Pharm Final (Ch. 78-80, 83-95, 101-103)
A nurse is discussing the care of a patient with cancer with a nursing student. The patient is about to begin chemotherapy with a bifunctional alkylating agent. Which statement by the student indicates an understanding of this chemotherapeutic agent?
"Alkylating agents are toxic to tissues that have rapidly dividing cells."
A patient asks a nurse about ways to minimize side effects of chemotherapy. Which response is correct?
"Avoid contact with people who are ill."
A nursing student asks a nurse to explain the differences between amphotericin B [Abelcet] and the azoles group of antifungal agents. Which statement by the nurse is correct?
"Azoles have lower toxicity than amphotericin B."
A nurse is teaching a group of nursing students about cancer treatment. Which statement by a student indicates an understanding of the characteristics of cancer cells?
"Cancer cells are characterized by unrestrained growth and division."
A nurse is explaining to nursing students why a cephalosporin is used in conjunction with an aminoglycoside for a patient with an infection. Which statement by a student indicates understanding of the teaching?
"Cephalosporins enhance the actions of aminoglycosides by weakening bacterial cell walls."
A nurse is teaching a group of nursing students about how cytotoxic anticancer drugs affect normal cells. Which statement by a student indicates an understanding of this teaching?
"Cytotoxic drugs lack tissue specificity."
A patient has lamivudine-resistant hepatitis B and has been taking entecavir [Baraclude] for 2 years. The patient asks the nurse why the provider has recommended taking the drug for another year. What will the nurse tell the patient?
"Entecavir can reverse fibrosis and cirrhosis of the liver when taken long term."
A patient who has leukemia is receiving chemotherapy and develops severe anemia. The provider has ordered hospitalization and blood transfusions. The patient asks the nurse about using erythropoietin (epoetin alfa) instead. What will the nurse tell this patient?
"Erythropoietin (epoetin alfa) can make your leukemia worse."
A nurse is teaching a patient who will undergo chemotherapy with fluorouracil [Adrucil] to treat a solid tumor. Which statement by the patient indicates understanding of this chemotherapeutic agent's actions?
"Fluorouracil acts to deprive cancer cells of thymidylate needed to make DNA."
A patient is receiving gentamicin once daily. A nursing student asks the nurse how the drug can be effective if given only once a day. The nurse explains drug dosing schedules for aminoglycosides. Which statement by the student indicates a need for further teaching?
"Gentamicin has a longer half-life than other aminoglycosides."
A nurse is providing teaching for a patient who will begin taking clarithromycin ER [Biaxin XL] to treat an Helicobacter pylori infection. Which statement by the patient indicates understanding of the teaching?
"I may experience distorted taste when taking this medication."
A patient is being treated for a systemic fungal infection with amphotericin B [Abelcet] and will be discharged home from the hospital to complete every other day infusions of the medication for 6 to 8 weeks. The nurse provides discharge teaching before dismissal. Which statement by the patient indicates a need for further teaching?
"I may experience headaches and pain in my lower back, legs, and abdomen."
The nurse is caring for a patient who is human immunodeficiency virus (HIV) positive and is taking high doses of zidovudine [Retrovir]. The nurse is providing patient education about the adverse effects of the medication. Which statement by the patient demonstrates a need for further teaching?
"I may have a deficiency of vitamin B6."
A nurse provides teaching to a patient who will begin taking oral cyclophosphamide to treat non-Hodgkin's lymphoma. Which statement by the patient indicates an understanding about how to minimize side effects while taking this drug?
"I should drink plenty of fluids while taking this drug."
A nurse is teaching a group of nursing students about influenza prevention. Which statement by a student indicates understanding of the teaching?
"I should receive the vaccine every year in October or November."
A nurse teaches a patient about sulfonamides. Which statement by the patient indicates a need for further teaching?
"I should stop taking this drug when my symptoms are gone."
A patient will receive oral ciprofloxacin [Cipro] to treat a urinary tract infection. The nurse provides teaching for this patient. Which statement by the patient indicates a need for further teaching?
"I should take this medication with food or milk to improve absorption."
A nurse is discussing intravenous amphotericin B treatment with a nursing student who is about to care for a patient with a systemic fungal infection. Which statement by the student indicates a need for further teaching?
"Infusions of amphotericin B should be administered over 1 to 2 hours."
A patient is diagnosed with periodontal disease, and the provider orders oral doxycycline [Periostat]. The patient asks the purpose of the drug. What is the nurse's response?
"It inhibits collagenase to protect connective tissue in the gums."
The nurse is providing education to a patient with ulcerative colitis who is being treated with sulfasalazine [Azulfidine]. What statement by the patient best demonstrates understanding of the action of sulfasalazine?
"It reduces the inflammation."
A nursing student asks a nurse about flucytosine [Ancobon]. Which statement by the nurse is correct?
"Resistance is common with this medication."
A nurse is discussing microbial resistance among sulfonamides and trimethoprim with a nursing student. Which statement by the student indicates a need for further teaching?
"Resistance to sulfonamides is less than resistance to trimethoprim."
A patient with chronic myeloid leukemia (CML) begins treatment with imatinib [Gleevec]. Which statement by the patient indicates understanding of this medication?
"Resistance to this drug may develop over time."
The nurse is teaching a nursing student about the mechanism by which antimicrobial agents achieve selective toxicity. Which statement by the student indicates a need for further teaching?
"Some agents cause phagocytosis of bacterial cells."
The nurse is providing education to a group of patients who are HIV positive. The nurse is discussing the various medications used to treat HIV infection. A patient asks about nevirapine [Viramune]. Which statements by the nurse most accurately reflect the facts about nevirapine? (Select all that apply.)
"Some herbal preparations can reduce the levels of this drug." "This agent can damage the liver; therefore, liver function tests are needed periodically." "You should call your healthcare provider immediately if you develop a rash."
A patient who is taking immunosuppressant medications develops a urinary tract infection. The causative organism is sensitive to sulfonamides and to another, more expensive antibiotic. The prescriber orders the more expensive antibiotic. The nursing student assigned to this patient asks the nurse why the more expensive antibiotic is being used. Which response by the nurse is correct?
"Sulfonamides are bacteriostatic and depend on host immunity to work."
A nurse explains to a patient with cancer why it is difficult to achieve 100% cell kill to cure cancer with chemotherapy. Which statement by the patient indicates a need for further teaching?
"The immune system attacks chemotherapeutic agents and renders them impotent."
A nurse provides teaching for a patient with cytomegalovirus (CMV) retinitis who will receive the ganciclovir ocular implant [Vitrasert]. Which statement by the patient indicates a need for further teaching?
"The implant will remain in place permanently."
The nurse wants to evaluate a nursing student's understanding of chemotherapy. The nurse asks, "Which factor would be a major obstacle to successful chemotherapy?" What is the student's best response?
"The toxicity of anticancer drugs to normal tissues."
A nurse is discussing vesicant chemotherapeutic agents with a nursing student. Which statement by the student indicates a need for further teaching about this type of drug?
"These drugs may be administered orally as well as intravenously."
A pregnant patient with fever, flank pain, and chills has a history of two previous bladder infections before getting pregnant. She is allergic to several antibiotics. She reports having taken methenamine successfully in the past. What will the nurse tell her?
"This agent is not effective against infections of the upper urinary tract."
A patient with cancer has a tumor composed mostly of G0 cells. When teaching this patient about the disease, the nurse will make which statement?
"This tumor will be managed primarily with surgery."
A patient has come to the clinic with tinea corporis, and the prescriber has ordered clotrimazole. When educating the patient about this medication, the nurse will include which statement?
"Use the medication for at least 1 week after the symptoms have cleared."
A nurse is teaching a group of adolescent students about sexually transmitted diseases. Which statement by a student indicates understanding of infections caused by C. trachomatis?
