Pharm Exam 7: Review Questions Ch 32, 34, 36, 37, 38

A nurse is caring for a client who is prescribed oral metronidazole (Flagyl) for a fungal infection. Which health history information should the nurse obtain? a. Alcohol use b. Nutritional intake c. Sexual activity d. Nicotine use

a. Alcohol use Rationale: In combination with alcohol, or other medications that may contain alcohol, metronidazole may elicit a disulfiram reaction with excessive nausea, vomiting, and possible hypotension. The nurse should caution the client regarding alcohol use while on this medication.

The nursing care plan for a client receiving epoetin alfa (Epogen, Procrit) should include careful monitoring for which symptom? a. Chest pain b. Severe hypotension c. Impaired liver function d. Severe diarrhea

a. Chest pain Rationale: Epoetin alfa increases the risk of thromboembolic disease. The client should be monitored for early signs of stroke or heart attack.

A nurse is caring for a client who will be receiving a protease inhibitor (PI)-based HAART regimen. Which drug combination should the nurse expect to administer to the client? a. Darunavir + emtricitabine + tenovir b. Efavirenz + emtricitabine + tenofovir c. Raltegravir + tenofovir + emtricitabine d. Dolutegravir + abacavir + lamivudine

a. Darunavir + emtricitabine + tenovir Rationale: Darunavir + emtricitabine + tenovir is the standard drug combination for PI-based regimen. Efavirenz + emtricitabine + tenofovir are combined to create a single drug named Atripla. Raltegravir + tenofovir + emtricitabine and dolutegravir + abacavir + lamivudine are integrase inhibitor-based regimens.

The nurse teaches the client to immediately report to the healthcare provider which adverse reaction to oprelvekin (Neumega)? a. Difficulty breathing b. Nausea c. Muscle pain d. Thirst

a. Difficulty breathing Rationale: Fluid retention is a common side effect of oprelvekin therapy. The client should be assessed for the symptoms of pleural effusion, which include difficulty breathing, cough, and dyspnea.

A nurse is caring for a client with chronic renal failure who is receiving epoetin alfa. Which health-promotion strategy should the nurse include in the client's plan of care? a. Encourage adequate dietary intake of iron and folic acid. b. Encourage frequent exercise or aerobic activity. c. Monitor for signs of cardiac adverse effects. d. Assess for symptoms of peripheral thrombosis.

a. Encourage adequate dietary intake of iron and folic acid. Rationale: The response to erythropoiesis-stimulating therapy may be decreased if blood levels of iron, folic acid, and vitamin B12 are deficient. Therefore, the nurse should encourage the client to maintain adequate dietary intake of iron, folic acid, and vitamin B12 (found in meats, dairy, eggs, fortified cereals and breads, leafy green vegetables, citrus fruits, dried beans, and peas). Provide dietary consult as needed and consider nutritional supplements of these nutrients if the diet is inadequate.

A nurse is caring for a client receiving iron preparation for treatment of iron-deficiency anemia. What are nursing considerations for administering this drug? (Select all that apply.) a. Monitor intravenous site for infiltration. b. Give the medication close to bedtime. c. Tablets may be crushed for ease of swallowing. d. Administer subcutaneously in the abdominal folds. e. Avoid taking antacids at the same time as the iron preparation. f. Take the medication 2 hours after a meal.

a. Monitor for infiltration at intravenous site; e. Avoid taking antacids at the same time as the iron preparation. Rationale: When administering intravenously, the nurse should be careful to prevent infiltration, because iron is highly irritating to tissues. Avoid taking antacids at the same time as the iron preparation. Ideally, iron preparations should be administered 1 hour before or 2 hours after a meal for maximum absorption. Taking the drug with food will diminish GI symptoms, but can decrease the absorption of iron by 50 percent to 70 percent. Do not crush tablets or empty contents of capsules when administering the drug. Do not give tablets or capsules within 1 hour of bedtime. Iron preparation should be administered intramuscularly using the Z-track method (deep muscle).

