Pharm Review IV

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The elderly female client diagnosed with diverticulosis is taking docusate calcium daily. The client tells the clinic nurse that her daughter has her taking the herb cascara every day. Which intervention should the nurse implement? 1. Instruct the client to quit taking the herb immediately. 2. Explain that the herb will help the diverticulosis. 3. Tell the client to have her daughter call the nurse. 4. Advise the client to inform her HCP.

1. Docusate calcium (Surfak, Colace) is a stool softener. When docusate and certain herbs, such as senna, cascara, rhubarb, or aloe, are taken simultaneously, it will increase their absorption and the risk of liver toxicity. The nurse should tell the client to stop taking the herb.

The client diagnosed with AIDS has a pruritic rash with pinkish-red macules. Which medication should the nurse suspect is causing the rash? 1. Trimethoprim-sulfamethoxazole. 2. Nelfi navir. 3. Efavirenz. 4. Zidovudine.

1. An antibiotic trimethoprim-sulfamethoxazole (Bactrim) sulfa allergy with this type of rash develops in up to 60% of clients diagnosed with AIDS.

The female client diagnosed with MS tells the nurse, "I am having problems having regular bowel movements." Which statement by the client indicates the client needs more medication teaching? 1. "I am taking a stimulant laxative tablet every day." 2. "I am taking a fi ber laxative daily." 3. "I take a stool softener at bedtime." 4. "I keep a glass of water with me at all times."

1. Bisacodyl (Dulcolax) is a stimulant laxative and should not be taken every day because it will cause a decrease in the bowel tone. A client diagnosed with MS already has diffi culty with bowel tone.

The nurse is administering 0800 medications. Which medication should the nurse question? 1. Misoprostol to a 29-year-old female with an NSAID-produced ulcer. 2. Omeprazole to a 68-year-old male with a duodenal ulcer. 3. Furosemide to a 56-year-old male with a potassium level of 4.2 mEq/L. 4. Acetaminophen to an 84-year-old female with a frontal headache.

1. Misoprostol (Cytec) is a prostaglandin analog. A 29-year-old female is of childbearing age. The nurse should determine that the client is not pregnant before administering this medication. Misoprostol can be used in night when it would be unusual for the client to consume food along with the medication.

The client diagnosed with acute herpes zoster is prescribed oral acyclovir. Which statement by the client indicates the client needs more medication teaching? 1. "I am so glad this medication will cure my shingles." 2. "I will have to take the pill five times a day." 3. "I should take this medication for 7 to 10 days." 4. "If the shingles gets near my eyes, I will call my HCP."

1. Acyclovir (Zovirax) is an antiviral medication. The client must understand that no medication will cure a herpes viral infection. Zovirax shortens the time of symptoms and speeds healing, but it does not cure the shingles. The client needs more medication teaching.

The nurse is transcribing the admitting HCP's orders for an elderly client diagnosed with diverticulitis. Which orders would the nurse question? Select all that apply. 1. Administer one bisacodyl by mouth, daily. 2. Insert a nasogastric tube to intermittent low suction. 3. Administer morphine 2 mg IV push (IVP) for pain every 4 hours. 4. Infuse D5 0.45 NS intravenously at 100 mL an hour. 5. Administer a Fleet's enema after each bowel movement.

1. Bisacodyl (Dulcolax) is a stimulant laxative. The client should be NPO and not have any fecal matter going through an infl amed descending and sigmoid bowel; therefore, the nurse would question administering a stimulant laxative, which would cause the client to have a bowel movement. 5. The client's rectum and sigmoid colon are irritated secondary to the diverticulitis, and nothing should be inserted to the rectum to further irritate the rectum. The client is not constipated, so therefore sodium phosphate (Fleet's enema), a saline laxative, should be questioned by the nurse.

Which statement best indicates the scientifi c rationale for administering erythromycin ophthalmic ointment to a newborn client? 1. Erythromycin prevents ophthalmia neonatorum in infants of mothers with gonorrhea. 2. Erythromycin prevents otitis externa in infants of mothers with herpes simplex virus. 3. Erythromycin prevents transient strabismus in infants of mothers with chlamydia. 4. Erythromycin prevents blindness in infants of mothers with cytomegalovirus.

1. Erythromycin ophthalmic ointment is prophylaxis against Neisseria gonorrhoeae, preventing ophthalmia neonatorum in infants of mothers with gonorrhea. It is required by law.

The client with TB is prescribed isoniazid. Which diet selection indicates the client needs more teaching? 1. Tuna fish sandwich on white bread, potato chips, and iced tea. 2. Pot roast, mashed potatoes with brown gravy, and a light beer. 3. Fried chicken, potato salad, corn on the cob, and white milk. 4. Caesar salad with chicken noodle soup and water.

1. Isoniazid (INH) is an antitubercular medication. Tuna, foods with yeast extracts, aged cheese, red wine, and soy sauce contain tyramine and histamine, which interact with INH and result in a headache, fl ushing, hypotension, light-headedness, palpitations, and diaphoresis. 2. Red wine, not

The nurse is discussing the problem of constipation with an elderly client. Which information should the nurse discuss with the client concerning laxative abuse? 1. Explain that stimulant laxatives, the chewing gum and chocolate types, are the kind most often abused. 2. Discuss that laxative abuse can occur if the client takes bulk-forming laxatives on a daily basis. 3. Tell the client that taking a Fleet's enema daily will help prevent the client from becoming dependent on laxatives. 4. Recommend to the client that eating a high-fiber diet and increasing fluid consumption will ensure the client will not get constipated.

1. This information is true and should be shared with the client. Chronic exposure to laxatives can diminish defecatory reflexes, leading to further reliance on laxatives. It may also cause serious pathologic changes, including electrolyte imbalance, dehydration, and colitis.

The client taking nitrofurantoin for a UTI calls the clinic and tells the nurse the urine has turned dark. Which statement is the nurse's best response? 1. "This is a side effect of the medication and is not harmful." 2. "This means that you have cystitis and should come in to see the HCP." 3. "If you take the medication with food it causes this reaction." 4. "There must be some other problem going on that is causing this."

1. This is a side effect of nitrofurantoin. The client should be warned that the urine might turn brown. This color will disappear when the client is no longer taking the medication. If the client is taking an oral suspension, the nurse should instruct the client to rinse the mouth after taking the medication to prevent staining of the teeth.

1. An antibiotic trimethoprim-sulfamethoxazole (Bactrim) sulfa allergy with this type of rash develops in up to 60% of clients diagnosed with AIDS.

The 17-year-old client is prescribed metronidazole and erythromycin for a persistent Chlamydia infection. Which statements by the client indicate the need for further teaching? Select all that apply. 1. "I can have a beer or two while taking these medications." 2. "My boyfriend will have to take the medications too." 3. "I can develop more problems if I don't treat this disease." 4. "My birth control pills will still be effective while taking these medications." 5. "Chlamydia is a sexually transmitted infection I got from my boyfriend."