"Women with asymptomatic Chlamydia trachomatis infections can become sterile."
A patient is about to begin treatment for latent tuberculosis. The patient is an alcoholic, has difficulty complying with drug regimens, and has mild liver damage. What will the nurse tell this patient?
"You must take isoniazid with close monitoring of hepatic function."
A healthcare worker who is asymptomatic has a screening TST result of 10 mm of induration during a pre-employment physical. What will the nurse reading this test tell the patient?
"You need to have a chest radiograph and a sputum culture."
A patient who has gastroesophageal reflux disease (GERD) receives a prescription for a proton pump inhibitor (PPI) medication. What will the nurse include when teaching the patient about this drug?
"You should report any fever and cough to your provider."
A patient with gastroesophageal reflux disease (GERD) is to begin taking oral metoclopramide [Reglan]. The patient asks the nurse about the medication. Which response by the nurse is correct?
"You should take the drug 30 minutes before each meal and at bedtime."
A patient who is taking didanosine [Videx] reports nausea, vomiting, and abdominal pain. What will the nurse recommend to this patient?
"You will need laboratory tests to determine if these are serious effects of the drug."
A 30-year-old male patient reports having two to four urinary tract infections a year. What will the nurse expect to teach this patient?
"You will need to take a low dose of medication for 6 months to prevent infections."
A patient who has drug-sensitive tuberculosis has completed 2 months of the standard four-drug therapy and asks the nurse how long he will have to take medication. Which response by the nurse is correct?
"You will need to take only two drugs for the next 4 months."
A newborn infant has been given erythromycin ophthalmic ointment as a routine postpartum medication. The infant's mother learns that she has a C. trachomatis infection and asks the nurse if her baby will need to be treated. Which response by the nurse is correct?
"Your baby will need to be treated with oral erythromycin."
The parent of a 5-year-old child who has had four urinary tract infections in the past year asks the nurse why the provider doesn't just order an antibiotic for the child's current symptoms of low-grade fever, flank pain, and dysuria since these are similar symptoms as before. Which is the most important reason given by the nurse?
"Your child may need tests to assess for urinary tract abnormalities."
A child has ringworm of the scalp. A culture of the lesion reveals a dermatophytic infection. The nurse teaching the child's parents about how to treat this infection will include which statement?
"Your child will need to take this oral medication for 6 to 8 weeks."
A patient is admitted to the unit for treatment for an infection. The patient receives IV amikacin [Amikin] twice a day. When planning for obtaining a peak aminoglycoside level, when should the nurse see that the blood is drawn?
30 minutes after the IV infusion is complete
A patient is receiving tobramycin 3 times daily. The provider has ordered a trough level with the 8:00 AM dose. The nurse will ensure that the level is drawn at what time?
7:45 AM
A young, nonpregnant female patient with a history of a previous urinary tract infection is experiencing dysuria, urinary urgency and frequency, and suprapubic pain of 3 days' duration. She is afebrile. A urine culture is positive for more than 100,000/mL of urine. The nurse caring for this patient knows that which treatment is most effective?
A 3-day course of trimethoprim/sulfamethoxazole [Bactrim]
Which patient should begin treatment for tuberculosis?
A recent immigrant from a country with a high prevalence of TB with a 10-mm region of induration
A patient who is taking gentamicin and a cephalosporin for a postoperative infection requests medication for mild postsurgical pain. The nurse will expect to administer which of the following medications?
Acetaminophen
The nurse is preparing to administer amphotericin B intravenously. The nurse will expect to pretreat the patient with which medications?
Acetaminophen [Tylenol], diphenhydramine [Benadryl], and meperidine [Demerol]
A patient complains of painful urination. A physical examination reveals vesicles on her labia, vagina, and the foreskin of her clitoris. The nurse will expect to teach this patient about which medication?
Acyclovir [Zovirax]
A patient has a systemic candidal infection, and the provider has ordered oral fluconazole [Diflucan] 400 mg on day 1 and 200 mg once daily thereafter. What will the nurse do?
Administer the drug as ordered.
A patient is taking oral ketoconazole [Nizoral] for a systemic fungal infection. The nurse reviews the medication administration record and notes that the patient is also taking omeprazole [Prilosec] for reflux disease. What action should the nurse take?
Administer the omeprazole at least 2 hours after the ketoconazole.
A nurse is preparing to administer medications to a patient recently started on delavirdine [Rescriptor]. Which concurrent prescription should the nurse question before administration?
Alprazolam [Xanax]
A patient will begin chemotherapy with cisplatin. Which medications will the nurse expect to administer to offset this agent's side effects?
Amifostine [Ethyol], diuretics, and antiemetics
A patient is diagnosed with a lung infection caused by P. aeruginosa. The culture and sensitivity report shows sensitivity to all aminoglycosides. The nurse knows that the rate of resistance to gentamicin is common in this hospital. The nurse will expect the provider to order which medication?
Amikacin [Amikin]
Which patient with a urinary tract infection will require hospitalization and intravenous antibiotics?
An older adult man with a low-grade fever, flank pain, and an indwelling catheter
A patient who is taking nelfinavir [Viracept] calls the nurse to report moderate to severe diarrhea. What will the nurse expect the provider to recommend?
An over-the-counter antidiarrheal drug
A nursing student asks the nurse what differentiates antiestrogen drugs from aromatase inhibitors in the treatment of breast cancer. What is the correct response by the nurse?
Antiestrogen drugs increase the risk for endometrial cancer.
During a routine screening, an asymptomatic, pregnant patient at 37 weeks' gestation learns that she has an infection caused by Chlamydia trachomatis. The nurse will expect the provider to order which drug?
Azithromycin
Which antibiotics may be administered topically? (Select all that apply.)
Bacitracin Polymyxin B
A male patient with hepatitis C will begin triple drug therapy with pegylated interferon alfa 2a [Pegasys], ribavirin [Ribasphere], and boceprevir [Victrelis]. The patient tells the nurse that his wife is pregnant. What will the nurse tell him?
Boceprevir is contraindicated in males whose partners are pregnant.
A patient is receiving an intraperitoneal aminoglycoside during surgery. To reverse a serious side effect of this drug, the nurse may expect to administer which agent?
Calcium gluconate
Amphotericin B is the drug of choice for which systemic mycosis? (Select all that apply.)
Candidiasis Histoplasmosis Mucormycosis
The nurse is caring for a patient in the oncology unit who was recently diagnosed with advanced renal carcinoma. The nurse prepares to administer aldesleukin [Proleukin] as part of the treatment regimen. What is the primary adverse effect of this drug?
Capillary leakage syndrome
An adolescent patient with mild cervicitis is diagnosed with gonorrhea. The nurse will expect the provider to order which drug(s)?
Ceftriaxone [Rocephin], 250 mg IM once, and azithromycin [Zithromax], 1 gm PO once
A nursing student asks about the differences between cell-cycle phase-specific chemotherapeutic agents and those that are cell-cycle phase nonspecific. What will the nurse explain?
Cell-cycle phase-specific drugs do not harm "resting" cells.
What contributes to drug resistance to chemotherapeutic agents? (Select all that apply.)
Cellular production of P-glycoprotein Creation of selection pressure by drugs Reduced target molecule sensitivity
A patient is receiving intravenous vincristine [Oncovin]. The patient complains of pain at the IV insertion site. The nurse examines the site and notes an area of erythema and edema. What will the nurse do?
Change the IV site and notify the provider of the extravasation.
Which infections may be acquired through nonsexual transmission? (Select all that apply.)
Chlamydia trachomatis Gardnerella vaginalis Herpes simplex Neisseria gonorrhea Treponema pallidum
Which condition would cause the nurse to withhold a PRN order for magnesium hydroxide?
Chronic renal failure
Which fluoroquinolone antibiotics may be administered to children? (Select all that apply.)