A nurse is caring for a client receiving the third round of chemotherapy, which includes a drug with high emetic potential. Which antiemetic drugs should the nurse anticipate to administer to the client prior to chemotherapy administration? (Select all that apply.) a. Ondansetron (Zofran) b. Prochlorperazine (Compazine) c. Megestrol (Megace) d. Metoclopramide (Reglan) e. Lorazepam (Ativan)

a. Ondansetron (Zofran); b. Prochlorperazine (Compazine); d. Metoclopramide (Reglan); e. Lorazepam (Ativan) Rationale: Before starting therapy with agents with high emetic potential, clients may be pretreated with antiemetic drugs such as ondansetron (Zofran), prochlorperazine (Compazine), metoclopramide (Reglan), and lorazepam (Ativan). Megestrol (Megace) is a progestin used to treat advanced endometrial cancer.

A 32-year-old female client comes to the clinic to update her immunizations. Which assessment information should the nurse obtain? (Select all that apply.) a. Possibility of pregnancy b. Sensitivity to albumin c. Quarantine status d. History of actual disease e. Previous reaction to vaccines

a. Possibility of pregnancy; b. Sensitivity to albumin; d. History of actual disease; e. Previous reaction to vaccines Rationale: When assessing a client prior to administration of immunizations, the nurse should obtain a complete health history, including pregnancy or breast-feeding, previous history of actual disease (e.g., chickenpox), any previous allergic response to immunizations or to products contained within immunization (e.g., yeast sensitivity, sensitivity to eggs or albumin products), and immunization history and any unusual reactions or responses that occurred.

The nurse administers DPT, polio, Hib, and hepatitis B immunizations to a 2-month-old child. Which instruction should the nurse provide to this child's mother? a. Remain in the clinic for 30 minutes for observation. b. Administer baby aspirin for fever and discomfort. c. Call the clinic if redness develops at the site of the injections. d. Return to the clinic for the next immunizations at 6 months of age.

a. Remain in the clinic for 30 minutes for observation. Rationale: The client should be observed for any immediate adverse reactions, especially anaphylaxis, following the administration of the immunizations. Common side effects of vaccines include fever and redness/discomfort at the site of the injection. Acetaminophen, not aspirin, is recommended to treat these common side effects. Cool compresses to the injection site may help alleviate malaise, fever, or injection site soreness. The next set of immunizations for this 2-month-old child will be at 4 months of age.

In case of extravasation during administration of carmustine (BiCNU) therapy, the nurse should be prepared to administer which antidote? a. Sodium bicarbonate and normal saline b. Leucovorin (folinic acid) c. Hyaluronidase d. Epinephrine (adrenalin)

a. Sodium bicarbonate and normal saline Rationale: Before administering intravenous antineoplastic agents, the nurse should know the emergency treatment for extravasation. Extravasation of carmustine is treated with injections of equal parts of sodium bicarbonate and normal saline into the extravasation site.

A 28-year-old female client with breast cancer is receiving methotrexate. Which information should the nurse include during client teaching? a. Use reliable birth control measures during and after therapy. b. Use aspirin or NSAIDs such as ibuprofen for minor discomfort. c. Take oral methotrexate with food to avoid gastric upset. d. Limit oral fluid intake during therapy with methotrexate.

a. Use reliable birth control measures during and after therapy. Rationale: Many antineoplastics are contraindicated in pregnancy. Methotrexate is pregnancy category X. Pregnancy should be avoided during therapy and for at least 6 months after therapy.

A client undergoing cancer chemotherapy asks the nurse why she is taking three different antineoplastics. Which is the most appropriate response by the nurse? a. "Your cancer was very advanced, and therefore it requires more medications." b. "Each drug attacks the cancer cells in a different way, increasing effectiveness of the therapy." c. "Several drugs are prescribed in order to find the right drug for your cancer." d. "One drug will cancel out the side effects of the other drugs you are receiving."

b. "Each drug attacks the cancer cells in a different way, increasing effectiveness of the therapy." Rationale: Effectiveness of chemotherapy is increased by use of multiple drugs from different classes that attack cancer cells at different points in the cell cycle, allowing for increased percentage of cell kill. This also allows lower doses of each individual agent to be used, thus reducing side effects. A third benefit of combination chemotherapy is reduced incidence of drug resistance.

A client taking methotrexate for cancer asks the nurse why leucovorin (folinic acid) has been prescribed. Which response by the nurse is most appropriate? a. "This drug is a vitamin to help with building up your resistance." b. "The drug protects normal cells from damage by methotrexate." c. "This is a second antineoplastic drug used to attack the cancer cells." d. "The drug will prevent arthritis that often accompanies methotrexate use."

b. "The drug protects normal cells from damage by methotrexate." Rationale: Leucovorin is administered with methotrexate to rescue normal cells and protect the client from severe bone marrow damage.

