. ototoxicity.

b. hemorrhagic cystitis.

A patient is prescribed metronidazole (Flagyl) for a gynecologic infection, and she provides a list of medications she takes routinely to the nurse. Which medication would lead the nurse to question the order for Flagyl? a. multivitamin b. lithium c. thyroid replacement hormone d. ibuprofen

b. lithium ***Flagyl is known to cause and increase in neurologic-associated medications and specifically can lead to lithium toxicity. A patient who reports taking lithium should be a red flag for the nurse to alert the provider due to the potential significant interaction.

When admitting a patient diagnosed with Pneumocystis jirovecii pneumonia, the nurse will anticipate administering which medication? a. iodoquinol (Yodoxin) b. pentamidine (Pentam) c. paromomycin (Humatin) d. albendazole (Albenza)

b. pentamidine (Pentam) **Iodoquinol and paromomycin are used to treat intestinal amebiasis, and albendazole is used to treat helminthic infections.

A patient is scheduled for colorectal surgery tomorrow. He does not have sepsis, his WBC count is normal, he has no fever, and he is otherwise in good health. However, there is an order to administer an antibiotic on call before he goes to surgery. The nurse knows that the rationale for this antibiotic order is to a. provide empiric therapy. b. provide prophylactic therapy. c. treat for a superinfection. d. reduce the number of resistant organisms.

b. provide prophylactic therapy.

During antibiotic therapy, the nurse will assess the patient for a condition that may occur due to the disruption of normal flora. The nurse recognizes this as: a. organ toxicity. b. superinfection. c. hypersensitivity. d. allergic reaction.

b. superinfection. ***Antibiotic therapy can destroy the normal flora of the body, which normally would inhibit the overgrowth of fungi and yeast. When the normal flora are decreased, these organisms can overgrow and cause infections.

A patient who has been anticoagulated with warfarin (Coumadin) is admitted with gastrointestinal bleeding. The nurse will anticipate administering which substance? a. vitamin E b. vitamin K c. protamine sulfate d. calcium gluconate

b. vitamin K **Vitamin K is the antagonist for warfarin.

When a patient is being taught about the potential adverse effects of an ACE inhibitor, which of these effects should the nurse mention as possibly occurring when this drug is taken to treat hypertension? a Diarrhea b Nausea c Dry, nonproductive cough d Sedation

c Dry, nonproductive cough

While monitoring a patient who is receiving intravenous amphotericin B, the nurse expects to see which adverse effect(s)? a Hypertension b Bradycardia c Fever and chills d Diarrhea and stomach cramps

c Fever and chills

After surgery for organ transplantation, a patient is receiving ganciclovir, even though he does not have a viral infection. Which statement best explains the rationale for this medication therapy? a Ganciclovir is used to prevent potential exposure to the HIV virus. b This medication is given prophylactically to prevent influenza A infection. c Ganciclovir is given to prevent CMV infection. d The drug works synergistically with antibiotics to prevent superinfections.

c Ganciclovir is given to prevent CMV infection.

During an infusion of amphotericin B, the nurse knows that which administration technique may be used to minimize infusion-related adverse effects? a Forcing of fluids during the infusion b Infusing the medication quickly c Infusing the medication over a longer period of time d Stopping the infusion for 2 hours after half of the bag has infused, then resuming 1 hour later

c Infusing the medication over a longer period of time

Which point will the nurse emphasize to a patient who is taking an antilipemic medication in the "statin" class? a The drug needs to be taken on an empty stomach before meals. b A low-fat diet is not necessary while taking these medications. c It is important to report muscle pain immediately. d Improved cholesterol levels will be evident within 2 weeks.

c It is important to report muscle pain immediately.

A patient is being assessed before a newly ordered antilipemic medication is given. Which condition would be a potential contraindication? a Diabetes insipidus b Pulmonary fibrosis c Liver cirrhosis d Myocardial infarction

c Liver cirrhosis

A patient is receiving instructions regarding warfarin therapy and asks the nurse about what medications she can take for headaches. The nurse will tell her to avoid which type of medication? a Opioids b acetaminophen (Tylenol) c NSAIDs d There are no restrictions while taking warfarin.

c NSAIDs

The nurse is teaching a patient who is starting antitubercular therapy with rifampin. Which adverse effects would the nurse expect to see? a Headache and neck pain b Gynecomastia c Reddish brown urine d Numbness or tingling of extremities

c Reddish brown urine

When the nurse is checking the laboratory data for a patient taking spironolactone (Aldactone), which result would be a potential concern? a Serum sodium level of 140 mEq/L b Serum calcium level of 10.2 mg/dL c Serum potassium level of 5.8 mEq/L d Serum magnesium level of 2.0 mg/dL

c Serum potassium level of 5.8 mEq/L

During assessment of a patient who is receiving digoxin, the nurse monitors for findings that would indicate an increased possibility of toxicity, such as: a apical pulse rate of 62 beats/min. b digoxin level of 1.5 ng/mL. c serum potassium level of 2.0 mEq/L. d serum calcium level of 9.9 mEq/L.

c serum potassium level of 2.0 mEq/L.