1. Consuming alcohol concurrently with metronidazole (Flagyl) can cause a severe reaction. This statement indicates the need for more teaching 4. Antibiotics may interfere with the effectiveness of some birth control pills. The client should use a supplemental form of birth control when taking birth control pills. This statement indicates the client does not understand the teaching.

The client diagnosed with HIV has a positive skin test for tuberculosis (TB). Which medication order should the nurse anticipate? Select all that apply. 1. Isoniazid. 2. Ethambutol. 3. Pyrazinamide. 4. Enfuvirtide. 5. Rifampin.

1. Isoniazid (INH) is the first line therapy of active TB in combination with other medications. 2. Ethambutol (Myambutol), an antiinfective, is a treatment for TB. 3. Pyrazinamide (Tebrazid) is the first-line therapy of active TB in combination with other medications. 5. Rifampin is the first-line therapy of active TB in combination with other medications.

The client taking antibiotics calls the clinic and tells the nurse the client has diarrhea. Which interventions should the nurse implement? Select all that apply. 1. Recommend the client take lactobacillus. 2. Explain diarrhea is a side effect of antibiotics and should be reported to the HCP. 3. Ask the client if he or she has had any type of bad-tasting or bad-smelling food. 4. Instruct the client to quit taking the antibiotic for 24 hours and then start taking again. 5. Tell the client to take one diphenoxylate/atropine after each loose stool up to eight a day.

1. Lactobacillus (Bacid, Lactinex) is a probiotic. Bacid is nonprescription product specifically used to treat diarrhea caused by antibiotics. It reestablishes normal intestinal flora and may be used prophylactically in clients with a history of antibiotic-induced diarrhea. 2. Diarrhea is a side effect of some antibiotics because antibiotics kill the good flora in the bowel, but the HCP needs to be notified so something can be done about the diarrhea. 5. Diphenoxylate/atropine (Lomotil), an antidiarrheal, may cause serious health problems when overdosed, which is why the client cannot take more than eight tablets in 24 hours.

The elderly client calls the clinic and reports loose, watery stools. Which interventions should the nurse implement? Select all that apply. 1. Instruct the client to take the antidiarrheal exactly as recommended. 2. Recommend the client drink clear liquids only, such as tea or broth. 3. Determine how long the client has been having the loose, watery stool. 4. Tell the client to go to the ED as soon as possible. 5. Ask the client what other medications he or she has taken in the past 24 hours.

1. Some antidiarrheal medications contain habit-forming drugs and should be used as directed only. 2. Clear liquids allow the bowel to rest. A client with diarrhea should be consuming clear liquids only for 24 hours, then move on to eating a bland diet, and after that progress to eating more solid food if the diarrhea does not reoccur. 3. If the client has had diarrhea more than 48 hours, the nurse should recommend the client come to the offi ce because an elderly client is at risk for dehydration. the client come to the office because an elderly client is at risk for dehydration.

The nurse is teaching the pregnant client diagnosed with HIV about methods to prevent transmission to the infant. Which information should the nurse discuss with the client? Select all that apply. 1. The client will take zidovudine po regularly beginning at 12 to 14 weeks gestation. 2. The client's newborn should receive oral zidovudine 8 to 12 hours after birth. 3. Breastfeeding should be encouraged to provide the infant passive immunity to HIV. 4. If treated in early pregnancy, the risk of transmission of HIV to the infant is 1% or less. 5. All clients diagnosed with HIV must have a cesarean delivery at 38 weeks gestation.

1. ZDV is given orally, as directed, around the clock. 2. The newborn should receive oral zidovudine syrup beginning 8 to 12 hours after birth until 6 weeks old. 4. The Centers for Disease Control (CDC) states that if the client is treated beginning in early pregnancy, the risk of transmission of HIV to the infant can be reduced to 1% or less.

The 80-year-old client with diverticulosis is prescribed docusate sodium. Which assessment data indicates the medication is effective? 1. The client has a bowel movement within 8 hours. 2. The client has soft, brown stools. 3. The client has a soft, nontender abdomen. 4. The client has bowel sounds in all four quadrants

2. Docusate calcium (Colace) is a stool softener. If the client has soft brown stools, the medication is effective.

Which side effects should the nurse explain to the male client who is prescribed cimetidine? 1. The medication can cause indigestion and heartburn. 2. The medication can cause impotence and gynecomastia. 3. The medication can cause insomnia and hypervigilance. 4. The medication can cause Zollinger-Ellison syndrome.

2. Cimetidine (Tagamet) is an H2 blocker. Over time, Tagamet can cause males to become impotent, have decreased libido, and have breast development (gynecomastia).

2. Docusate calcium (Colace) is a stool softener. If the client has soft brown stools, the medication is effective.

The client diagnosed with AIDS is receiving IV acyclovir. Which intervention should the home health-care nurse implement when administering this medication? 1. Restrict all visitors when administering this medication. 2. Arrange for IV tubing and bag to be incinerated. 3. Store reconstituted solutions at room temperature. 4. Have the pharmacy mix the medication for 1 week at a time.

2. Ganciclovir and acyclovir (Cytogenesis), an antiviral medication, are teratogenic and carcinogenic; therefore, it must be disposed of in a manner that protects the environment. It should be burned at a high temperature to prevent the chem

1. The elderly client with diverticulosis is instructed to take psyllium mucilloid. Which question is most important for the nurse to ask the client? 1. "When was your last bowel movement?" 2. "Do you have any diffi culty swallowing?" 3. "How much fiber do you eat daily?" 4. "Do you ever notice any abdominal tenderness?"

2. Psyllium mucilloid (Metamucil) is a fi ber laxative. Bulk laxatives can swell and cause obstruction of the esophagus; therefore, the most important question to ask the client is if he or she has diffi culty swallowing. If the client has diffi culty swallowing, the nurse should question the client taking Metamucil.

The nurse is discharging a client diagnosed with GERD. Which information should the nurse include in the teaching? 1. "There are no complications of GERD as long as you take the medications." 2. "Notify the HCP if the medication does not resolve the symptoms." 3. "Immediately after a meal, lie down for at least 45 minutes." 4. "If any discomfort is noted, take an NSAID for the pain."

2. The client should always be informed of what symptoms to report to the HCP.

The female client calls the clinic reporting diarrhea and states that she just came back from vacation in Mexico. Which intervention should the nurse implement first? 1. Instruct the client to take loperamide. 2. Ask how long the client has had the diarrhea and when she returned from Mexico. 3. Explain that an antibiotic should be prescribed and that the client needs to see the HCP. 4. Tell the client this is probably traveler's diarrhea and it will run its course.