A nurse anticipates administering which drug to a client for influenza prophylaxis? a. Oseltamivir (Tamiflu) b. Amantadine (Symmetrel) c. Zanamivir (Relenza) d. Famciclovir (Famvir)

b. Amantadine (Symmetrel) Rationale: Amantadine (Symmetrel) and rimantadine (Flumadine) can be given to prevent influenza. Oseltamivir and zanamivir are classified as neuroaminidase inhibitors, which are used for treatment of influenza. Famciclovir is a drug used to treat herpesvirus infection.

A client is receiving cyclophosphamide (Cytoxan) therapy for treatment of Hodgkin's lymphoma. Which assessment finding should the nurse report to the healthcare provider? a. High blood pressure b. Blood in the urine c. High platelet count d. Mild alopecia

b. Blood in the urine Rationale: Several metabolites of cyclophosphamide may cause hemorrhagic cystitis if the urine becomes concentrated; patients should be advised to maintain high fluid intake during therapy.

The nurse is caring for a client receiving an oral antifungal medication. What should the nurse consider when administering this medication? a. Do not administer with food. b. Give with plenty of fluids. c. Alternate with capsule and oral solution. d. Can be given with an antacid.

b. Give with plenty of fluids. Rationale: The nurse should ensure adequate hydration in patients on oral or IV antifungals. Antifungal drugs are renal-toxic and adequate hydration helps to prevent adverse renal effects.

A nurse is caring for a client who has been on a prolonged interferon alfa-2b (Intron A) therapy. For what should the nurse monitor in this client? a. Nephrotoxicity b. Hepatotoxicity c. Hypertension d. Diabetes

b. Hepatotoxicity Rationale: Prolonged therapy with interferon alfa-2b can result in serious toxicities such as immunosuppression, hepatotoxicity, and neurotoxicity.

What should the nurse monitor while caring for a client receiving intravenous acyclovir (Zovirax) for acute herpesvirus infection? a. Nausea and vomiting b. Kidney function tests c. Liver function tests d. Cardiovascular status

b. Kidney function tests Rationale: Nephrotoxicity and neurotoxicity are possible when acyclovir is given intravenously. Values for kidney function tests such as blood urea nitrogen (BUN) and serum creatinine may increase and should be monitored closely.

A nurse is caring for a client who has been taking methotrexate (Rheumatrex) tablets for treatment of rheumatoid arthritis. Which assessment should the nurse conduct to determine whether the client is experiencing a serious adverse effect of the medication? a. Neurologic status b. Lung sounds c. Musculoskeletal function d. Sexual dysfunction

b. Lung sounds Rationale: Pulmonary fibrosis and pneumonia are serious adverse effects of methotrexate; therefore, the nurse should obtain baseline and follow-up assessments of the client's lung sounds.

A nurse is caring for a client who is experiencing pseudomembranous colitis. Which medication should the nurse anticipate administering? a. Pentamidine (Pentam) b. Metronidazole (Flagyl) c. Atovaquone (Malarone) d. Caspofungin (Cancidas)

b. Metronidazole (Flagyl) Rationale: Off-label uses of metronidazole include the pharmacotherapy of pseudomembranous colitis and Crohn's disease. Pentamidine is used for treatment of P. carinii. Atovaquone is an antimalarial drug. Caspofungin is used for treatment of candidiasis.

A client with a diagnosis of cancer is receiving epoetin alfa (Epogen, Procrit) as part of the treatment regimen. Which nursing action is most appropriate for determining the effectiveness of this drug? a. Assessing the client's energy level b. Monitoring the hematocrit and hemoglobin levels c. Monitoring the client's blood pressure d. Assessing the client's level of consciousness

b. Monitoring the hematocrit and hemoglobin levels Rationale: This medication does not cure the primary disease condition; however, it helps reduce the anemia that dramatically affects the client's ability to function. The hematocrit and hemoglobin levels will provide a reference for evaluating the drug's effectiveness.