When preparing an IV solution that contains potassium, the nurse knows that a contraindication to the potassium infusion would be a diarrhea. b serum sodium level of 145 mEq/L. c serum potassium level of 5.6 mEq/L. d dehydration.

c serum potassium level of 5.6 mEq/L.

After giving an injection to a patient with HIV infection, the nurse accidentally receives a needlestick from a too-full needle disposal box. Recommendations for occupational HIV exposure may include the use of which drug(s)? a didanosine b lamivudine and enfuvirtide c zidovudine, lamivudine, and indinavir d acyclovir

c zidovudine, lamivudine, and indinavir

Which statement when made by the patient indicates deficient knowledge regarding warfarin? a. "I will avoid contact sports." b. "I will take my medication in the early evening each day." c. "I will increase the dark green leafy vegetables in my diet." d. "I will contact my physician if I develop excessive bruising."

c. "I will increase the dark green leafy vegetables in my diet." **Dark green leafy vegetables are rich in vitamin K, which would antagonize the effects of warfarin. Therefore, it is important to maintain a consistent daily intake of vitamin K and avoid eating large amounts of these foods.

Which statement by the patient leads the nurse to believe that the patient has understood the teaching regarding ethambutol (Myambutol)? a. "Dizziness, drowsiness, and decreased urinary output are common with this drug, but they will subside over time." b. "Constipation will be a problem, so I will increase the fiber in my diet." c. "I will need to have my eyes checked periodically while I am taking this drug." d. "This medication may cause my bodily secretions to turn red-orange."

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

The nurse is assessing a patient noted to have third spacing and edema of the hands and feet at +3, yet the patient is having signs and symptoms of intravascular dehydration. The patient's lab results report a total protein level of 4.6 g/dL. What fluid does the nurse anticipate the provider will order for this patient? a. Normal saline b. Lactated Ringer's c. 5% albumin d. Whole blood

c. 5% albumin **If the total protein level falls below 5.3 g/dL, fluid shifts out of blood vessels into the tissues. When this happens, colloid replacement therapy is required to reverse this process by increasing the colloid oncotic pressure. The three most commonly used are 5% albumin, dextran 40, and hetastarch. They all have a very rapid onset of action as well as a long duration of action.

The nurse is teaching a patient who is preparing to travel to a malarious country about the prophylactic medication chloroquine. The nurse would instruct the patient to take chloroquine for how long after leaving the affected area? a. 2 weeks b. 4 weeks c. 8 weeks d. 12 weeks

c. 8 weeks **Treatment for malaria prophylaxis is usually started 2 weeks before travel and continues for 8 weeks after travel is completed.

The nurse would question the use of mannitol for which patient? a. A 67-year-old patient who ingested a poisonous substance b. A 21-year-old patient with a head injury c. A 47-year-old patient with anuria d. A 55-year-old patient who receives cisplatin to treat ovarian cancer

c. A 47-year-old patient with anuria **Mannitol is not metabolized but excreted unchanged by the kidneys. Potential water intoxication could occur if mannitol is given to a patient without urine output and thus renal function.

What is the priority nursing assessment to monitor when administering vaccinations? a. Pain at the injection site b. Signs and symptoms of infection c. Anaphylaxis d. Myalgias

c. Anaphylaxis ***Anaphylaxis is a potential life-threatening adverse reaction to vaccines. Pain and myalgias can occur but are not life threatening.

Before administering a dose of an antidysrhythmic drug to an assigned patient, which assessments would be of highest priority? a. Urine output and specific gravity b. Temperature and pulse rate c. Apical pulse and blood pressure d. Peripheral pulses and level of consciousness

c. Apical pulse and blood pressure **Antiarrhythmic drugs can cause both hypotension and bradycardia; therefore it is important to assess blood pressure and apical pulse before administration. Peripheral pulses are not as reliable as the apical pulse assessment.

In order to prevent the development of tolerance, the nurse instructs the patient to perform which action? a. Apply the nitroglycerin patch every other day. b. Switch to sublingual nitroglycerin when the patient's systolic blood pressure elevates to >140 mm Hg. c. Apply the nitroglycerin patch for 16 hours each and remove for 8 hours at night. d. Use the nitroglycerin patch for acute episodes of angina only.

c. Apply the nitroglycerin patch for 16 hours each and remove for 8 hours at night. **Tolerance can be prevented by maintaining an 8-hour nitrate-free period each day.