2. Tourists are often plagued by infectious diarrhea, known as traveler's diarrhea, which is caused by the bacteria E. coli. As a rule, treatment is not necessary and the diarrhea is self-limiting. If diarrhea is severe, it is treated with an antibiotic. Therefore, the nurse should assess the severity of the diarrhea first.

The nurse is administering medications to clients on a urology floor. Which medication should the nurse question? 1. Ceftriaxone to a client who is pregnant. 2. Cephalexin to a client who is allergic to penicillin. 3. Trimethoprim sulfa to a client post-prostate surgery. 4. Nitrofurantoin to a client diagnosed with urinary stasis.

2. A cross-sensitivity exists in some clients between penicillin and cephalosporins such as cephalexin (Kefl ex). The nurse should assess the type of reaction that the client experienced when taking penicillin. If the client indicates any symptom of an anaphylactic reaction, the nurse would hold the medication and discuss the situation with the HCP.

Which is the preferred treatment for the diagnosis of primary syphilis in a teenage client? 1. Doxycycline po every 4 hours for 10 days. 2. Benzathine penicillin G, IM one time only. 3. Miconazole topical daily for 1 week. 4. Nitrofurantoin b.i.d. for 1 month.

2. A one-time injection of benzathine penicillin G is the usual treatment for primary syphilis infections.

2. Cimetidine (Tagamet) is an H2 blocker. Over time, Tagamet can cause males to become impotent, have decreased libido, and have breast development (gynecomastia).

The nurse is administering medications on a psychiatric unit. Which client should the nurse discuss with the HCP? 1. The 17-year-old client diagnosed with bipolar disorder who is receiving risperidone. 2. The client diagnosed with schizophrenia who is receiving cimetidine. 3. The client diagnosed with a heroin dependency who is receiving rifampin. 4. The 16-year-old client diagnosed with anorexia nervosa who is receiving amitriptyline.

2. Cimetidine (Tagamet), a histamine blocker, may reduce the effects of antipsychotic medications and lead to medication failure. The client diagnosed with schizophrenia would be taking an antipsychotic medication, so the nurse should discuss an alternate medication to decrease the client's gastric acidity

The client diagnosed with end-stage liver failure has an elevated ammonia level. The HCP prescribes lactulose. Which intervention should the nurse implement to determine the effectiveness of the medication? 1. Monitor the client's intake and output. 2. Assess the client's neurological status. 3. Measure the client's abdominal girth. 4. Document the number of bowel movements

2. Lactulose (Cephulac) is an osmotic laxative that functions as an ammonia detoxicant. An elevated ammonia level affects the client's neurological status. Lactulose is prescribed to remove ammonia through the intestinal tract. Assessing the client's neurological status will determin

The male client who has essential hypertension tells the clinic nurse he is taking the OTC medication docusate sodium. Which priority action should the clinic nurse implement? 1. Determine how often the client has a bowel movement. 2. Discuss the importance of not taking this stool softener. 3. Ask the client for his last blood pressure reading. 4. Obtain a stool specimen for an occult blood test.

2. Docusate calcium (Surfak, Colace) is a stool softener that contains sodium as well as calcium. A client with essential hypertension would be on a low-sodium diet. Docusate sodium (Colace) should not be given to clients on sodium restriction.

76. The older adult client is discussing constipation with the clinic nurse. The client tells the nurse, "I take a laxative every day so that I will have a bowel movement every day." Which statement should the nurse respond to first? 1. "Do you have heart problems or diabetes?" 2. "Have you ever had a rash or itching when you took a laxative?" 3. "You should not use laxatives every day." 4. "Most people don't have to have bowel movements daily."

3. Laxatives are indicated for short-term use only and overuse of laxatives robs the bowel of its ability to perform well on its own. Laxative dependency is a very serious and common problem of the elderly; therefore, this should be the nurse's fi rst response. The nurse should teach the client safety. 4. This is a true statement, but the

Which statement is the scientific rationale for administering a proton-pump inhibitor (PPI) to a client diagnosed with GERD? 1. PPI medications neutralize the gastric secretions. 2. PPI medications block H2 receptors on the parietal cells. 3. PPI medications inhibit the enzyme that generates gastric acid. 4. PPI medications form a protective barrier against acid and pepsin.

3. PPIs inhibit the enzyme that generates gastric acid.

25. The intensive care nurse is preparing to administer ranitidine IV piggyback (IVPB) to a client with severe burns. Which statement is the scientifi c rationale for administering this medication? 1. Ranitidine IVPB will prevent an H. pylori infection. 2. The client has a history of ulcer disease. 3. It is for prophylaxis to prevent Curling's ulcer. 4. There is no rationale; the nurse should question the order.

3. Ranitidine (Zantac) is an H2 receptor blocker. Because of the fl uid shifts that occur as a result of severe burn injuries, the blood supply to the gastrointestinal tract is diminished, while the stress placed on the body increases the gastric acid secretion, leading to gastric ulcers, a condition called Curling's ulcer. Ranitidine (Zantac) would be administered to decrease the production of gastric acid.

The home health-care nurse is caring for a male client diagnosed with a hiatal hernia and reflux. Which data indicates the medication therapy is effective? 1. The client takes the antacid 1 hour before and 3 hours after a meal. 2. The client reports indigestion after eating a large meal. 3. The client states that he did not wake up with heartburn during the night. 4. The client has lost 3 pounds in the past 2 weeks.

3. The client states that he did not wake up with heartburn during the night.

3. This indicates an improvement in symptoms and that the medication is effective. MEDICATION MEMORY JOGGER: The nurse determines the effectiveness of a medication by assessing for the symptoms, or lack thereof, for which the medication was prescribed.

The pregnant client's HIV test is positive. Which medication should the client take to prevent transmission of the virus to the fetus? 1. Efavirenz. 2. Lopinavir. 3. Zidovudine. 4. Ganciclovir.

3. Although zidovudine (AZT), a nucleoside reverse transcriptase inhibitor, is a pregnancy category C drug, research has proved that taking the drug during pregnancy reduces the risk of maternal-to-fetal transmission of the HIV virus by almost 70%. This is the only medication approved for this purpose

The female client diagnosed with acne is prescribed tetracycline. Which intervention should the nurse include in the medication teaching? 1. Tell the client to take the medication with milk or milk products. 2. Explain that this medication may cause the teeth to discolor. 3. Tell the client to use sunscreen and protective clothing when outside. 4. Advise the client to take birth control pills.

3. Photosensitivity (sun reaction) may occur in persons taking tetracycline; therefore, the client should be taught to use safety precautions when in the sunlight.

The client is scheduled for a bowel resection in the morning. The nurse administered one dose of polyethylene glycol 3350 and electrolyte oral solution. Which task is most appropriate for the nurse delegate to the UAP? 1. Remove the client's water pitcher from the room. 2. Take the client's vital signs every 2 hours. 3. Place a bedside commode in the client's room. 4. Administer moisture barrier cream to the anal area.