A client will be taking mebendazole (Vermox) for a pinworm infection. What information should the nurse include regarding administration of this drug? a. The drug should be taken with a low-fat meal. b. Only a single dose of the drug will be taken. c. The medication should be swallowed whole. d. Increase fiber in the diet to prevent constipation.

b. Only a single dose of the drug will be taken. Rationale: For pinworm infections, a single dose of the medication is usually sufficient; other infections require 3 consecutive days of therapy. The drug is most effective when chewed and taken with a fatty meal. However, high-fat foods may increase the absorption of the drug. As the worms die, some abdominal pain, distention, and diarrhea may be experienced. Constipation is not an adverse effect of the drug.

A nurse is caring for a client receiving sargramostim (Leukine). What should the nurse assess when administering this medication? a. Blood pressure b. Respirations c. Level of consciousness d. Bowel sounds

b. Respirations Rationale: The nurse should assess the client's respiratory status, because respiratory distress may develop after the administration of sargramostim and should be reported immediately to the healthcare provider.

A nurse is caring for a client who will be receiving a vaccination to confer passive immunity. Which agent should the nurse anticipate administering to the client? a. Poliovirus, inactivated (poliovax) b. Rh0(D) immune globulin (RhoGAM) c. Pneumococcal, polyvalent (Pneumovax 23) d. Measles, mumps, and rubella (MMR II)

b. Rh0(D) immune globulin (RhoGAM) Rationale: To confer passive immunity, the individual is given antibodies—in the form of immunoglobulins—against the foreign agent. This form of immunity has a fast onset, but lasts only 3-6 months, and the immune system does not mount a response. The administration of RhoGAM is an example of this type of indication. The other agents are vaccines that confer active immunity.

The nurse should monitor a transplant patient for the major adverse effect of cyclosporine therapy by evaluating which laboratory test? a. Complete blood count (CBC) b. Serum creatinine c. Liver enzymes d. Electrolyte levels

b. Serum creatinine Rationale: The primary adverse effect of cyclosporine occurs in the kidneys, with up to 75 percent of patients experiencing reduction in urine output. Serum creatinine level is a good indicator of renal function.

A nurse is caring for a client receiving tamoxifen for breast cancer prophylaxis. For which serious adverse effects should the nurse monitor while the client is on this medication? (Select all that apply.) a. Hypotension b. Stroke c. Uterine cancer d. Cataracts e. Hot flashes

b. Stroke; c. Uterine cancer Rationale: The most serious problem associated with tamoxifen use is the increased risk of uterine cancer. Black Box warning also include risk for thromboembolic disease, including stroke, pulmonary embolism, and deep vein thrombosis. Hypertension and edema occur in about 10 percent of patients taking the drug. Ocular toxicity is not an adverse effect of tamoxifen. Hot flashes are a common adverse effect of the drug.

A nurse is caring for a client who tested positive for HIV infection and will be starting highly active antiretroviral therapy (HAART). What is the most accurate information the nurse can provide about HAART? a. The main purpose of the therapy is to prevent HIV transmission. b. The goal of the therapy is to keep plasma HIV levels as low as possible. c. The primary target of the therapy is HIV present in the lymph nodes. d. The aim of the therapy is to restore and preserve immunologic function.

b. The goal of the therapy is to keep plasma HIV levels as low as possible. Rationale: The goal of HAART is to reduce the plasma HIV RNA to its lowest possible level. However, HIV is harbored in locations other than the blood, such as lymph nodes; therefore, elimination of the virus from the blood is not a cure.

When the client is started on antiretroviral drugs for management of HIV infection, which information is important for the nurse to provide the client? a. This drug therapy will cure the disease over a period of time. b. This drug regimen can extend life expectancy. c. This drug therapy is used prior to giving the vaccine. d. This drug regimen is available throughout the world.

b. This drug regimen can extend life expectancy. Rationale: Although pharmacotherapy for HIV-AIDS has not produced a cure, many patients with HIV infection are able to live symptom-free with the disease for a longer time because of medications. Along with better patient education and prevention, successes in pharmacotherapy have produced a 70 percent decline in the death rate due to HIV-AIDS in the United States.

A client diagnosed with a systemic fungal infection is prescribed amphotericin B (Fungizone). The nurse should include which information during client education? a. "Drug therapy will be for a very short time, probably 2-4 weeks." b. "Carefully inspect all intramuscular injection sites for bruising." c. "Notify the clinic if you gain 2 pounds or more in a 24-hour period." d. "You can stop the medication when you start feeling better."

c. "Notify the clinic if you gain 2 pounds or more in a 24-hour period." Rationale: Amphotericin B (Fungizone) causes some degree of kidney damage in 80 percent of patients who take the drug. Excessive weight gain or edema may indicate renal dysfunction, so the nurse should instruct the patient to report a weight gain of more than 1 kg (2 lbs) in a 24-hour period.