When teaching a patient receiving paclitaxel (Taxol), the nurse needs to prepare the patient for which adverse effect? a. Weight gain b. Vertigo c. Arthralgias d. Hypertension

c. Arthralgias ***Myalgias and arthralgias are a common side effect of paclitaxel that the patient should be prepared to expect.

To prevent the occurrence of cinchonism in a patient prescribed quinidine, what does the nurse emphasize as important? a. Wear sunscreen. b. Change positions slowly. c. Avoid drinking grapefruit juice. d. Increase dietary intake of potassium.

c. Avoid drinking grapefruit juice. **Grapefruit juice can also inhibit the metabolism of quinidine, which increases the risk of cinchonism.

During treatment with doxorubicin (Adriamycin), the nurse must monitor closely for which potentially life-threatening adverse effect? a. Nephrotoxicity b. Peripheral neuritis c. Cardiomyopathy d. Ototoxicity

c. Cardiomyopathy

A patient receiving a unit of red blood cells suddenly develops shortness of breath, chills, and fever. Following patient assessment, what is the nurse's initial action? a. Reassure the patient that this is an expected reaction. b. Notify the physician while a peer monitors the blood transfusion. c. Discontinue the infusion of packed cells. d. Decrease the infusion rate, and reassess the patient in 15 minutes.

c. Discontinue the infusion of packed cells. **These are signs and symptoms of a blood transfusion reaction that could escalate to anaphylaxis. Therefore it is a priority to immediately stop the blood transfusion.

A patient is admitted to the hospital with pneumonia and has a history of chronic renal insufficiency. Why does the physician order furosemide (Lasix) 40 mg twice a day? a. Furosemide will not cause potassium loss. b. Furosemide is effective in treating patients with pulmonary congestion. c. Furosemide is effective in treating patients with renal insufficiency. d. Furosemide will increase PO2 levels.

c. Furosemide is effective in treating patients with renal insufficiency. **Furosemide is effective in patients with creatinine clearance as low as 25 L/min (normal is 125 L/min).

The nurse would teach a patient prescribed cyclosporine to avoid which substance? a. Sunscreen b. Chocolate milk c. Grapefruit juice d. Acetaminophen

c. Grapefruit juice ***Patients should avoid consuming grapefruit or grapefruit juice because they will increase the blood concentrations of cyclosporine. Sunscreen should be used to avoid photosensitivity, and the medication should be taken with food or chocolate milk to prevent gastrointestinal upset.

The nurse would question an order for a calcium channel blocker in a patient with which condition? a. Angina pectoris b. Increased intracranial pressure c. Hypotension d. Dysrhythmia

c. Hypotension **Calcium channel blockers cause vasodilation and thus a drop in blood pressure. They are contraindicated in the presence of hypotension.

The nurse has provided education to a patient about fungal skin infections. The nurse needs to reinforce teaching when the patient includes what disorder in the discussion of fungal skin infections? a. Vaginal yeast infection b. Athlete's foot c. Impetigo d. Thrush

c. Impetigo **Impetigo is a bacterial skin infection and would not be classified as a fungal skin infection. If the patient included this in the discussion, further teaching is needed. All other skin infections listed are fungal and would be treated with antifungal medications.

The nurse is administering methotrexate as part of the treatment for rheumatoid arthritis and will monitor for which sign of bone marrow suppression? a. Edema b. Tinnitus c. Increased bleeding tendencies d. Tingling in the extremities

c. Increased bleeding tendencies

The nurse will assess a patient receiving gemfibrozil (Lopid) and warfarin (Coumadin) for which adverse effect? a. Increased risk of clotting b. Increased risk of vitamin K toxicity c. Increased risk of bleeding d. Deep vein thrombosis

c. Increased risk of bleeding **Gemfibrozil can bind with vitamin K in the intestinal tract, reducing vitamin K absorption. Since vitamin K is the antidote for warfarin, a lack of vitamin K increases the anticoagulant effect of warfarin and thus the risk of bleeding.

A nurse with adequate knowledge about the administration of intravenous nitroglycerin will recognize that which statement is correct? a. The intravenous form is given by IV push injection. b. Because the intravenous forms are short-lived, the dosing must be every 2 hours. c. Intravenous nitroglycerin must be protected from exposure to light through use of special tubing. d. Intravenous nitroglycerin can be given via gravity drip infusions.

c. Intravenous nitroglycerin must be protected from exposure to light through use of special tubing.