3. Polyethylene glycol 3350 and electrolyte oral solution (GoLYTELY) is an osmotic laxative and electrolyte solution administered to remove the stool from the body prior to bowel surgery; therefore, the client should have a bedside commode readily available and the nurse can delegate the UAP to perform this task.

The client diagnosed with AIDS is to receive an initial dose of amphotericin B. Which intervention should the nurse implement first? 1. Administer IV piggyback (IVPB) in 500 mL of D5W over 6 hours. 2. Administer meperidine 25 mg IV push (IVP) over 5 minutes. 3. Administer a test dose of 1 mg over 20 minutes. 4. Administer acetaminophen 650 mg orally.

3. The first action by the nurse is to administer a small test dose of amphotericin B (Fungizone), an antifungal agent, to assess for the client's potential response.

3. This indicates an improvement in symptoms and that the medication is effective.

The client diagnosed with end-stage liver failure is taking lactulose. Which assessment data indicates the medication is effective? 1. The client reports a decrease in pruritus. 2. The client's abdominal girth has decreased. 3. The client is experiencing diarrhea. 4. The client's ammonia level is decreased.

4. Lactulose (Cephulac), an osmotic laxative, is administered to decrease the client's serum ammonia level. The normal adult level is 19 to 60 mcg/dL.

The client is diagnosed with a Helicobacter pylori infection and peptic ulcer disease (PUD). Which discharge instructions should the nurse teach? Select all that apply. 1. Discuss placing the head of the bed on blocks to prevent reflux. 2. Teach to never use NSAIDs again. 3. Encourage the client to quit smoking cigarettes. 4. Instruct the client to eat a soft, bland diet. 5. Take the combination of medications for 14 days as directed.

3. Smoking decreases prostaglandin production and results in decreased protection of the mucosal lining. Smoking should be stopped. 5. H. pylori is a bacterial infection that is treated with a combination of medications. At least two antibiotics and an antisecretory medication will be ordered. As with all antibiotic prescriptions, the client should be taught to take all the medications as ordered. Resistant strains of H. pylori are being documented in clients who have not been compliant with the treatment program.

The client is prescribed a bulk-forming agent. Which statement best describes the scientific rationale for administering this medication? 1. The medication acts by lubricating the stool and the colon mucosa. 2. Bulk-forming agents irritate the bowel to increase peristalsis. 3. The medication causes more water and fat to be absorbed into the stool. 4. Bulk-forming agents absorb water, which adds size to the fecal mass.

4. Bulk-forming agents absorb water and swell, thus increasing the size of the fecal mass. The larger the fecal mass, the more the defecation refl ex is stimulated and the passage of stool is promoted.

The client diagnosed with male pattern baldness is prescribed finasteride. When should the nurse evaluate for effectiveness of the medication? 1. After the client has been taking the medication for 1 month. 2. When the client states there are no hair strands in the comb. 3. At the time the client's hair changes texture and color. 4. One year after taking the hair growth stimulant medication daily.

4. Finasteride (Propecia) is a hair growth stimulant. Only 50% of clients regrow hair, and it may require up to 1 year of daily treatment to determine if the medication is effective.

4. Which statement is an advantage to administering a histamine2 (H2) blocker rather than an antacid to a client diagnosed with GERD? 1. Antacids are more potent than H2 blockers in relieving the symptoms of GERD. 2. H2 blockers have more side effects than antacids. 3. H2 blockers are less expensive than antacids. 4. H2 blockers require less frequent dosing than antacids

4. H2 blockers require less frequent administration than do antacids, which require frequent administration, seven or more times a day, for therapeutic effects. The fewer times a client is expected to take a medication, the more likely the client is to comply with a medication regimen.

The client has been on a therapeutic regimen for an H. pylori infection. Which data suggests the medication is not effective? 1. The client states that the midepigastric pain has been relieved. 2. The client's Hgb level is 15 g/dL and Hct level is 44%. 3. The client has gained 3 pounds in 1 week. 4. The client's pulse is 124 beats per minute and blood pressure is 92/48.

4. The client has a rapid pulse and low blood pressure, which indicate shock. This could be caused by hemorrhage from the ulcer. This client's treatment has not been effective.

The male client diagnosed with chronic hepatitis C tells the nurse that he is taking the herb St. John's wort for depression. Which intervention should the nurse implement? 1. Tell the client to quit taking the herb immediately. 2. Document the information and take no action. 3. Encourage the client to take a prescribed antidepressant. 4. Determine if the herb has hepatotoxic properties.

4. The nurse should advise the client to avoid substances (medications, herbs, illicit drugs, and toxins) that may affect liver function; therefore, the nurse should determine if St. John's wort is hepatotoxic.

The home health-care nurse is caring for a client diagnosed with HIV infection. Which data suggests the need for prophylaxis with trimethoprim sulfa? 1. The client has a positive HIV viral load. 2. The client's white blood cell (WBC) count is 5,000/mm3 . 3. The client has a hacking cough and dyspnea. 4. The client's CD4 count is less than 300/mm3 .

4. The client with a CD4 count of less than 300/mm3 is at risk for developing PJP. Trimethoprim sulfa (Bactrim) is prophylaxis for PJP. Normal levels for CD4 are 450 to 1,400/mm3 .

The client is diagnosed with acute bacterial conjunctivitis. The HCP prescribed erythromycin ophthalmic ointment. Which information should the nurse discuss with the client? 1. Apply a thick line of ointment in the upper lid margin of the eye. 2. Look downward when applying the ointment. 3. Clean the eye with antibiotic solution prior to applying ointment. 4. Apply the ophthalmic ointment from the inner to the outer canthus.

4. When applying ointment, a thin line of ointment should be applied evenly along the inner edge of the lower lid margin, from the

The nurse administers loperamide (Imodium) to decrease the number and liquidity of stool by what mechanism? A) Decreasing intestinal motility B) Absorbing toxins C) Binding with fecal material to increase bulk D) Blocking the chemoreceptor trigger zone (CTZ)

A Feedback: Systemic antidiarrheal agents slow the motility of the gastrointestinal (GI) tract through direct action on the lining of the GI tract to inhibit local reflexes (bismuth subsalicylate), through direct action on the muscles of the GI tract to slow activity (loperamide), or through action on central nervous system (CNS) centers that cause GI spasm and slowing (opium derivatives). Options B, C, and D are not correct.

. A patient who is diagnosed with genital herpes is taking topical acyclovir. The nurse will provide which teaching for this patient? (Select all that apply.) a. "Be sure to wash your hands thoroughly before and after applying this medicine." b. "Apply this ointment until the lesion stops hurting." c. "Use a clean glove when applying this ointment." d. "If your partner develops these lesions, then he can also use the medication." e. "You will need to avoid touching the area around your eyes." f. "You will have to practice abstinence when these lesions are active."