A nurse should administer hepatitis A immunoglobulin (HAIg) to which client? a. A 6-year-old child who lives in a rural area b. A client who uses illicit drugs intravenously c. A client traveling to a country where HAV is prevalent d. A male client who has sex with other men

c. A client traveling to a country where HAV is prevalent Rationale: Hepatitis A immunoglobulin (HAIg) is administered as prophylaxis for patients traveling to endemic areas and to close personal contacts of infected patients to prevent transmission of the virus. A single intramuscular (IM) dose of HAIg can provide passive protection and prophylaxis for about 3 months. On the other hand, HAV vaccine (Havrix, VAQTA) is indicated for all children ages 2-18, travelers to countries with high HAV infection rates, men who have sex with men, and illegal drug users.

The nurse is caring for a client receiving a series of antineoplastic drugs for treatment of lung cancer. Which lab results should the nurse monitor to assess the client's risk for infection? a. BUN and serum creatinine b. Serum electrolytes c. Complete blood count d. Bone scan

c. Complete blood count Rationale: The nurse should monitor for low white blood counts resulting from bone marrow suppression. The complete blood count (CBC) with differential will provide information regarding the client's white bl

A nurse is caring for a client who will be receiving chloroquine (Aralen) for acute infection with malaria. Which nursing action is most appropriate to take prior to administration of this drug? a. Obtain a comprehensive travel history. b. Send stool sample for O & P testing. c. Conduct a baseline visual exam. d. Assess respiratory status.

c. Conduct a baseline visual exam. Rationale: Chloroquine can cause retinal toxicity, including blurred vision, photophobia, and difficulty focusing. Because chloroquine can cause retinal toxicity, it is contraindicated in patients with pre-existing retinal or visual field changes.

A nurse is caring for a client who is receiving cyanocobalamin injections once a month. For what should the nurse monitor while the client is on this drug? a. Bone marrow depression b. Lack of intrinsic factor c. Hypokalemia d. Hemorrhage

c. Hypokalemia Rationale: Hypokalemia is possible in patients receiving cyanocobalamin; thus, the nurse should monitor serum potassium levels periodically.

The client receiving chemotherapy is prescribed oprelvekin (Neumega) as part of the treatment regimen. Which explanation by the nurse of the rationale for the drug is most accurate? a. It promotes white blood cell production. b. It reverses bone marrow suppression. c. It stimulates platelet cell production. d. It reduces excessive immature white cells.

c. It stimulates platelet cell production. Rationale: Oprelvekin is used to enhance the production of platelets in patients who are at risk for thrombocytopenia caused by cancer chemotherapy. The drug shortens the time that the patient is thrombocytopenic and very susceptible to adverse bleeding events.

A nurse is caring for a client who is receiving high doses of chloroquine (Aralen) for acute infection with malaria. Which is the most appropriate action for the nurse to take? a. Monitor the client's respirations the first 30 minutes after taking the first dose. b. Ensure that daily weights are taken every morning and documented in the chart. c. Obtain baseline neurologic and cardiovascular status, and assess regularly. d. Administer the medication with antacids to prevent gastrointestinal distress.

c. Obtain baseline neurologic and cardiovascular status, and assess regularly. Rationale: At higher doses of the drug chloroquine, CNS and cardiovascular toxicity may be observed.

A nurse is caring for a newborn whose mother has an HIV infection. Which pharmacotherapy intervention should the nurse implement? a. Oral administration of trimethoprim-sulfamethoxazole (Bactrim) within 24 hours of birth b. Intravenous administration of zidovudine following confirmation of HIV status in 1 week c. Oral administration of zidovudine immediately after delivery and for the next 6 weeks d. Intramuscular administration of HIV vaccine, with a booster shot within 6 months

c. Oral administration of zidovudine immediately after delivery and for the next 6 weeks Rationale: To decrease the risk of HIV transmission to the newborn, the regimen includes oral administration of zidovudine to the newborn to begin immediately after delivery and continuing for 6 weeks following delivery. Starting antiretroviral therapy more than 48 hours after birth is ineffective in preventing the infection. In addition to antiretrovirals, infants born to women with HIV infection usually receive trimethoprim-sulfamethoxazole at 4-6 weeks of age to prevent Pneumocystis jiroveci pneumonia.