Ciprofloxacin [Cipro] Levofloxacin [Levaquin]
A patient is about to begin therapy with ethambutol. The nurse knows that, before initiating treatment with this drug, it is important to obtain which test(s)?
Color vision and visual acuity
The nurse is caring for a patient who is HIV positive and is taking zidovudine [Retrovir]. Before administering the medication, the nurse should monitor which laboratory values?
Complete blood count (CBC)
A patient is taking erythromycin ethylsuccinate for a chlamydial infection and develops vaginal candidiasis. The prescriber orders ketoconazole to treat the superinfection. What will the nurse do?
Contact the provider to discuss changing to a different antifungal medication.
A patient admitted to the hospital has a history of peptic ulcer disease. The patient takes ranitidine [Zantac] and sucralfate [Carafate]. The patient tells the nurse that discomfort is usually controlled but that symptoms occasionally flare up. What will the nurse do?
Contact the provider to discuss serologic testing and an antibiotic.
A patient with a urinary tract infection is given a prescription for TMP/SMZ. When reviewing the drug with the patient, the nurse learns that the patient has type 1 diabetes mellitus and consumes alcohol heavily. What will the nurse do?
Contact the provider to request a different antibiotic for this patient.
A nurse is caring for a patient who is receiving amphotericin B [Abelcet] for a systemic fungal infection. In spite of receiving diphenhydramine and acetaminophen before initiation of treatment, the patient has fever and chills with rigors. The nurse will contact the provider to discuss the addition of which drug?
Dantrolene
A nurse is preparing to administer an antibiotic to a patient with methicillin-resistant Staphylococcus aureus (MRSA). The nurse would expect the healthcare provider to order which antibiotic?
Daptomycin [Cubicin]
A patient with advanced cancer of the prostate begins treatment with leuprolide [Lupron Depot] injections and will receive 7.5 mg IM once per month. After the first injection, the patient experiences an increase in cancer symptoms. What will the nurse tell the patient?
Desensitization to the drug over time will result in a decrease in these symptoms.
A patient with colorectal cancer is admitted to the hospital oncology unit to receive cetuximab [Erbitux]. The nurse notes that the prescriber has not ordered any other medications. The nurse will contact the prescriber to request an order for which medication in order to minimize cetuximab's side effects?
Diphenhydramine [Benadryl]
A patient is receiving fluorouracil [Adrucil] as a continuous intravenous dose to treat a solid tumor. The patient reports soreness and blisters in the mouth, loose stools, and tingling of the hands and feet. What will the nurse do?
Discontinue the medication and contact the provider to report these symptoms.
A patient will begin treatment with posaconazole [Noxafil] to treat oropharyngeal candidiasis that has not responded to fluconazole. The provider has ordered 200 mg three times daily. Which action by the nurse is correct?
Discuss a 400-mg twice daily drug regimen with the provider.
A patient is diagnosed with pelvic inflammatory disease (PID). Which treatment regimen is most appropriate for reducing the risk of sterility in this patient?
Doxycycline [Vibramycin], 100 mg IV twice daily, and cefoxitin, 2 gm IV every 6 hours in the hospital
A child has received amoxicillin [Amoxil] for three previous ear infections, but a current otitis media episode is not responding to treatment. The nurse caring for this child suspects that resistance to the bacterial agent has occurred by which microbial mechanism?
Drug inactivation
Which are guidelines for selecting chemotherapeutic agents to use in combination therapy? (Select all that apply.)
Drugs used should have different mechanisms. Each drug should be effective. Toxicities should be minimally overlapping.
The nurse is caring for a patient who has been receiving vinorelbine [Navelbine] for about 5 days. Which assessment finding in this patient would cause the nurse to withhold the next dose and notify the prescriber?
Dyspnea and cough
Before giving methenamine [Hiprex] to a patient, it is important for the nurse to review the patient's history for evidence of which problem?
Elevated blood urea nitrogen and creatinine
The nurse is preparing to administer a first dose of ado-trastuzumab emtansine [Kadcycla] to a patient who has metastatic breast cancer. Which nursing action is correct?
Ensure that the patient has HER2-positive disease.
A patient who has urinary bladder cancer will begin receiving the chemotherapeutic agent valrubicin [Valstar]. What will the nurse do when administering this drug?
Ensure that the tubing used to administer the drug does not contain polyvinyl chloride.
The nurse asks a graduate nurse, "When a patient in the initial phase of HIV infection is assessed, which findings would you expect to see?" The graduate nurse would be correct to respond with which conditions? (Select all that apply.)
Fever Myalgia Lymphadenopathy
A patient with a history of congestive heart failure and renal impairment has esophageal candidiasis. Which antifungal agent would the nurse anticipate giving to this patient?
Fluconazole [Diflucan]
A patient admitted to the hospital is using metronidazole [Flagyl] 0.75% gel. The nurse understands that this agent is used to treat which condition?
Gardnerella vaginalis
A patient is receiving tobramycin three times daily. A tobramycin peak level is 4.5 and the trough is 1.2. What will the nurse do?
Give the next dose as ordered.
An adolescent patient comes to the clinic complaining of a burning sensation upon urination and a pus-like discharge from the penis. The nurse is correct to suspect that the patient has which disorder?
Gonorrhea
The nurse is performing a physical assessment on a patient who is receiving treatment with abacavir, zidovudine, and lamivudine [Trizivir]. The patient complains of fatigue. Upon further assessment, the nurse finds a rash and notes that the patient has a temperature of 101.1°F. What is the nurse's best course of action?
Have the patient hold the medications and arrange for an immediate evaluation by the prescriber.
A 45-year-old patient with a family history of breast cancer is considering using tamoxifen [Nolvadex] for cancer prevention. The nurse performs a health history and learns that the woman had a child when she was 35 years old, that she has not had a hysterectomy, and that she experienced DVT when she was pregnant. What will the nurse tell the patient?
Her history of DVT outweighs any possible benefits she may have with this drug.
A 43-year-old patient with a strong family history of breast cancer considers taking tamoxifen [Nolvadex] for cancer prevention. Which assessment finding is a possible contraindication?
History of deep vein thrombosis (DVT)
The nurse is preparing to discharge a patient with HIV who will continue to take enfuvirtide [Fuzeon] at home. The nurse is providing patient education about the medication. What information about the administration of enfuvirtide is most appropriate for the patient?
How to reconstitute and self-administer a subcutaneous injection
The nurse is caring for a patient who is HIV positive and has a previous history of drug and alcohol abuse. The patient is being treated with combination therapies, including didanosine [Videx]. Which laboratory findings would most concern the nurse?
Increased serum amylase and triglycerides and decreased serum calcium
A patient who is being treated for HIV infection has a 5-mm area of induration after a routine TST. The patient's chest radiograph is normal, and there are no other physical findings. The nurse will expect this patient to begin treatment with which drugs?
Isoniazid and rifabutin
A patient with HIV who takes protease inhibitors develops tuberculosis and will begin treatment. Which drug regimen will be used for this patient?
Isoniazid, pyrazinamide, ethambutol + rifabutin
A patient is beginning treatment for active tuberculosis (TB) in a region with little drug-resistant TB. Which treatment regimen will be used initially?
Isoniazid, rifampin, pyrazinamide, and ethambutol
Ketoconazole is used as an alternative to amphotericin B for less severe systemic mycosis. Which are the primary reasons for choosing ketoconazole? (Select all that apply.)
It can be given orally. It is less toxic.
A patient with second-degree burns is treated with silver sulfadiazine [Silvadene]. A nursing student asks the nurse about the differences between silver sulfadiazine and mafenide [Sulfamylon], because the two are similar products, and both contain sulfonamides. What does the nurse tell the student about silver sulfadiazine?
It has antibacterial effects related to release of free silver.