A, C, E, F This medication needs to be applied as long as prescribed, and the medication needs to be applied with clean gloves. Prescriptions should not be shared; if the partner develops these lesions, the partner will have to be evaluated before medication is prescribed, if needed. Eye contact should be avoided. The presence of active genital herpes lesions requires sexual abstinence.

A patient will be receiving nitrofurantoin (Macrodantin) treatment for a urinary tract infection. The nurse is reviewing the patient's history and will question the nitrofurantoin order if which disorder is present in the history? (Select all that apply.) a. Liver disease b. Coronary artery disease c. Hyperthyroidism d. Type 1 diabetes mellitus e. Chronic renal disease

A,E Nitrofurantoin is contraindicated in cases of known drug allergy and also in cases of significant renal function impairment, because the drug concentrates in the urine. Because adverse effects include hepatotoxicity, which is rare but often fatal, the nurse should also question the order if liver disease is present. The other options are not contraindications.

When reviewing the medication orders for a patient who is taking penicillin, the nurse notes that the patient is also taking the oral anticoagulant warfarin (Coumadin). What possible effect may occur as the result of an interaction between these drugs? a. The penicillin will cause an enhanced anticoagulant effect of the warfarin. b. The penicillin will cause the anticoagulant effect of the warfarin to decrease. c. The warfarin will reduce the anti-infective action of the penicillin. d. The warfarin will increase the effectiveness of the penicillin.

A Administering penicillin reduces the vitamin K in the gut (intestines); therefore, enhanced anticoagulant effect of warfarin may occur. The other options are incorrect.

A patient is asking advice about which over-the-counter antacid is considered the most safe to use for heartburn. The nurse explains that the reason that calcium antacids are not used as frequently as other antacids is for which of these reasons? a. Their use may result in kidney stones. b. They cause decreased gastric acid production. c. They cause severe diarrhea. d. Their use may result in fluid retention and edema.

A Calcium antacids are not used as frequently as other antacids because their use may lead to the development of kidney stones; they also cause increased gastric acid production. The other options are incorrect.

The nurse teaches the patient that a common adverse effect of loperamide (Imodium) is what? A) Fatigue B) Flatulence C) Disorientation D) Tremors

A Feedback: Adverse effects associated with antidiarrheal drugs, such as constipation, distention, abdominal discomfort, nausea, vomiting, dry mouth, and even toxic megacolon, are related to their effects on the gastrointestinal (GI) tract. Other adverse effects that have been reported include fatigue (option A), weakness, dizziness, and rash. options B, C, and D are not correct.

The nurse administers ranitidine (Zantac) cautiously to patients with evidence of what conditions? A) Renal disease B) Diabetes mellitus C) Pulmonary disease D) Migraine headaches

A Feedback: All histamine-2 antagonists are eliminated through the kidneys; dosages need to be reduced in patients with renal impairment. No caution is necessary with Zantac therapy in people with diabetes, pulmonary disease, or migraine headaches.

A man with irritable bowel syndrome reports ongoing diarrhea and asks for a prescription for alosetron (Lotronex), which was helpful for his coworker who recently started taking the drug. What is the nurse's best response? A) This drug is only approved for use in women. B) This drug is used as a laxative. C) This drug is contraindicated with irritable bowel syndrome. D) This drug is no longer on the market for prescription use.

A Feedback: Alosetron (Lotronex) is approved for use in women with irritable bowel syndrome with diarrhea being the predominant complaint and should be discontinued immediately if the patient develops constipation or symptoms of ischemic colitis. Patients must read and sign a patientphysician agreement before it can be prescribed. Options B, C, and D are not correct.

The nurse is caring for a 62-year-old patient who is receiving IV gentamicin (Garamycin). The patient complains of difficulty hearing. What should the nurse do? A) Hold the dose and notify the physician immediately. B) Administer the dose and speak in a louder voice when talking to the patient. C) Administer the dose and report this information to the oncoming nurse. D) Administer the dose and document the finding in the nurse's notes.

A Feedback: Aminoglycosides are contraindicated in the following conditions: known allergy to any of the aminoglycosides; renal or hepatic disease that could be exacerbated by toxic aminoglycoside effects and that could interfere with drug metabolism and excretion, leading to higher toxicity; preexisting hearing loss, which could be intensified by toxic drug-related adverse effects on the auditory nerve. Ototoxicity should be reported and the drug should be stopped. You would not administer the dose and then call the physician, administer the dose and report information to oncoming nurse, or administer the dose and document the finding in the nurse's notes because each additional dose administered could potentially worsen hearing loss.

The patient is admitted to the acute care facility with acute septicemia and has orders to receive gentamicin and ampicillin IV. The nurse is performing an admission assessment that includes a complete nursing history. What information provided by the patient would indicate the need to consult the health care provider before administering the ordered medication? A) Takes furosemide (Lasix), a potent diuretic, daily B) Had prostate surgery 3 months ago C) History of hypothyroidism D) Allergic to peanuts and peanut products

A Feedback: Aminoglycosides should be avoided if the patient takes a potent diuretic because of the increased risk of ototoxicity, nephrotoxicity, and neurotoxicity. Learning the patient takes a potent diuretic would indicate the need to consult with the health care provider before administering gentamicin. Prostate surgery, hypothyroidism, and an allergy to peanuts would not preclude administration of these medications and would not indicate a need to consult with the provider.

The nurse explains why viruses are so difficult to treat when making what statement? A) Viruses are contained inside the human cell and cannot be destroyed without destroying the cell. B) Release of interferons by the host cell makes the virus replicate more quickly allowing the virus to spread. C) Drugs exist to treat all viral infections but they carry serious adverse effects and the benefit often does not outweigh the risk. D) Individual antiviral drugs are often effective in treating many different viruses because one virus in a category behaves like others in the same category.

A Feedback: Because viruses are contained inside human cells while they are in the body, researchers have difficulty developing effective drugs that destroy a virus without harming the human host. Interferons are released by the host in response to viral invasion of a cell and act to prevent the replication of that particular virus. Some interferons that affect particular viruses can now be genetically engineered to treat particular viral infections. Other drugs that are used in treating viral infections are not natural substances and have been effective against only a limited number of viruses. Very few viruses are treatable with medications; a few more can be prevented through immunization but most have no known treatment. Each antiviral is generally only suited to treat the single virus it was developed for and will not be effective against other viruses.

What drug does the nurse recognize as being classified as a chemical stimulant? A) Bisacodyl (Dulcolax) B) Polycarbophil (FiberCon) C) Magnesium hydroxide (Milk of Magnesia) D) Docusate (Colace)

A Feedback: Bisacodyl is a chemical stimulant. Polycarbophil and magnesium hydroxide are bulk laxatives. Docusate is a lubricant laxative.