The most significant drug interactions with use of antivirals occur when antivirals are administered via which route? a. Topically b. Rectally c. Intravenously d. Optically

c. Intravenously ***Significant drug interactions that occur with antiviral drugs arise most often when they are administered via systemic routes such as intravenously and orally. Many of these drugs are also applied topically to the eye or body, however, and the incidence of drug interactions associated with these routes of administration is much lower.

Calcium channel blockers reduce myocardial oxygen demand by reducing afterload. How would the nurse explain afterload to the patient? a. It is the blood volume within the heart. b. It is the pressure within the heart. c. It is the pressure against which the heart must pump. d. It is the contractility of the heart muscle.

c. It is the pressure against which the heart must pump. **Afterload is determined by the pressure in the aorta just before systole.

The nurse is administering an intravenous aminoglycoside to a patient who has had gastrointestinal surgery. Which nursing measures are appropriate? (Select all that apply.) a. Report a trough drug level of 0.8 mcg/mL, and hold the drug. b. Enforce a strict fluid restriction. c. Monitor serum creatinine levels. d. Instruct the patient to report dizziness or a feeling of fullness in the ears. e. Warn the patient that the urine may turn darker in color.

c. Monitor serum creatinine levels. d. Instruct the patient to report dizziness or a feeling of fullness in the ears.

The patient is being treated with the drug fingolimod (Gilenya). What disease or disorder would the nurse expect the patient to have? a. Guillain-Barré syndrome b. Amyotrophic lateral sclerosis c. Multiple sclerosis d. Parkinson's disease and dementia

c. Multiple sclerosis ***A new drug, fingolimod (Gilenya), which actually failed as an antirejection drug, was approved in 2010 for multiple sclerosis. It is the only oral drug for relapsing forms of multiple sclerosis. It has significant adverse effects, including headache, hepatotoxicity, flulike symptoms, back pain, atrioventricular block, bradycardia, hypertension, and macular edema.

When giving intravenous quinolones, the nurse needs to keep in mind that these drugs may have serious interactions with which drugs? a. Selective serotonin reuptake inhibitor antidepressants b. Nonsteroidal antiinflammatory drugs c. Oral anticoagulants d. Antihypertensives

c. Oral anticoagulants

Adenosine is used to treat which condition? a. Atrial fibrillation b. Atrial flutter c. Paroxysmal supraventricular tachycardia (PSVT) d. Second-degree atrioventricular block

c. Paroxysmal supraventricular tachycardia (PSVT) **The only therapeutic indication of use for adenosine is the treatment of PSVT.

When assessing a patient who has been taking amiodarone for 6 months, the nurse monitors for which potential adverse effect? a. Hyperglycemia b. Dysphagia c. Photophobia d. Urticaria

c. Photophobia

A patient with a known heart condition is scheduled to have dental surgery and is prescribed antibiotics before the dental surgery. What type of therapy is this considered? a. Empiric therapy b. Definitive therapy c. Prophylactic therapy d. Supportive therapy

c. Prophylactic therapy ***Prophylactic antibiotic therapy is used to prevent infections in individuals who are at high risk of development of an infection during or after a procedure. The antibiotics are given before the procedure for prophylactic treatment.

The most severe adverse effects of amiodarone are evidenced in which body system? a. Renal b. Hepatic c. Pulmonary d. Hematologic

c. Pulmonary **Patients taking amiodarone must have baseline and serial pulmonary function tests in order to monitor for potential pulmonary toxicity.

Which is a complication of vancomycin infusions? a. Cardiomyopathy b. Angioedema c. Red man syndrome d. Neurotoxicity

c. Red man syndrome ***When infused too rapidly, patients receiving vancomycin may develop hypotension accompanied by flushing and warmth of the neck and face. This phenomenon is called red man syndrome.

The nurse is providing care to a patient newly admitted for trauma from a motor vehicle accident. The provider has ordered IV fluids with potassium. What information noted in the patient's history would alert the nurse to question the order for this IV fluid? a. Hypertension b. Cirrhosis of the liver c. Renal failure d. Multiple sclerosis

c. Renal failure **Potassium supplements are administered either to prevent or to treat potassium depletion. Potassium is contraindicated in patients with severe renal disease, severe hemolytic disease, or Addison's disease and in those with hyperkalemia, acute dehydration, or extensive tissue breakdown stemming from multiple traumas. The other history information is not contraindicated in the administration of potassium.

If extravasation of an antineoplastic medication occurs, which intervention will the nurse perform first? a. Apply cold compresses to the site while elevating the arm. b. Inject subcutaneous doses of epinephrine around the IV site every 2 hours. c. Stop the infusion immediately while leaving the catheter in place. d. Inject the appropriate antidote through the IV catheter.

c. Stop the infusion immediately while leaving the catheter in place.