A patient has been taking senna [Senokot] for several days, and the nurse notes that the urine is yellowish-brown. What does the nurse know about this symptom?
It is an expected, harmless effect of senna.
A nursing student is caring for a patient with community-acquired pneumonia (CAP) who also has a methicillin-resistant Staphylococcus aureus (MRSA) skin infection. The prescriber has ordered daptomycin [Cubicin]. The nurse encourages the student to approach the provider to request a different antibiotic because of which facts about daptomycin? (Select all that apply.)
It is approved only for bloodstream and skin infections. It increases the risk of serious cardiorespiratory events.
A patient is about to begin treatment for latent tuberculosis with a short course of daily rifampin. The patient asks why rifapentine [Priftin] cannot be used, because it can be given twice weekly. What will the nurse tell this patient about rifapentine?
It is not approved for treatment of latent TB.
A patient with non-Hodgkin's lymphoma is about to begin chemotherapy with a massive dose of methotrexate [Rheumatrex]. The nurse will expect to administer which medication concurrently with this drug?
Leucovorin
A female patient has come to the STD clinic and has been diagnosed with a Trichomonas vaginalis infection. What education should be provided to this patient?
Male partners should always be treated, even if they are asymptomatic.
The nurse is preparing to administer medication to a patient receiving cyclophosphamide [Cytoxan]. To protect against the side effect of hemorrhagic cystitis, the nurse would expect to administer which drug?
Mesna [Mesnex]
A patient on an oncology unit has been receiving ifosfamide [Ifex] for a few days. Before administering the next dose, the nurse reviews the patient's laboratory test results. Which finding would cause the nurse to hold the dose?
Microscopic hematuria
A patient with histoplasmosis is being treated with itraconazole [Sporanox]. The nurse will teach this patient to report which symptoms?
Nausea, vomiting, and anorexia
A patient shows signs and symptoms of conjunctivitis. Which aminoglycoside would the nurse expect to be ordered?
Neomycin [Neomycin]
The nurse on an oncology unit prepares to administer the fourth cycle of docetaxel [Taxotere] to a patient with breast cancer. Which clinical finding would cause the nurse to withhold the dose and call the prescriber?
Neutrophil count below 1500/mm3
A patient with HIV and mucocutaneous HSV is being treated with foscarnet after failing treatment with acyclovir. After 2 weeks, the patient's dose is increased to 90 mg/kg over 2 hours from 40 mg/kg over 1 hour. The patient reports numbness in the extremities and perioral tingling. What will the nurse do?
Notify the provider and request an order for a serum calcium level.
A patient will begin taking an immunosuppressant medication. The nurse learns that the patient has a history of frequent candidal infections. The nurse will expect the provider to order which drug as prophylaxis?
Posaconazole [Noxafil]
A nurse is caring for a patient who takes an ACE inhibitor and an ARB medication who will begin taking TMP/SMZ to treat a urinary tract infection. Which serum electrolyte will the nurse expect to monitor closely?
Potassium
A patient is receiving intravenous voriconazole [Vfend]. Shortly after the infusion starts, the patient tells the nurse, "Colors look different, and the light hurts my eyes." What will the nurse do?
Reassure the patient that these effects will subside in about 30 minutes.
A nurse is preparing to administer a second infusion of trastuzumab [Herceptin] to a patient who has breast cancer. The patient tells the nurse that she experienced chills, fever, pain, and nausea after her first infusion. What will the nurse do?
Reassure the patient that these symptoms will diminish with each infusion.
A nurse is performing a physical assessment on a patient with tuberculosis who takes rifampin [Rifadin]. What would be an expected finding?
Red-orange-tinged urine
A nurse is caring for a patient who has a superficial fungal infection and notes that the provider has ordered 200 mg of ketoconazole [Nizoral] 200 mg PO once daily. Which action by the nurse is correct?
Request an order for a different antifungal medication.
A nurse is reviewing the culture results of a patient receiving an aminoglycoside. The report reveals an anaerobic organism as the cause of infection. What will the nurse do?
Request an order for a different class of antibiotic.
A patient will undergo a colonoscopy, and the provider has ordered sodium phosphate as a bowel cleanser before the procedure. The nurse reviews the patient's chart and notes that the patient's creatinine clearance and blood urea nitrogen are both elevated. What will the nurse do?
Request an order to give polyethylene glycol and electrolytes (PEG-ELS) instead.
A patient is admitted to the hospital with fever, headache, malaise, joint pain, and enlarged lymph nodes. Blood cultures are positive for Treponema pallidum. The nurse recognizes this as which type of syphilis?
Secondary
A patient who is receiving a final dose of intravenous (IV) cephalosporin begins to complain of pain and irritation at the infusion site. The nurse observes signs of redness at the IV insertion site and along the vein. What is the nurse's priority action?
Select an alternate intravenous site and administer the infusion more slowly.
The nurse is caring for a patient who will begin receiving intravenous ciprofloxacin [Cipro] to treat pyelonephritis. The nurse learns that the patient has a history of myasthenia gravis. Which action by the nurse is correct?
Suggest that the provider order a different antibiotic for this patient.
A patient who has been taking gentamicin for 5 days reports a headache and dizziness. What will the nurse do?
Suspect ototoxicity and notify the prescriber.
An immunocompromised child is exposed to chickenpox and the provider orders valacyclovir [Valtrex] to be given orally three times daily. The nurse will contact the provider to change this order for which reason?
The drug may cause serious adverse effects in immunocompromised patients.
A patient starting therapy with efavirenz [Sustiva] asks about the timing of the medication with regard to meals. What patient education about the administration of this medication should the nurse provide?
The drug should be taken once daily on an empty stomach.
A patient taking stavudine [Zerit] telephones the clinic and reports numbness and tingling in the hands and feet. What should the nurse tell the patient?
The medication will probably be stopped, and the patient should come into the clinic for further evaluation.
A patient with type 2 diabetes mellitus takes glipizide. The patient develops a urinary tract infection, and the prescriber orders TMP/SMZ. What will the nurse tell the patient?
The patient should check the blood glucose level more often while taking TMP/SMZ.
These patients are receiving chemotherapy. Which patient should the nurse see first?
The patient with a fever of 100.3°F
A patient who is taking ketoconazole tells the nurse that her periods have become irregular. What will the nurse tell her?
This is caused by a reversible effect on estradiol synthesis.
Which superficial mycosis is generally treated with oral antifungal agents?
Tinea capitis
A patient will begin receiving vincristine [Oncovin] to treat Hodgkin's lymphoma. Which side effect(s) will the nurse tell the patient to report immediately?
Tingling of the extremities
A patient who is taking nitrofurantoin calls the nurse to report several side effects. Which side effect of this drug causes the most concern and would require discontinuation of the medication?
Tingling of the fingers
A 20-year-old female patient has suprapubic discomfort, pyuria, dysuria, and bacteriuria greater than 100,000/mL of urine. Which are the most likely diagnosis and treatment?
Uncomplicated lower urinary tract infection treatable with short-course therapy
A premenopausal woman has ER-positive breast cancer, and her prescriber has ordered tamoxifen [Nolvadex]. She asks the nurse if anastrozole [Arimidex] would work better for her. What will the nurse tell her?
Until she is postmenopausal, anastrozole will not be effective.
A provider has ordered oral voriconazole [Vfend] for a patient who has a systemic fungal infection. The nurse obtains a medication history and learns that the patient takes phenobarbital for seizures. The nurse will contact the provider to discuss which possibility?
Using a different antifungal agent
A patient has an invasive aspergillosis infection. Which antifungal agent is the drug of choice for this infection?
Voriconazole [Vfend]
A patient with bronchitis is taking TMP/SMZ, 160/800 mg orally, twice daily. Before administering the third dose, the nurse notes that the patient has a widespread rash, a temperature of 103°F, and a heart rate of 100 beats per minute. The patient looks ill and reports not feeling well. What will the nurse do?