A local bioterrorism medical team is learning about germ warfare. The team is instructed that a fluoroquinolone may be used to prevent an outbreak of anthrax infection. What fluoroquinolone would the nurse be most likely to administer for this purpose? A) Ciprofloxacin (Cipro) B) Gemifloxacin (Factive) C) Norfloxacin (Noroxin) D) Sparfloxacin (Zagam)

A Feedback: Ciprofloxacin (Cipro) is the most widely used fluoroquinolone and is indicated for the prevention of anthrax infection. Gemifloxacin and sparfloxacin are most useful in treating acute episodes of chronic bronchitis and community-acquired pneumonia. Norfloxacin is recommended only for certain types of urinary tract infections.

The nurse, teaching a patient to be discharged with an order to use chemical stimulant laxatives PRN, instructs the patient that one of the most common adverse effects of this type of laxative is what? A) Abdominal cramping B) Rectal bleeding C) Confusion D) Iron deficiency anemia

A Feedback: Common adverse effects of laxatives are diarrhea, abdominal cramping, and nausea. Central nervous system (CNS) adverse effects such as dizziness, headache, and weakness can occur. Rectal bleeding, confusion, and iron deficiency anemia are not associated with appropriate use of laxatives but may occur when laxatives are abused.

After administering an antibiotic, the nurse assesses the patient for what common, potentially serious, adverse effect? A) Rash B) Pain C) Constipation D) Hypopnea

A Feedback: Examine skin for any rash or lesions, examine injection sites for abscess formation, and note respiratory status including rate, depth, and adventitious sounds to provide a baseline for indications of an allergic or adverse response to the drug. Report nausea, vomiting, diarrhea, rash, recurrence of symptoms for which the antibiotic drug was prescribed, or signs of new infection (e.g., fever, cough, sore mouth, drainage). These problems may indicate adverse effects of the drug, lack of therapeutic response to the drug, or another infection. Pain, constipation, and hypopnea are not common adverse effects of antibiotic drugs.

An immunocompromised 3-year-old has been exposed to avian flu. The patient is brought to the clinic and the mother reports that the patient has had flu-like symptoms for the past 12 hours. What medication would you expect the physician to order for this patient? A) Oseltamivir (Tamiflu) B) Amantadine (Symmetrel) C) Ribavirin (Rebetron) D) Zanamivir (Relenza)

A Feedback: Oseltamivir is the only antiviral agent that has been shown to be effective in treating avian flu. Therefore Options B, C, and D are incorrect.

A patient comes to the clinic complaining of acid indigestion and tells the nurse he is tired of buying over-the-counter (OTC) antacids and wants a prescription drug to cure the problem. What would the nurse specifically assess for? A) Alkalosis B) Hypocalcemia C) Hypercholesterolemia D) Rebound tenderness at McBurney's point

A Feedback: Prolonged or excessive use of OTC antacids can lead to the development of metabolic alkalosis. Many antacids contain calcium so that low calcium levels would be unlikely. Because metabolic alkalosis is a concern, metabolic acidosis is unlikely. High cholesterol levels are not associated with OTC antacid use. Rebound tenderness at McBurney's point is related to appendicitis and not antacid use.

The nurse is planning care for an AIDS patient admitted with chronic severe diarrhea secondary to adverse effects of the antiviral drugs prescribed. What would be the most appropriate goal for this patient? A) Patient will show improved nutritional status evidenced by weight gain. B) Alleviation or reduction of signs and symptoms of AIDS. C) Patient will be able to demonstrate the effectiveness of the teaching plan. D) Patient will state that comfort and safety measures are effective and show compliance with the regimen.

A Feedback: Severe chronic diarrhea is likely to result in malnutrition and weight loss along with potential alterations in fluid and electrolyte balance. The best indicator of improvement would be an improvement in nutritional status as indicated by weight gain. Although the other outcomes might be applicable to a patient with AIDS, weight gain is the priority concern for a patient with severe chronic diarrhea.

The nurse is caring for a female patient whose tests confirm she is 10 weeks pregnant and has contracted tuberculosis. The health care provider orders a combination of antimycobacterials. What combination of drugs would the nurse identify as safest for this pregnant patient? A) Isoniazid, ethambutol, and rifampin B) Rifabutin, streptomycin, and rifampin C) Capreomycin, cycloserine, and ethionamide D) Dapsone, ethambutol, and cycloserine

A Feedback: The antituberculosis drugs are always used in combination to affect the bacteria at various cellular stages and first-line drugs are always the first choice, using second-line drugs only when the patient is unable to take the first-line medications. Because this patient is pregnant, the safest choices would be isoniazid, ethambutol, and rifampin but no drug is administered during pregnancy unless the benefit outweighs the risk. The other drug choices would be less safe and would not be used unless the safer drugs were contraindicated.

The nurse is admitting a 12-year-old girl to the acute care facility and notices discolored secondary teeth. The mother says she doesn't know why the teeth are discolored because the child is very good about brushing and flossing and sees the dentist regularly. What question would the nurse ask? A) Has she ever received tetracycline? B) Has she ever received gentamicin? C) Has she ever received ampicillin? D) Has she ever received cephalexin?

A Feedback: The nurse would question whether the child was ever given tetracycline because this drug is commonly associated with discoloration of secondary teeth when it is administered to children who still have their primary teeth. Gentamicin, ampicillin, and cephalexin are not associated with discoloration of the teeth.

The nurse is administering intravenous acyclovir (Zovirax) to a patient with a viral infection. Which administration technique is correct? a. Infuse intravenous acyclovir slowly, over at least 1 hour. b. Infuse intravenous acyclovir by rapid bolus. c. Refrigerate intravenous acyclovir. d. Restrict oral fluids during intravenous acyclovir therapy.

A Intravenous acyclovir is stable for 12 hours at room temperature and often precipitates when refrigerated. Intravenous infusions must be diluted as recommended (e.g., with 5% dextrose in water or normal saline) and infused with caution. Infusion over longer than 1 hour is suggested to avoid the renal tubular damage seen with more rapid infusions. Adequate hydration should be encouraged (unless contraindicated) during the infusion and for several hours afterward to prevent drug-related crystalluria.

During drug therapy for pneumonia, a female patient develops a vaginal superinfection. The nurse explains that this infection is caused by: a. large doses of antibiotics that kill normal flora. b. the infection spreading from her lungs to the new site of infection. c. resistance of the pneumonia-causing bacteria to the drugs. d. an allergic reaction to the antibiotics.

A Normally occurring bacteria are killed during antibiotic therapy, allowing other flora to take over and resulting in superinfections. The other options are incorrect.