Which statement best describes health care-associated infections? a. They occur outside the health care facility and are brought in by the patient. b. They are easier to treat than community-acquired infections. c. They are defined as health care-acquired infections that the patient did not have or incubate before admission. d. They develop in more than 30% of hospitalized patients.

c. They are defined as health care-acquired infections that the patient did not have or incubate before admission. ***Health care-associated infections occur in 5% to 10% of hospitalized patients and are very difficult to treat. They are incubated once the patient is admitted to a health care facility and are caused by germs that live within that environment.

What is the general action of immunosuppressants? a. They increase antibody response. b. They increase natural killer (NK) cellular activity. c. They suppress T-lymphocytes. d. They suppress hepatic metabolism of steroids.

c. They suppress T-lymphocytes. ***Immunosuppressants inhibit T-lymphocyte synthesis, thus preventing an immune response to organ transplants.

While assessing a woman who is receiving an antibiotic for community acquired pneumonia, the nurse notes that the patient has a thick, white vaginal discharge. The patient is also complaining about perineal itching. The nurse suspects that the patient has a. resistance to the antibiotic. b. an adverse effect of the antibiotic. c. a superinfection. d. an allergic reaction.

c. a superinfection.

When planning administration of hypertonic saline solution to treat a patient with severe hyponatremia, the nurse monitors for signs and symptoms of overdose as manifested by a. lethargy and hypotension. b. vomiting and diarrhea. c. flushed skin and increased thirst. d. confusion and seizures.

c. flushed skin and increased thirst. **Flushed skin and increased thirst are signs and symptoms of hypernatremia. The other choices are signs and symptoms of hyponatremia.

A patient with severe trauma is admitted to the intensive care unit. The patient has received 5000 mL of normal saline, is exhibiting peripheral edema, and remains hypotensive. The nurse anticipates administering which substance to correct fluid balance? a. Ringer's lactate b. A 3% saline solution c. hetastarch (Hespan) d. D5W

c. hetastarch (Hespan) **The patient needs to increase intravascular fluid volume. Hetastarch will enable this since it is a colloid that will increase osmotic pull from the extravascular spaces to the intravascular area. A 3% saline solution is also hypertonic, but its use is not preferred secondary to risk of hypernatremia.

The nurse would anticipate administering which medication to patients receiving high-dose methotrexate (Trexall)? a. bleomycin (Blenoxane) b. cisplatin (Platinol) c. leucovorin d. dactinomycin (Cosmegen)

c. leucovorin ***Leucovorin is given to block the systemic toxic effect of high-dose methotrexate. It is a form of folic acid that does not require dihydrofolate reductase to produce folic acid. Therefore it is used to prevent or treat toxicity induced by methotrexate, a folic acid antagonist. All the other options are chemotherapeutic drugs, which are not specifically associated with methotrexate.

The nurse would anticipate administering which medication to a patient demonstrating acute organ rejection? a. azathioprine (Imuran) b. basiliximab (Simulect) c. muromonab-CD3 (Orthoclone OKT3) d. sirolimus (Rapamune)

c. muromonab-CD3 (Orthoclone OKT3) ***Only muromonab-CD3 (Orthoclone OKT3) is used to treat acute organ rejection. The other immunosuppressants are used to prevent organ rejection.

The nurse will teach patients taking rifampin and INH prophylactically secondary to tuberculosis exposure that a. these drugs will only need to be taken for 7 to 10 days. b. INH may decrease serum glucose in susceptible people. c. oral contraceptives become ineffective when given with rifampin. d. tanning beds may be used to counteract the pale skin tone caused by these medications.

c. oral contraceptives become ineffective when given with rifampin. **Women taking oral contraceptives who are prescribed rifampin must be switched to another form of birth control because oral contraceptives become ineffective when given with rifampin. These medications must be taken long term because mycobacterium is slow growing. They can cause photosensitivity, necessitating the use of sunscreen, not tanning beds. Finally, INH may increase, not decrease, serum glucose levels.

Parents ask why their son has been prescribed Amoxicillin and clavulanic acid for otitis media since amoxicillin was ineffective? The nurse's response is based on the fact that the clavulanic acid: a. aids the penicillin in attaching to microbial penicillin binding proteins b. affects a wider spectrum of bacteria c. prevents pencillinase from inactivating the amoxicillin d. provides additional activity to disrupt the bacterial cell wall.

c. prevents pencillinase from inactivating the amoxicillin

Nausea and vomiting are frequent adverse effects associated with antineoplastic therapy. Patients who are experiencing this unpleasant effect will be advised a. to avoid eating any food during chemotherapy. b. that nothing can be done for this effect and that it will pass with time. c. to try to maintain hydration and nutrition, which are very important during treatment. d. to use antacids to relieve the irritation to the stomach, which should stop the nausea.

c. to try to maintain hydration and nutrition, which are very important during treatment. ***It is very important for patients undergoing chemotherapy to maintain adequate nutrition and hydration. Several antiemetic drugs are available that are very successful in controlling this side effect.