Withhold the dose and notify the provider of the symptoms.
A 65-year-old patient who receives glucocorticoids for arthritis is admitted to the hospital for treatment of a urinary tract infection. The prescriber has ordered intravenous ciprofloxacin [Cipro]. Before administering the third dose of this drug, the nurse reviews the bacterial culture report and notes that the causative organism is Escherichia coli. The bacterial sensitivity report is pending. The patient complains of right ankle pain. What will the nurse do?
Withhold the dose of ciprofloxacin and notify the provider of the patient's symptoms.
A patient who is receiving intravenous ciprofloxacin for pneumonia develops diarrhea. A stool culture is positive for Clostridium difficile. The nurse will expect the provider to:
add metronidazole [Flagyl].
A nursing student asks a nurse why chemotherapeutic agents are given intermittently instead of continuously. The nurse will tell the student that intermittent dosing:
allows normal cells to recover and repopulate.
A patient with hepatitis B begins treatment with adefovir [Hepsera] and asks the nurse how long the drug therapy will last. The nurse will tell the patient that the medication will need to be taken for:
an indefinite, prolonged period of time.
A patient with high-risk factors for tuberculosis will begin therapy for latent TB with isoniazid and rifampin. The nurse learns that this patient takes oral contraceptives. The nurse will counsel this patient to discuss ____ with her provider.
another birth control method
A patient who has a brain tumor will receive a nitrosourea agent. A nursing student asks why this type of drug is used for this type of cancer. The nurse will tell the student that nitrosoureas are useful because they:
are lipophilic.
A patient who is taking drugs to treat HIV has tuberculosis and has been on a four-drug regimen for 3 months without improvement in symptoms. Which drug will the nurse anticipate that the provider will add to this patient's regimen?
bedaquiline [Sirturo]
A patient has a positive urine culture 1 week after completion of a 3-day course of antibiotics. The nurse anticipates that the prescriber will:
begin a 2-week course of antibiotics.
A patient with a history of renal calculi has fever, flank pain, and bacteriuria. The nurse caring for this patient understands that it is important for the provider to:
begin antibiotic therapy after urine culture and sensitivity results are available.
A patient with cancer who is receiving chemotherapy develops a fever. The patient's chest radiograph is normal. The patient's neutrophil count is 750/mm3. The nurse expects the provider to:
begin empiric therapy with intravenous antibiotics.
A patient will begin taking tamoxifen [Nolvadex] to treat breast cancer. The nurse performs a medication history and learns that the patient is taking sertraline [Zoloft] for depression. The nurse will tell the patient to contact her provider to ask about:
changing from sertraline to escitalopram [Lexapro].
A patient newly diagnosed with tuberculosis asks the nurse why oral medications must be given in the clinic. The nurse will tell the patient that medications are given in the clinic so that:
clinic staff can observe adherence to drug regimens.
A patient who has undergone surgical removal of a solid tumor has just begun chemotherapy. The patient experiences severe nausea and vomiting as well as alopecia. The nurse will expect the provider to:
continue the chemotherapeutic agent at the same dose.
A patient comes to a clinic for tuberculosis medications 2 weeks after beginning treatment with a four-drug induction phase. The patient's sputum culture remains positive, and no drug resistance is noted. At this point, the nurse will expect the provider to:
continue the four-drug regimen and recheck the sputum in 2 weeks.
A patient who has been receiving intravenous gentamicin for several days reports having had a headache for 2 days. The nurse will request an order to:
discontinue the gentamicin.
A patient will be discharged from the hospital with a prescription for TMP/SMZ [Bactrim]. When providing teaching for this patient, the nurse will tell the patient that it will be important to:
drink 8 to 10 glasses of water each day.
A patient with advanced prostate cancer will begin treatment with leuprolide [Lupron]. The provider has ordered flutamide to be given as adjunct therapy. The patient asks the nurse why both drugs are necessary. The nurse will tell the patient that:
flutamide suppresses initial tumor flare caused by leuprolide.
A patient with HIV contracts herpes simplex virus (HSV), and the prescriber orders acyclovir [Zovirax] 400 mg PO twice daily for 10 days. After 7 days of therapy, the patient reports having an increased number of lesions. The nurse will expect the provider to:
give intravenous foscarnet every 8 hours for 2 to 3 weeks.
A patient who takes the loop diuretic ethacrynic acid is given intravenous gentamicin for an infection. After several days of treatment with gentamicin, the nurse reviews the patient's most recent laboratory results and notes a gentamicin trough of 2.1 mcg/mL and normal blood urea nitrogen (BUN) and serum creatinine levels. The nurse will question the patient about:
headache, dizziness, or vertigo.
A nurse is caring for an African American patient who has been admitted to the unit for long-term antibiotic therapy with sulfonamides. The patient develops fever, pallor, and jaundice. The nurse would be correct to suspect that the patient has developed:
hemolytic anemia.
The nurse is caring for a patient receiving intravenous acyclovir [Zovirax]. To prevent nephrotoxicity associated with intravenous acyclovir, the nurse will:
hydrate the patient during the infusion and for 2 hours after the infusion.
After starting an antiviral protease inhibitor, a patient with HIV telephones the nurse, complaining, "I'm so hungry and thirsty all the time! I'm urinating 10 or 12 times a day." The nurse recognizes these findings to be consistent with:
hyperglycemia.
A hospitalized patient is being treated for tuberculosis with a drug regimen that includes pyrazinamide. The patient complains of pain in the knee and shoulder joints. The nurse will contact the provider to request an order for:
ibuprofen.
A nursing student asks a nurse why pegylated interferon alfa is used instead of regular interferon for a patient with hepatitis C. The nurse will tell the student that pegylated interferon:
is administered less frequently than interferon.
A pregnant patient is treated with trimethoprim/sulfamethoxazole (TMP/SMZ) [Bactrim] for a urinary tract infection at 32 weeks' gestation. A week later, the woman delivers her infant prematurely. The nurse will expect to monitor the infant for:
kernicterus.
A patient is being treated with amphotericin B [Abelcet] for a systemic fungal infection. After several weeks of therapy, the provider orders flucytosine [Ancobon] in addition to the amphotericin. The nurse understands that the rationale for this combination is that it:
lowers the dose of amphotericin B and reduces toxicity.
A patient has a positive test for influenza type A and tells the nurse that symptoms began 5 days before being tested. The prescriber has ordered oseltamivir [Tamiflu]. The nurse will tell the patient that oseltamivir:
may not be effective because of the delay in starting treatment.
A pregnant female patient with bacteriuria, suprapubic pain, urinary urgency and frequency, and a low-grade fever is allergic to sulfa, ciprofloxacin, and amoxicillin. The nurse knows that the best alternative for treating this urinary tract infection is with:
methenamine [Hiprex].
The nurse is caring for a patient who is taking a protease inhibitor (PI). Upon review of the laboratory test results, the nurse notes that the patient has newly elevated plasma triglycerides and cholesterol. The nurse expects that the prescriber will manage these levels with:
modified diet and exercise.
A nurse is preparing to administer oral ofloxacin to a patient. While taking the patient's medication history, the nurse learns that the patient takes warfarin and theophylline. The correct action by the nurse is to request an order to:
monitor coagulation levels.
A nurse is obtaining a drug history from a patient about to receive sulfadiazine. The nurse learns that the patient takes warfarin, glipizide, and a thiazide diuretic. Based on this assessment, the nurse will expect the provider to:
monitor the patient's coagulation levels.
A patient is about to begin treatment with isoniazid. The nurse learns that the patient also takes phenytoin [Dilantin] for seizures. The nurse will contact the provider to discuss:
monitoring phenytoin levels.