A client is prescribed paromomycin (Humatin) for an intestinal amebiasis infection. For which serious adverse effect should the nurse monitor in the client? (Select all that apply.) a. Agranulocytosis b. Peripheral neuropathy c. Ototoxicity d. Transient leukopenia e. Nephrotoxicity

c. Ototoxicity; e. Nephrotoxicity Rationale: Serious adverse effects of paromomycin include ototoxicity and nephrotoxicity.

A nurse is preparing to administer immunostimulant therapy to a client. Which client condition would warrant immediate notification of the healthcare provider? a. Viral infection b. Immunodeficiency c. Pregnancy d. Cancer

c. Pregnancy Rationale: Immunostimulant drugs should be used with high precaution in pregnant clients due to the neurological adverse effects, which can harm the fetus. Viral infection, immunodeficiency disease, and cancer are indications for use of immunostimulant drugs.

10. A nurse is caring for a client diagnosed with hepatitis C virus (HCV) infection. Which pharmacotherapies should the nurse anticipate to administer to this client? (Select all that apply.) a. HCV immunoglobulin b. Twinrix c. Ribavarin d. Tenofovir disoproxil (Viread) e. Pegylated interferon (PEG-IFN) f. Telaprivir (Incivek)

c. Ribavarin; e. Pegylated interferon (PEG-IFN); f. Telaprivir (Incivek) Rationale: Current pharmacotherapy for chronic HCV infection includes PEG-IFN, the antiviral ribavirin, and protease inhibitors (e.g., boceprivir (Victelis) and telaprivir (Incivek)). The three-drug combination produces a more sustained viral inhibition, especially in patients with cirrhosis.

Which information should the nurse emphasize when providing education to a client receiving drug therapy for HIV-AIDS? a. It will take about 1 year of therapy to reduce plasma HIV to undetectable levels. b. Genotypic drug testing is performed to determine the client's resistance to the therapy. c. Strict adherence to the drug regimen promotes effectiveness of the therapy. d. The medications can help the client become a long-term nonprogressor.

c. Strict adherence to the drug regimen promotes effectiveness of the therapy. Rationale: To be successful, antiretroviral therapy requires strict patient compliance with a complex regimen. The goal of antiretroviral therapy is to reduce plasma HIV RNA to less than 75 copies/mL.

A nurse is administering pneumonia vaccinations to older adults during a community health fair. Which significant information should the nurse emphasize with the clients regarding this immunization? a. The immunization is free of charge. b. The immunization is required annually. c. The immunization can decrease mortality. d. The immunization can eradicate the disease.

c. The immunization can decrease mortality. Rationale: Of the vaccine-preventable diseases, pneumococcal pneumonia is the most lethal, with about 4,250 deaths occurring annually in the United States. The Centers for Disease Control and Prevention (CDC, 2015) recommends 1 or 2 doses of the pneumococcal vaccine for adults age 19 and older. Nurses play a key role in encouraging patients to be vaccinated according to established guidelines.

A client undergoing antineoplastic therapy is also prescribed filgrastim (Neupogen). The client asks the nurse why he is receiving this new medication. Which would be the best response by the nurse? a. This drug works with chemotherapy to attack cancer cells. b. This drug helps reduce nausea during chemotherapy. c. This drug helps decrease the risk of opportunistic infections. d. This drug will help prevent hair loss during chemotherapy.

c. This drug helps decrease the risk of opportunistic infections. Rationale: The administration of filgrastim often prevents or shortens the time period of neutropenia, thus lowering the risk of opportunistic infections and allowing the patient to maintain an optimum dosing schedule.

Which statement by a client taking cyclosporine would indicate a need for further teaching by the nurse? a. "I will report any reduction in urine output to my healthcare provider." b. "I will wash my hands frequently and thoroughly." c. "I will take my blood pressure at home every day." d. "I will take cyclosporine at breakfast with a glass of grapefruit juice."

d. "I will take cyclosporine at breakfast with a glass of grapefruit juice." Rationale: Grapefruit juice will increase cyclosporine levels 50 percent to 200 percent, resulting in drug toxicity. Thus, the nurse should instruct the client to avoid taking cyclosporine with grapefruit juice. Handwashing is important to prevent infection while taking cyclosporine. Renal toxicity and hypertension are adverse effects of cyclosporine therapy for which the client should monitor and which the client should report to the healthcare provider.