Because of the risk of prolonged QT interval, the nurse would consult the prescriber before administering erythromycin to a patient who has experienced? a. frequent headaches b. nausea c. unexplained fainting d. wheezing

c. unexplained fainting

A patient with diabetes has a new prescription for a thiazide diuretic. Which statement will the nurse include when teaching the patient about the thiazide drug? a "There is nothing for you to be concerned about when you are taking the thiazide diuretic." b "Be sure to avoid foods that are high in potassium." c "You need to take the thiazide at night to avoid interactions with the diabetes medicine." d "Monitor your blood glucose level closely, because the thiazide diuretic may cause the levels to increase."

d "Monitor your blood glucose level closely, because the thiazide diuretic may cause the levels to increase."

While monitoring a patient who is receiving an infusion of a crystalloid solution, the nurse will monitor for which potential problem? a Bradycardia b Hypotension c Decreased skin turgor d Fluid overload

d Fluid overload

The nurse is preparing an infusion for a patient who has a deficiency in clotting factors. Which type of infusion is most appropriate? a Albumin 5% b Packed RBCs c Whole blood d Fresh frozen plasma

d Fresh frozen plasma

The nurse is monitoring a patient who is receiving antithrombolytic therapy in the emergency department because of a possible MI. Which adverse effect would be of the greatest concern at this time? a Dizziness b Blood pressure of 130/98 mm Hg c Slight bloody oozing from the IV insertion site d Irregular heart rhythm

d Irregular heart rhythm

The nurse is reviewing the medications that have been ordered for a patient for whom a loop diuretic has just been prescribed. The loop diuretic may have a possible interaction with which of the following? a Vitamin D b warfarin c Penicillins d NSAIDs

d NSAIDs

While monitoring a patient, the nurse knows that a therapeutic response to antitubercular drugs would be: a The patient states that he or she is feeling much better. b The patient's laboratory test results show a lower white blood cell count. c The patient reports a decrease in cough and night sweats. d There is a decrease in symptoms, along with improved chest radiograph and sputum culture results.

d There is a decrease in symptoms, along with improved chest radiograph and sputum culture results.

The nurse is assessing a patient who is receiving a milrinone infusion and checks the patient's cardiac rhythm on the heart monitor. What adverse cardiac effect is most likely to occur in a patient who is receiving intravenous milrinone? a Tachycardia b Bradycardia c Atrial fibrillation d Ventricular dysrhythmia

d Ventricular dysrhythmia

When administering antifungal drug therapy, the nurse knows that an issue that contributes to many of the drug interactions with antifungals is the patient's a history of cardiac disease. b history of gallbladder surgery. c ethnic background. d cytochrome P-450 enzyme system

d cytochrome P-450 enzyme system.

When counseling a patient who has been newly diagnosed with TB, the nurse will make sure that the patient realizes that he or she is contagious a during all phases of the illness. b any time up to 18 months after therapy begins. c during the postictal phase of TB. d during the initial period of the illness and its diagnosis.

d during the initial period of the illness and its diagnosis.

The nurse is reviewing the medication history of a patient who is taking hydroxychloroquine. However, the patient's chart does not reveal a history of malaria or travel out of the country. The patient is most likely taking this medication for a Plasmodium. b thyroid disorders. c roundworms. d rheumatoid arthritis.

d rheumatoid arthritis.

What education and discharge information for a patient receiving an antilipemic medication would the nurse include for the patient? a. "This medication will take over for other interventions you have been trying to decrease your cholesterol." b. "It is important for you to double your dose if you miss one in order to maintain therapeutic blood levels." c. "Stop taking the medication if it causes nausea and vomiting." d. "Continue your exercise program, and maintain a diet high in omega-3 fatty acids."

d. "Continue your exercise program, and maintain a diet high in omega-3 fatty acids." **Antilipemic medications are an addition to, not a replacement of, the therapeutic regimen used to decrease serum cholesterol.

Which statement by the patient demonstrates a need for further education regarding nitroglycerin? a. "If I get a headache, I should keep taking my nitroglycerin and use Tylenol for pain relief." b. "I should keep my nitroglycerin in a cool, dry place." c. "I should change positions slowly to avoid getting dizzy from the nitroglycerin's effect on my blood pressure." d. "I can take up to four tablets at 5-minute intervals for chest pain."

d. "I can take up to four tablets at 5-minute intervals for chest pain." **Patients are taught to take up to three tablets 5 minutes apart. According to current guidelines, if the chest pain or discomfort is not relieved in 5 minutes, after one dose, the patient (or family member) must call 911 immediately.