A patient has a positive test for hepatitis C and is admitted to the hospital. The admission laboratory tests reveal a normal ALT, and a liver biopsy is negative for hepatic fibrosis and inflammation. The nurse will prepare this patient for:
no medication therapy at this time.
A patient who is pregnant has a history of recurrent genital herpesvirus (HSV). The patient asks the nurse what will be done to suppress an outbreak when she is near term. The nurse will tell the patient that:
oral acyclovir [Zovirax] may be used during pregnancy.
A patient has been taking isoniazid [Nydrazid] for 4 months for latent tuberculosis. The patient reports bilateral tingling and numbness of the hands and feet, as well as feeling clumsy. The nurse expects the provider to:
order pyridoxine 100 mg per day.
A nurse is preparing to administer a dose of gentamicin to a patient who is receiving the drug 3 times daily. The nurse will monitor ____ levels.
peak and trough
An older male patient comes to the clinic with complaints of chills, malaise, myalgia, localized pain, dysuria, nocturia, and urinary retention. The nurse would most likely suspect that the patient has:
prostatitis.
A patient presents to the emergency department with complaints of chills, severe flank pain, dysuria, and urinary frequency. The patient has a temperature of 102.9°F, a pulse of 92 beats per minute, respirations of 24 breaths per minute, and a blood pressure of 119/58 mm Hg. The nurse would be correct to suspect that the patient shows signs and symptoms of:
pyelonephritis.
A nurse reads a tuberculin skin test on a patient and notes a 6- to 7-mm area of induration. The patient is a young adult who has recently immigrated from a country with a high prevalence of tuberculosis. The patient has no other risk factors. The nurse will expect the provider to:
reassure the patient that this is not considered a positive test result.
A provider orders intravenous moxifloxacin [Avelox] for a patient who has sinusitis. Before administering the drug, the nurse will review this patient's chart for:
recent serum electrolyte levels.
A patient will receive intrathecal liposomal cytarabine [DepoCyt] to treat acute myelogenous leukemia. The provider has ordered the concurrent administration of dexamethasone. The nurse understands that this is given to:
reduce the severity of chemical arachnoiditis.
A nursing student asks a nurse how cancer cells become resistant to methotrexate [Rheumatrex]. The nurse is correct to respond by saying that cancer cells acquire resistance to methotrexate by:
reduced uptake of methotrexate into cells.
A nurse preparing to administer intravenous gentamicin to a patient notes that the dose is half the usual dose for an adult. The nurse suspects that this is because this patient has a history of:
renal disease.
A female patient who has hepatitis C is being treated with pegylated interferon alfa and ribavirin [Ribasphere]. It will be important for the nurse to teach this patient that:
she will need a monthly pregnancy test during her treatment.
The nurse would be correct to state that the purpose of angiogenesis inhibitors is to:
suppress the formation of new blood vessels in tumors.
A patient who is taking calcium supplements receives a prescription for ciprofloxacin [Cipro] for a urinary tract infection. The nurse will teach this patient to:
take the calcium either 6 hours before or 2 hours after taking the ciprofloxacin.
A patient is receiving chemotherapy. Seven days after a dose, the patient's neutrophil count is 1000 cells/mm3. The nurse will tell this patient:
that the provider will probably repeat the lab work in 3 to 5 days.
A hospitalized patient with cancer is receiving chemotherapy and reports oral pain. Inspection of this patient's oral mucosa reveals erythema and inflammation without denudation or ulceration. The nurse understands that:
the patient can use a mouthwash with a topical anesthetic to control pain.
A patient has just been diagnosed with cancer and will begin chemotherapy. The patient asks the nurse about the possibility of nausea and vomiting. The nurse will tell the patient that:
the provider will order drugs to help prevent nausea and vomiting before each dose.
To prevent yellow or brown discoloration of teeth in children, tetracyclines should not be given:
to pregnant patients after the fourth month of gestation.
A patient stops taking a proton pump inhibitor (PPI) after 6 weeks of therapy for treatment of peptic ulcer disease. The patient reports symptoms of dyspepsia to the nurse. The nurse will tell this patient to:
try an antacid to see whether it relieves these symptoms.
A patient comes to the clinic and receives valacyclovir [Valtrex] for a herpes-zoster virus. The nurse instructs the patient to take the medication:
without regard to meals.
A patient has a Pseudomonas aeruginosa infection that is sensitive to aminoglycosides, and the prescriber orders gentamicin. The patient tells the nurse that a friend received amikacin [Amikin] for a similar infection and wonders why amikacin was not ordered. What will the nurse tell the patient?
"Amikacin is given when infectious agents are resistant to other aminoglycosides."
A nursing student is discussing with a nurse the plan of care for a patient about to undergo a third round of chemotherapy with cisplatin. Which statement by the nursing student about the treatment of CINV is correct?
"Aprepitant [Emend] will be necessary to treat CINV caused by cisplatin."
A nurse is teaching a nursing student what is meant by "generations" of cephalosporins. Which statement by the student indicates understanding of the teaching?
"Cephalosporins have increased activity against gram-negative bacteria with each generation."
A nurse is discussing the use of immunosuppressants for the treatment of inflammatory bowel disease (IBD) with a group of nursing students. Which statement by a student indicates understanding of the teaching?
"Cyclosporine [Sandimmune] can be used to induce remission of IBD."
A child with an upper respiratory infection caused by B. pertussis is receiving erythromycin ethylsuccinate. After 2 days of treatment, the parent asks the nurse why the child's symptoms have not improved. Which response by the nurse is correct?
"Erythromycin eliminates the bacteria that causes the infection, but not the toxin that causes the symptoms."
A patient has a viral sinus infection, and the provider tells the patient that antibiotics will not be prescribed. The patient wants to take an antibiotic and asks the nurse what possible harm could occur by taking an antibiotic. Which response by the nurse is correct?
"Even normal flora can develop resistance and transfer this to pathogens."
A nurse explains to a nursing student why opioid antidiarrheal medications are classified as drugs with little or no abuse potential. Which statement by the student indicates a need for further teaching?
"Formulations for the treatment of diarrhea have very short half-lives."
A 6-year-old child has frequent constipation. The nurse provides teaching after the parent asks the nurse why the provider recommended using laxatives only when needed. Which statement by the parent indicates a need for further teaching?
"Frequent use of laxatives can cause diverticulitis."
A nurse is providing education about tetracycline [Sumycin]. Which statement by the patient best demonstrates understanding of the administration of this medication?
"I should not take this medication with milk or other dairy products."
A patient's provider has recommended a bulk-forming laxative for occasional constipation. Which statement by the patient indicates understanding of the teaching about this agent?
"I should take each dose with a full glass of water."
A patient is to begin taking doxycycline to treat a rickettsial infection. Which statement by the patient indicates a need for teaching about this drug?
"I should take this drug with food to ensure more complete absorption."
A nurse is discussing methicillin-resistant Staphylococcus aureus (MRSA) with a group of nursing students. Which statement by a student correctly identifies the basis for MRSA resistance?
"MRSA bacteria have developed PBPs with a low affinity for penicillins."
A nurse is teaching a nursing student about dalfopristin/quinupristin [Synercid]. Which statement by the student indicates an understanding of the teaching?
"Patients taking this drug should have blood tests performed frequently."
A nurse is providing teaching to a nursing student about to care for a woman with irritable bowel syndrome with diarrhea (IBS-D) who is receiving alosetron [Lotronex]. Which statement by the student indicates a need for further teaching?
"Patients with diverticulitis and IBS-C may take this drug."
A nursing student is caring for a patient who is taking sucralfate [Carafate] and ciprofloxacin [Cipro] to treat peptic ulcer disease. The student asks the nurse about the pharmacokinetics of sucralfate. Which statement by the student indicates a need for further teaching?
"Sucralfate has a moderate acid-neutralizing capacity."