During an intravenous (IV) infusion of amphotericin B, a patient develops tingling and numbness in his toes and fingers. What will the nurse do first? a. Discontinue the infusion immediately. b. Reduce the infusion rate gradually until the adverse effects subside. c. Administer the medication by rapid IV infusion to reduce these effects. d. Nothing; these are expected side effects of this medication.

A Once the intravenous infusion of amphotericin B has begun, vital signs must be monitored frequently to assess for adverse reactions such as cardiac dysrhythmias, visual disturbances, paresthesias (numbness or tingling of the hands or feet), respiratory difficulty, pain, fever, chills, and nausea. If these adverse effects or a severe reaction occur, the infusion must be discontinued (while the p

A patient will be taking a 2-week course of combination therapy with omeprazole (Prilosec) and another drug for a peptic ulcer caused by Helicobacter pylori. The nurse expects a drug from which class to be ordered with the omeprazole? a. Antibiotic b. Nonsteroidal anti-inflammatory drug c. Antacid d. Antiemetic

A The antibiotic clarithromycin is active against H. pylori and is used in combination with omeprazole to eradicate the bacteria. First-line therapy against H. pylori includes a 10- to 14-day course of a proton pump inhibitor such as omeprazole, plus the antibiotics clarithromycin and either amoxicillin or metronidazole, or a combination of a proton pump inhibitor, bismuth subsalicylate, and the antibiotics tetracycline and metronidazole. Many different combinations are used.

The nurse is providing teaching to a patient taking an oral tetracycline antibiotic. Which statement by the nurse is correct? a. "Avoid direct sunlight and tanning beds while on this medication." b. "Milk and cheese products result in increased levels of tetracycline." c. "Antacids taken with the medication help to reduce gastrointestinal distress." d. "Take the medication until you are feeling better."

A Drug-related photosensitivity occurs when patients take tetracyclines, and it may continue for several days after therapy. Milk and cheese products result in decreased levels of tetracycline when the two are taken together. Antacids also interfere with absorption and should not be taken with tetracycline. Counsel patients to take the entire course of prescribed antibiotic drugs, even if they feel that they are no longer ill.

The nurse is caring for a 27-year-old female patient who has just been prescribed misoprostol. What is a priority teaching point for this patient? A) You will need to use a barrier-type contraceptive B) Do not take NSAIDs with this drug C) Adverse effects include nausea and diarrhea D) It protects the lining of the stomach

A Feedback: Misoprostol is contraindicated during pregnancy because it is an abortifacient. Women of childbearing age who use misoprostol should be advised to use barrier-type contraceptives. All other options are correct but are not a priority for this patient.

The mother of a 5-year-old asks the nurse why it seems amoxicillin is always prescribed when her child needs an antibiotic. What is the priority rationale the nurse should give the mother? A) It is better absorbed. B) It is less costly. C) It has a less frequent dosing schedule. D) It tastes better in oral form

A Feedback: Most penicillins are rapidly absorbed from the GI tract, reaching peak levels in 1 hour. Although amoxicillin is less expensive, that fact has far less impact on choosing the proper antibiotic than the effectiveness of the drug. Most oral antibiotics for children are available in pleasant tasting syrups so taste would not be a factor. Ampicillin is often given up to 4 times a day so it actually has a frequent dosing schedule.

The nurse is teaching the patient about amoxicillin prior to discharge and includes what important teaching point? A) Blackening of the tongue may occur but will subside when the drug is discontinued. B) Even if it seems like the infection is not improving, the drug is still working. C) Yeast infections are unlikely to occur with this medication because it is narrow spectrum. D) Appearance of a rash is common and does not indicate an allergic reaction.

A Feedback: One of the adverse effects of ampicillin is blackening of the tongue but the discoloration goes away after stopping the drug. If it is accompanied by swelling, the patient should be instructed to call the prescribing health care provider immediately. Many penicillin-resistant pathogens exist, so if the infection does not seem to be responding to the drug, the patient should notify the health care provider because a different antibiotic may be required. Yeast infections are very likely after taking ampicillin because it is a broad-spectrum antibiotic. Appearance of a rash should be evaluated by a health care professional because allergic reactions to this class of antibiotic are very common.

The 59-year-old patient has peptic ulcer disease and is started on sucralfate (Carafate). What is an appropriate nursing diagnosis related to this medication? A) Risk for constipation related to GI effects B) Risk for injury: bleeding C) Imbalanced nutrition related to nausea D) Deficient fluid volume

A Feedback: The adverse effects associated with sucralfate are primarily related to its GI effects. Constipation is the most frequently seen adverse effect. Imbalanced nutrition, if seen, would be related to diarrhea or constipation and not nausea. Fluid volume deficit and bleeding are not common adverse effects of this drug.

. The nurse is reviewing the sputum culture results of a patient with pneumonia and notes that the patient has a gram-positive infection. Which generation of cephalosporin is most appropriate for this type of infection? a. First generation b. Second generation c. Third generation d. Fourth generation

A First-generation cephalosporins provide excellent coverage against gram-positive bacteria but limited coverage against gram-negative bacteria

A patient with AIDS is taking an antiviral agent. What comment by the patient would indicate that the teaching plan was effective? A) I feel like I do when I have the flu. B) I will continue to take the over-the-counter medication for my allergies. C) Excessive fatigue and a severe headache are common adverse effects of my medication. D) This drug will cure AIDS.

A Feedback: Common adverse effects of antiviral agents are flu-like symptoms, which may be related to the underlying disease. Excessive fatigue and a severe headache can indicate a serious complication and should be reported immediately. Antiviral agents do not cure the disease. HIV causes loss of helper T- cell function. This causes the immune system to be depressed and allows opportunistic infections to occur. Antiviral agents reduce the number of mutant viruses that are formed and spread to noninfected cells.

The nurse is caring for a patient who is taking adefovir to treat hepatitis B. The nurse would hold the medication and notify the health care provider if assessing the signs and symptoms of what? (Select all that apply.) A) Lactic acidosis B) Hepatotoxicity C) Headache D) Nausea E) Asthenia

A, B Feedback: Withdraw the drug and monitor the patient if he or she develops signs of lactic acidosis or hepatotoxicity because these adverse effects can be life threatening. Headache, nausea, and asthenia are potential adverse effects but are not life threatening and would not require withdrawal of the drug

For what viruses might the nurse administer acyclovir (Zovirax)? (Select all that apply.) A) Herpes simplex virus B) Shingles C) Chickenpox D) HIV E) Cytomegalovirus (CMV)

A, B, C Feedback: Acyclovir is indicated for the treatment of herpes simplex virus, shingles, and chickenpox as well as topically for treating herpes labialis. Acyclovir is not effective against HIV or CMV.