Which statement, made by the patient, demonstrates a knowledge deficit regarding colestipol (Colestid)? a. "The medication may cause constipation, so I will increase fluid and fiber in my diet." b. "I should take this medication 1 hour after or 4 hours before my other medications." c. "I might need to take fat-soluble vitamins to supplement my diet." d. "I should mix and stir the powder in as small an amount of fluid as possible in order to maintain potency of the medication."

d. "I should mix and stir the powder in as small an amount of fluid as possible in order to maintain potency of the medication." **Colestipol is available as a powder that must be well diluted in fluids before administration to avoid esophageal irritation or obstruction and intestinal obstruction. The powder should not be stirred because it may clump—it should be left to dissolve slowly for at least 1 minute.

The nurse evaluates and determines the patient has a good understanding of the discharge instructions regarding warfarin (Coumadin) when the patient responds with which statement? a. "I will double my dose if I forget to take it the day before." b. "I should keep taking ibuprofen for my arthritis." c. "I should decrease the dose if I start bruising easily." d. "I should use a soft toothbrush for dental hygiene."

d. "I should use a soft toothbrush for dental hygiene." **The patient should reduce the risk of bleeding, such as using a soft toothbrush. The other choices are inaccurate.

Patient teaching regarding sublingual nitroglycerin should include which statement? a. "You can take up to five doses every 3 minutes for chest pain." b. "Chew the tablet for the quickest effect." c. "Keep the tablets locked in a safe place until you need them." d. "Sit or lie down after you take a nitroglycerin tablet to prevent dizziness."

d. "Sit or lie down after you take a nitroglycerin tablet to prevent dizziness." **Nitroglycerin is a vasodilator and can cause orthostatic hypotension, resulting in dizziness. It should be kept in a readily accessible location for immediate use should chest pain occur. Three tablets may be taken 5 minutes apart. It should be placed under the tongue and allowed to dissolve.

A patient asks about taking potassium supplements while taking spironolactone (Aldactone). What is the nurse's best response? a. "You are correct about your concern. I will make sure that you get some right away." b. "I will call your doctor and let him know of your concern." c. "Potassium supplements are usually not necessary with this type of diuretic." d. "You are on a diuretic that is potassium-sparing, so there is no need for extra potassium."

d. "You are on a diuretic that is potassium-sparing, so there is no need for extra potassium." **Spironolactone is a potassium-sparing diuretic and thus the patient does not need potassium supplementation. Although it is true that potassium supplements are not necessary with this type of diuretic, providing the patient with an explanation of why the potassium is not needed is a better response.

When preparing to administer metronidazole via an intravenous route, the nurse will anticipate administering the medication for how long? a. 1 to 5 minutes b. 5 to 10 minutes c. 15 to 30 minutes d. 30 to 60 minutes

d. 30 to 60 minutes **Infuse intravenous doses of metronidazole as ordered and generally over more than 30 to 60 minutes and never as an intravenous bolus.

A patient who is receiving chemotherapy with cisplatin (Platinol) has developed pneumonia. The nurse would be concerned about nephrotoxicity if which type of antibiotic was ordered as treatment for the pneumonia at this time? a. Penicillin b. Sulfa drug c. Fluoroquinolone d. Aminoglycoside

d. Aminoglycoside

The nurse would monitor which laboratory values in a patient receiving intravenous gentamicin (Garamycin)? a. Hematocrit and hemoglobin b. Serum glutamic-oxaloacetic transaminase (SGOT) and alanine transaminase (ALT) c. Prothrombin time (PT) and partial thromboplastin time (PTT) d. Blood urea nitrogen (BUN) and creatinine

d. Blood urea nitrogen (BUN) and creatinine Correct ***Gentamycin has a high potential for nephrotoxicity and is thus contraindicated in patients with elevated renal function tests such as BUN and creatinine.

When a patient is receiving metronidazole (Flagyl) via an intravenous route, what side effect would the nurse immediately report to the health care provider? a. Elevated blood pressure b. Diminished breath sounds c. Dark colored urine d. Dizziness or confusion, change in neurologic status

d. Dizziness or confusion, change in neurologic status **During use of this drug, metronidazole administered intravenously, report to the prescriber any changes in neurologic status (e.g., dizziness, confusion).

An allergy to which substance is listed as a contraindication to the administration of an immunizing drug? a. Soy b. Corn c. Wheat d. Egg

d. Egg ***Contraindications to the administration of immunizing drugs include allergy to the immunization itself or allergy to any of its components, such as eggs or yeast.