The nurse is providing education to a patient who has been prescribed both an antacid and cimetidine [Tagamet]. Which instruction should the nurse give the patient about taking the medications?
"Take the antacid 1 hour after the ranitidine."
A pregnant adolescent patient asks the nurse whether she should continue to take her prescription for tetracycline [Sumycin] to clear up her acne. Which response by the nurse is correct?
"Tetracycline can be harmful to the baby's teeth and should be avoided."
A child with otitis media has had three ear infections in the past year. The child has just completed a 10-day course of amoxicillin [Amoxil] with no improvement. The parent asks the nurse why this drug is not working, because it has worked in the past. What will the nurse tell the patient?
"The bacteria have synthesized penicillinase."
A patient with Crohn's disease will begin receiving an initial infusion of infliximab [Remicade]. The nurse explains how this drug works to treat this disease. Which statement by the patient indicates a need for further teaching?
"This drug sometimes provides a complete cure of inflammatory bowel disease."
A patient who has traveler's diarrhea asks the nurse about using loperamide to stop the symptoms. What will the nurse tell the patient about this drug?
"Use of this drug may prolong symptoms by slowing peristalsis."
A parent asks a nurse if the provider will prescribe an antibiotic for a child who attends school with several children who have strep throat. The child is complaining of a sore throat and has a fever. What will be the nurse's response?
"Your child should come to the clinic to have a throat culture done today."
A patient received 500 mg of azithromycin [Zithromax] at 0800 as a first dose. What are the usual amount and time of the second dose of azithromycin?
250 mg at 0800 the next day
A patient will be discharged home to complete treatment with intravenous cefotetan with the assistance of a home nurse. The home care nurse will include which instruction when teaching the patient about this drug treatment?
Abstain from alcohol consumption during therapy.
A patient is diagnosed with an infection caused by Staphylococcus aureus, and the prescriber orders intravenous gentamicin and penicillin (PCN). Both drugs will be given twice daily. What will the nurse do?
Administer gentamicin, flush the line, and then give the penicillin.
A prescriber has ordered cefoxitin for a patient who has an infection caused by a gram-negative bacteria. The nurse taking the medication history learns that the patient experienced a maculopapular rash when taking amoxicillin [Amoxil] several years earlier. What will the nurse do?
Administer the cefoxitin and observe for any side effects.
A provider has ordered ceftriaxone 4 gm once daily for a patient with renal impairment. What will the nurse do?
Administer the medication as prescribed.
A patient is diagnosed with peptic ulcer disease. The patient is otherwise healthy. The nurse learns that the patient does not smoke and that he drinks 1 or 2 glasses of wine with meals each week. The nurse anticipates that the provider will prescribe which drugs?
Amoxicillin [Amoxil], clarithromycin, and omeprazole [Prilosec]
The parent of an infant with otitis media asks the nurse why the prescriber has ordered amoxicillin [Amoxil] and not ampicillin [Unasyn]. What will the nurse tell the parent?
Ampicillin is not as acid stable as amoxicillin.
A nurse is taking a history on a clinic patient who reports being constipated. Upon further questioning, the nurse learns that the patient's last stool was 4 days ago, that it was of normal, soft consistency, and that the patient defecated without straining. The patient's abdomen is not distended, and bowel sounds are present. The patient reports usually having a stool every 1 to 2 days. What will the nurse do?
Ask about recent food and fluid intake.
When metronidazole [Flagyl] is a component of the H. pylori treatment regimen, the patient must be instructed to do what?
Avoid any alcoholic beverages
A patient who is in her first trimester of pregnancy asks the nurse to recommend nonpharmaceutical therapies for morning sickness. What will the nurse suggest?
Avoiding fatty and spicy foods
Which cephalosporin may be used to treat meningitis?
Cefotaxime
A patient has a skin infection and the culture reveals methicillin-resistant Staphylococcus aureus (MRSA). What is an appropriate treatment for this patient?
Ceftaroline
A nurse receives an order to administer castor oil to a patient. Which action by the nurse is correct?
Chill the medication and mix it with fruit juice.
A patient with no known drug allergies is receiving amoxicillin [Amoxil] PO twice daily. Twenty minutes after being given a dose, the patient complains of shortness of breath. The patient's blood pressure is 100/58 mm Hg. What will the nurse do?
Contact the provider and prepare to administer epinephrine.
A nurse is preparing to administer intramuscular penicillin to a patient who is infected with T. pallidum and notes that the order is for sodium penicillin G. Which action is correct?
Contact the provider to discuss changing the drug to benzathine penicillin G.
A 30-year-old male patient will begin a three-drug regimen to treat peptic ulcer disease. The regimen will consist of bismuth subsalicylate, tetracycline, and cimetidine [Tagamet]. The nurse will include which information when teaching this patient about this drug regimen?
Decreased libido, impotence, and gynecomastia are reversible side effects.
Which side effect of clindamycin [Cleocin] causes the most concern and may warrant discontinuation of the drug?
Diarrhea
A patient receiving a cephalosporin develops a secondary intestinal infection caused by Clostridium difficile. What is an appropriate treatment for this patient?
Discontinuing the cephalosporin and beginning metronidazole [Flagyl]
The nurse is caring for an older adult patient after a right hip open reduction internal fixation (ORIF). The patient is taking an opioid every 6 hours as needed for pain. The nurse discusses obtaining an order from the prescriber for which medication?
Docusate sodium [Colace]
A 6-week-old infant who has not yet received immunizations develops a severe cough. While awaiting nasopharyngeal culture results, the nurse will expect to administer which antibiotic?
Erythromycin ethylsuccinate
A patient is to undergo orthopedic surgery, and the prescriber will order a cephalosporin to be given preoperatively as prophylaxis against infection. The nurse expects the provider to order which cephalosporin?
First-generation cephalosporin
A nurse transcribes a new prescription for potassium penicillin G given intravenously (IV) every 8 hours and gentamicin given IV every 12 hours. Which is the best schedule for administering these drugs?
Give the penicillin at 0800, 1600, and 2400; give the gentamicin [Garamycin] at 1800 and 0600.
A recent campaign, initiated by the Centers for Disease Control (CDC), to delay the emergence of antibiotic resistance in hospitals, has what as one of its objectives?
Increased adherence to prescribed antibiotics
A patient with a history of chronic alcohol abuse has been admitted to the unit with cirrhosis. Upon review of the patient's laboratory test results, the nurse notes that the patient's ammonia level is elevated at 218 mcg/dL. What medication should the nurse prepare to administer?
Lactulose
An older adult patient with severe gastroesophageal reflux disease (GERD) has had only minimal relief using a histamine2-receptor antagonist (H2RA). The patient is to begin taking omeprazole [Prilosec]. What will the nurse teach this patient?
Long-term therapy may be needed.
A patient has an infection caused by Pseudomonas aeruginosa. The prescriber has ordered piperacillin and amikacin, both to be given intravenously. What will the nurse do?
Make sure to administer the drugs at different times using different IV tubing.
A patient with severe community-acquired pneumonia has been prescribed telithromycin [Ketek]. Which aspect of the patient's medical history is of concern to the nurse?
Myasthenia gravis
A patient is receiving intravenous promethazine [Phenergan] 25 mg for postoperative nausea and vomiting. What is an important nursing action when giving this drug?
Observing the IV insertion site frequently for patency
The nurse is caring for a patient on a medical-surgical unit who has a fever of unknown origin. The prescriber has ordered a broad-spectrum antibiotic. Which intervention is the priority?
Obtaining all cultures before the antibiotic is administered
A patient has been taking psyllium [Metamucil] two to three times daily for several days. The patient complains of stomach pain but has not had a stool. What will the nurse do?
Palpate the patient's abdomen and auscultate for bowel sounds.