A nurse is caring for a pediatric client with Wilms tumor and is receiving vincristine (Oncovin) for treatment. The nurse should routinely perform which assessment when caring for this client? a. Level of consciousness b. Respiratory effort c. Nutritional intake d. Abdominal sounds

d. Abdominal sounds Rationale: Severe constipation is common and paralytic ileus may occur in young children receiving vincristine. Therefore, the nurse should frequently conduct an abdominal assessment.

A nurse is caring for a client with diabetes who is being treated for infection with Candida. When administering fluconazole (Diflucan) to this client, which nursing action is most appropriate? a. Instruct the client to chew the tablet. b. Double the dose the next day if a dose is missed. c. Provide at least eight glasses of water daily. d. Assess the client for signs of hypoglycemia.

d. Assess the client for signs of hypoglycemia. Rationale: Hypoglycemia may result if fluconazole is administered concurrently with certain oral hypoglycemics, including glyburide. Therefore, the most appropriate nursing action is to assess the client for signs of hypoglycemia.

The nurse should monitor the client receiving filgrastim (Neupogen) for which common adverse effect? a. Hypoglycemia b. Elevated liver enzymes c. Elevated serum creatinine d. Bone pain

d. Bone pain Rationale: Bone pain may occur in up to 33 percent of patients receiving filgrastim. Bone pain tends to occur 2-3 days prior to rise in circulating WBC due to the production of WBCs in bone marrow. Other common adverse effects of the drug include fatigue, rash, epistaxis, decreased platelet counts, neutropenic fever, nausea, and vomiting.

A nurse caring for a client who has an HIV infection should monitor for effectiveness of antiretroviral therapy using which laboratory test? a. Complete blood count b. Absolute neutrophil count c. Blood cultures d. CD4 lymphocyte count

d. CD4 lymphocyte count. Rationale: Two laboratory tests used to monitor the progress of pharmacotherapy of HIV are absolute CD4 T-cell count and measurement of HIV RNA in the plasma. The number of CD4 T-cells is an important indicator of immune function and predicts the likelihood of opportunistic disease and the need for prophylactic antibiotic therapy; however, it does not indicate how rapidly HIV is replicating. CD4 counts are performed every 3-6 months to assess the degree of effectiveness of antiretroviral therapy.

A client who is receiving cyclosporine after a heart transplant exhibits a sore throat, fatigue, low-grade fever, and white blood count of 12,000 cells/mm3. The nurse should anticipate planning interventions for which client condition? a. Transplant rejection b. Heart failure c. Dehydration d. Infection

d. Infection. Rationale: Transplant patients on immunosuppressant therapy are at high risk for infections, and the client is exhibiting such symptoms. Therefore, the nurse should plan to implement interventions for treatment and management of an infection.

What should the nurse anticipate as the rationale for administering filgrastim (Neupogen) to a client? a. Bone marrow transplant immunosuppressant b. Diagnosis of acute lymphoblastic leukemia c. Treatment for non-Hodgkin's lymphoma d. Neutropenia secondary to chemotherapy

d. Neutropenia secondary to chemotherapy Rationale: Filgrastim is a colony-stimulating factor used primarily for chronic neutropenia or neutropenia secondary to chemotherapy. Administration of filgrastim will shorten the length of time of neutropenia in patients with cancer whose bone marrow has been suppressed by antineoplastic drugs or in patients following bone marrow or stem cell transplants.

A nurse is caring for a client who is prescribed nystatin (Mycostatin) suspension for oral candidiasis. Which instruction is most appropriate for the nurse to provide with administration of this drug? a. Take the medication with meals to prevent nausea and vomiting. b. Swallow the medication dose quickly, and drink a full glass of water. c. Apply the medication in affected areas of the mouth using a swab applicator. d. Swish the liquid medication in the mouth for approximately 2 minutes.

d. Swish the medication in the mouth for 2 minutes. Rationale: For adults with oral candidiasis, the drug should be swished in the mouth for at least 2 minutes. The medication is applied with a swab to the affected area in infants and children because swishing is difficult or impossible.