It is most important to instruct a patient prescribed nitroglycerin to avoid which substance(s)? a. Antacids b. Grapefruit juice c. Thiazide diuretics d. Erectile dysfunction medications

d. Erectile dysfunction medications **Concurrent administration of erectile dysfunction medications such as sildenafil citrate (Viagra) can cause an acute exacerbation of nitrate-related hypotension.

The nurse is monitoring a patient who has been receiving aldesleukin (IL-2) (Proleukin) for treatment of malignant melanoma. Which adverse effect, if noted on assessment, is of primary concern? a. Chills b. Fatigue c. Headache d. Fluid retention

d. Fluid retention

Administration of which of the following provides passive immunity? a. Vaccines b. Toxoids c. Antitoxins d. Immunoglobulins

d. Immunoglobulins ***Vaccines, antitoxins, and toxoids provide active immunity by stimulating the humoral immune system. Immunoglobulins provide passive immunity by giving the patient substances to fight specific antigens.

By which action does atorvastatin (Lipitor) decrease lipid levels? a. Inhibiting absorption of dietary cholesterol in the small intestine b. Binding to bile in the intestinal tract, forming an insoluble complex that is excreted in the feces c. Stimulating the biliary system to increase excretion of dietary cholesterol d. Inhibiting HMG-CoA reductase, the enzyme responsible for the biosynthesis of cholesterol in the liver

d. Inhibiting HMG-CoA reductase, the enzyme responsible for the biosynthesis of cholesterol in the liver **Atorvastatin (Lipitor) is an HMG-CoA reductase inhibitor, decreasing the synthesis of cholesterol in the liver.

During patient education regarding an oral macrolide such as erythromycin, the nurse will include which information? a. If GI upset occurs, the drug will have to be stopped. b. The drug needs to be taken with an antacid to avoid GI problems. c. The patient needs to take each dose with a sip of water. d. The patient may take the drug with a small snack to reduce GI irritation.

d. The patient may take the drug with a small snack to reduce GI irritation.

Which nitrate preparation or dosage form has the longest duration of action? a. Sublingual nitroglycerin b. Sublingual isosorbide dinitrate c. Oral isosorbide dinitrate d. Transdermal nitroglycerin patch

d. Transdermal nitroglycerin patch **The transdermal patch has an 8- to 12-hour duration of action, compared with 0.5 to 6 hours for the other choices.

A nurse needs to be aware that the antifungal drug with the most common adverse events is which drug? a. griseofulvin b. fluconazole c. ketoconazole d. amphotericin B

d. amphotericin B **The major adverse effects caused by antifungal drugs are encountered most commonly in conjunction with amphotericin B treatment. Drug interactions and hepatotoxicity are the primary concerns in patients receiving other antifungal drugs, but the intravenous administration of amphotericin B is associated with a multitude of adverse effects.

The nurse monitors a patient who is experiencing thrombocytopenia from severe bone marrow suppression by looking for a. severe weakness and fatigue. b. elevated body temperature. c. decreased skin turgor. d. excessive bleeding and bruising.

d. excessive bleeding and bruising.

Which antifungal drug can be given intravenously to treat severe yeast infections as well as a one-time oral dose to treat vaginal yeast infections? a. nystatin (Mycostatin) b. caspofungin (Cancidas) c. voriconazole (Vfend) d. fluconazole (Diflucan)

d. fluconazole (Diflucan) **Fluconazole is an antifungal drug that does not cause the severe side effects of amphotericin when given intravenously. It also has almost 100% bioavailability and therefore a single dose is often sufficient to treat vaginal yeast infections.

Which medication would the nurse question if prescribed concurrently with ACE inhibitors? a. furosemide (Lasix) b. morphine c. Colace d. potassium

d. potassium **ACE inhibitors block the conversion of angiotensin I to angiotensin II, thus also blocking the stimulus for aldosterone production. Aldosterone is responsible for potassium excretion—decreased aldosterone can result in increased serum potassium.

Before emergency surgery, the nurse would anticipate administering which medication to a patient receiving heparin? a. vitamin K b. vitamin E c. phenytoin d. protamine sulfate

d. protamine sulfate **Protamine sulfate binds with heparin in the bloodstream to inactivate it and thus reverse its effect.

The nurse is assessing for adverse effects of IV tobramycin. Which change would be priority to report to the prescriber? a. dilute urine b. headache c. limp, weak muscles d. ringing in the ears

d. ringing in the ears

What is the drug of choice for hospital-acquired MRSA? a. dicloxacillin b. nafcillin c. cefazolin d. vancomycin

d. vancomycin