The parent of a child with cerebral palsy reports that the child has pebble-like stools most of the time and seems uncomfortable if several days have passed between stools. The nurse will suggest that the parent discuss which medication with the child's provider?
Polyethylene glycol [MiraLax]
A patient who takes nonsteroidal anti-inflammatory drugs (NSAIDs) for arthritis asks a nurse what can be done to prevent ulcers. The nurse will recommend asking the provider about using which medication?
Proton pump inhibitors
A hospitalized patient who is taking demeclocycline [Declomycin] reports increased urination, fatigue, and thirst. What will the nurse do?
Provide extra fluids and reassure the patient that these are expected side effects.
A patient has an infection caused by Streptococcus pyogenes. The prescriber has ordered dicloxacillin PO. What will the nurse do?
Question the need for a penicillinase-resistant penicillin.
A patient is diagnosed with Zollinger-Ellison syndrome. Which medication does the nurse expect the provider to order for this patient?
Ranitidine [Zantac]
A patient is taking bismuth subsalicylate [Pepto-Bismol] to prevent diarrhea. The nurse performing an assessment notes that the patient's tongue is black. What will the nurse do?
Reassure the patient that this is an expected side effect of this drug.
A patient is about to receive penicillin G for an infection that is highly sensitive to this drug. While obtaining the patient's medication history, the nurse learns that the patient experienced a rash when given amoxicillin [Amoxil] as a child 20 years earlier. What will the nurse do?
Request an order for a skin test to assess the current risk.
A patient is receiving intravenous potassium penicillin G, 2 million units to be administered over 1 hour. At 1900, the nurse notes that the dose hung at 1830 has infused completely. What will the nurse do?
Request an order for serum electrolytes and cardiac monitoring.
A nurse caring for a patient who is undergoing a third round of chemotherapy is preparing to administer ondansetron [Zofran] 30 minutes before initiation of the chemotherapy. The patient tells the nurse that the ondansetron did not work as well the last time as it had the first time. What will the nurse do?
Request an order to administer dexamethasone with the ondansetron.
A nursing student asks a nurse to clarify the differences between the mechanisms of spontaneous mutation and conjugation in acquired resistance of microbes. What will the nurse say?
Spontaneous mutation leads to resistance to only one antimicrobial agent.
A child has been receiving chloramphenicol for a Neisseria meningitidis central nervous system (CNS) infection. The nurse administers the dose and subsequently notes that the child has vomited and appears dusky and gray in color. The child's abdomen is distended. What will the nurse do?
Stop the infusion immediately and notify the provider.
A patient is being treated for chemotherapy-induced nausea and vomiting (CINV) with ondansetron [Zofran] and dexamethasone. The patient reports getting relief during and immediately after chemotherapy but has significant nausea and vomiting several days after each chemotherapy treatment. What will the nurse do?
Suggest adding aprepitant [Emend] to the medication regimen.
The nurse has been caring for a patient who has been taking antibiotics for 3 weeks. Upon assessing the patient, the nurse notices the individual has developed oral thrush. What describes the etiology of the thrush?
Superinfection
A patient who has been taking linezolid [Zyvox] for 6 months develops vision problems. What will the nurse do?
Tell the patient that this symptom is reversible when the drug is discontinued.
A patient recently began receiving clindamycin [Cleocin] to treat an infection. After 8 days of treatment, the patient reports having 10 to 15 watery stools per day. What will the nurse tell this patient?
The patient should stop taking the clindamycin now and contact the provider immediately.
A pregnant patient who is taking ondansetron [Zofran] for morning sickness tells the nurse she is experiencing headache and dizziness. What will the nurse tell her?
These are common side effects of ondansetron.
A patient is preparing to travel to perform missionary work in a region with poor drinking water. The provider gives the patient a prescription for ciprofloxacin [Cipro] to take on the trip. What will the nurse instruct this patient to do?
Use the drug if symptoms are severe or do not improve in a few days.
A patient who has cystic fibrosis has a Pseudomonas aeruginosa infection and the provider has ordered aztreonam [Cayston]. What will the nurse teach this patient about administration of this drug?
Use the nebulizer to administer the drug three times daily.
A patient develops CDAD. Which antibiotic is recommended for treating this infection?
Vancomycin
A nurse is caring for a patient with cancer who has been undergoing chemotherapy. The patient has oral mucositis as a result of the chemotherapy, and the provider has ordered palifermin [Kepivance]. Which is an appropriate nursing action when giving this drug?
Warning the patient about the potential for distortion of taste
A child with an ear infection is not responding to treatment with amoxicillin [Amoxil]. The nurse will expect the provider to order:
amoxicillin-clavulanic acid [Augmentin].
A patient newly diagnosed with PUD reports taking low-dose aspirin (ASA) for prevention of cardiovascular disease. The nurse learns that the patient drinks 2 to 3 cups of coffee each day and has a glass of wine with dinner 3 or 4 nights per week. The patient eats three meals a day. The nurse will counsel this patient to:
change the meal pattern to five or six smaller meals per day.
A nurse assisting a nursing student with medications asks the student to describe how penicillins (PCNs) work to treat bacterial infections. The student is correct in responding that penicillins:
disrupt bacterial cell wall synthesis.
A woman complains of burning on urination and increased frequency. The patient has a history of frequent urinary tract infections (UTIs) and is going out of town in 2 days. To treat the infection quickly, the nurse would expect the healthcare provider to order:
fosfomycin [Monurol].
A patient who experiences motion sickness is about to go on a cruise. The prescriber orders transdermal scopolamine [Transderm Scop]. The patient asks the nurse why an oral agent is not ordered. The nurse will explain that the transdermal preparation:
has less intense anticholinergic effects than the oral form.
A nurse is admitting a patient to the hospital who reports having recurrent, crampy abdominal pain followed by diarrhea. The patient tells the nurse that the diarrhea usually relieves the pain and that these symptoms have occurred daily for the past 6 months. The patient undergoes a colonoscopy, for which the findings are normal. The nurse will plan to teach this patient to:
keep a food, stress, and symptom diary.
A patient has a localized skin infection, which is most likely caused by a gram-positive cocci. Until the culture and sensitivity results are available, the nurse will expect the provider to order a ____-spectrum ____ agent.
narrow; topical
An older adult patient with chronic obstructive pulmonary disease (COPD) develops bronchitis. The patient has a temperature of 39.5°C. The nurse will expect the provider to:
order empiric antibiotics while waiting for sputum culture results.
A patient is admitted with lower abdominal pain and nausea. The nurse performing the initial assessment notes that the patient's abdomen is distended and firm, and hypoactive bowel sounds are present. The patient has not had a stool for 3 days. The nurse will contact the provider, who will:
perform diagnostic tests.
A patient with renal disease is scheduled for a colonoscopy. Before the procedure, the nurse will anticipate administering:
polyethylene glycol and electrolytes.
A patient who is taking doxycycline for a serious infection contacts the nurse to report anal itching. The nurse will contact the provider to discuss:
prescribing an antifungal drug to treat a superinfection.
The nurse is caring for a patient who is receiving vancomycin [Vancocin]. The nurse notes that the patient is experiencing flushing, rash, pruritus, and urticaria. The patient's heart rate is 120 beats per minute, and the blood pressure is 92/57 mm Hg. The nurse understands that these findings are consistent with:
red man syndrome.
A patient with an infection caused by Pseudomonas aeruginosa is being treated with piperacillin. The nurse providing care reviews the patient's laboratory reports and notes that the patient's blood urea nitrogen and serum creatinine levels are elevated. The nurse will contact the provider to discuss:
reducing the dose of piperacillin.
A patient reports taking an oral bisacodyl laxative [Dulcolax] for several years. The provider has suggested discontinuing the laxative, but the patient is unsure how to do this. The nurse will tell the patient to:
stop taking the laxative immediately and expect no stool for several days.