. When the nurse cares for a patient receiving an antibiotic, what instructions will the nurse provide no matter what medication is prescribed? (Select all that apply.) A) Drink plenty of fluids to avoid kidney damage. B) Take all medications as prescribed until all of the medication is gone. C) Report difficulty breathing, severe headache, or changes in urine output. D) Take antibiotic with food to avoid gastrointestinal (GI) upset. E) Take safety precautions such as changing position slowly.

A, B, C Feedback: The patient taking any antibiotic needs to drink plenty of fluids to avoid kidney damage and improve excretion of the metabolized drug; take all medications as prescribed until all of the medication is gone to avoid developing a resistant strain of bacteria; and report any difficulty breathing, severe headache, or changes in urine output because these are primary manifestations of serious adverse effects. Although some antibiotics need to be taken with food, others may be best taken on an empty stomach so this does not apply to all antibiotics. Not all antibiotics are associated with central nervous system (CNS) toxicity so taking safety precautions need only be included in patient teaching if they are taking a drug associated with CNS adverse effects.

What would the nurse consider an indication for the use of antacids? (Select all that apply.) A) Gastric hyperacidity B) Gastritis C) Peptic esophagitis D) Hiatal hernia E) Duodenal ulcer

A, B, C, D Feedback: Antacids neutralize stomach acid by direct chemical reaction. They are recommended for the symptomatic relief of upset stomach associated with hyperacidity, as well as the hyperacidity associated with peptic ulcer, gastritis, peptic esophagitis, gastric hyperacidity, and hiatal hernia. Duodenal ulcer is not an indication for the use of an antacid.

A patient is in the HIV clinic for a follow-up appointment. He has been on antiretroviral therapy for HIV for more than 3 years. The nurse will assess for which potential adverse effects of longterm antiretroviral therapy? (Select all that apply.) a. Lipodystrophy b. Liver damage c. Kaposi's sarcoma d. Osteoporosis e. Type 2 diabetes

A, B, D, E Anti-HIV drugs produce strain on the liver and may result in liver disease. A major adverse effect of protease inhibitors is lipid abnormalities, including lipodystrophy, or redistribution of fat stores under the skin. In addition, dyslipidemias such as hypertriglyceridemia can occur, and insulin resistance and type 2 diabetes symptoms can result. The increase in long-term antiretroviral drug therapy due to prolonged disease survival has led to the emergence of another long-term adverse effect associated with these medications—bone demineralization and possible osteoporosis. Kaposi's sarcoma is an opportunistic disease associated with HIV, not a result of long-term drug therapy

A clinic patient with a history of heart failure requires a laxative for treatment of chronic constipation. What medication would be most appropriate for this patient? A) Senna (Senokot) B) Lactulose (Chronulac) C) Magnesium sulfate (Milk of Magnesia) D) Castor oil (Neoloid)

B Lactulose is often the drug of choice when a patient with cardiovascular problems requires a laxative. It is salt free, an important consideration in patients with heart failure; it acts by exerting a gentle osmotic pull of fluid into the intestinal lumen. Senna, magnesium sulfate, and castor oil are more aggressive laxatives and might not be the best choice for a patient with cardiovascular problems.

What is the antidiarrheal of choice the nurse will administer to children older than 2 years of age with diarrhea? A) Bismuth salts (Pepto-Bismol) B) Loperamide (Imodium) C) Paregoric (generic) D) Difenoxin (Motofen)

B Loperamide may be the antidiarrheal of choice in children older than 2 years of age if such a drug is needed. Special precautions need to be taken to monitor for electrolyte and fluid disturbances and supportive measures should be taken as needed. Serious fluid volume deficits may rapidly develop in children with diarrhea. Appropriate fluid replacement should include oral rehydration solutions. Although bismuth salts and paregoric may be given to children, they are not the drugs of choice. Difenoxin is not for use in children under 12 years of age.

A patient is receiving an aluminum-containing antacid. The nurse will inform the patient to watch for which possible adverse effect? a. Diarrhea b. Constipation c. Nausea d. Abdominal cramping

B Aluminum-based antacids have a constipating effect as well as an acid-neutralizing capacity. The other options are incorrect.

What nursing interventions are included in the plan of care for a patient receiving antacids to relieve GI discomfort? A) Administer this drug with other drugs or food. B) Administer the antacid 1 hour before or 2 hours after other oral medications. C) Limit fluid intake to decrease dilution of the medication in the stomach. D) Have the patient swallow the antacid whole and do not crush or chew the tablet.

B Feedback: A patient taking antacids should be advised to take the antacid 1 hour before or 2 hours after other oral medications. These tablets are often chewed to increase effectiveness. Limiting fluid intake can result in rebound fluid retention so that patients should be encouraged to maintain hydration. It is not necessary to take an antacid with other drugs, nor with food.

What drug does the nurse administer that inhibits intestinal peristalsis through direct effects on the longitudinal and circular muscles of the intestinal wall? A) Bismuth subsalicylate B) Loperamide C) Paregoric D) Magnesium citrate

B Feedback: Actions of loperamide include that it inhibits intestinal peristalsis through direct effects on the longitudinal and circular muscles of the intestinal wall, slowing motility and movement of water and electrolytes. Bismuth subsalicylate inhibits local reflexes. Paregoric works through action on CNS centers that cause GI spasm and slowing. Magnesium citrate is a laxative.

The nurse is caring for a pregnant woman diagnosed with HIV on prenatal drug screening. What medication would the nurse expect to administer to reduce the risk of maternal to fetal transmission of the virus? A) Lamivudine (Epivir) B) Zidovudine (Retrovir) C) Stavudine (Zerit XR) D) Tenofovir (Viread)

B Feedback: AZT, or zidovudine is administered to prevent the transmission of HIV from mother to child and can be administered to both after birth to treat symptomatic HIV. The other medications (options A, C, and D) are not used for this purpose

A patient taking a chemical stimulant laxative and medications for heart failure and osteoarthritis calls the clinic and reports to the nurse that she is not feeling right. What is the priority question the nurse should ask this patient? A) Effectiveness of laxatives B) Timing of medication administration C) The amount of fiber in her diet D) Amount of fluid ingested

B Feedback: Because laxatives increase the motility of the gastrointestinal (GI) tract and some laxatives interfere with the timing or process of absorption, it is not advisable to take laxatives with other prescribed medications. The administration of laxatives and other medications should be separated by at least 30 minutes, so the nurse should question when the patient is taking the laxatives and other medication. Other options may be questions the nurse would eventually ask, but the priority is timing of medication administration.

A 28-year-old patient has been prescribed penicillin for the first time. What nursing diagnosis would be most appropriate for this patient? A) Acute pain related to gastrointestinal (GI) effects of the drug B) Deficient knowledge regarding drug therapy C) Imbalance nutrition: less than body requirements related to multiple GI effects of the drug D) Constipation

B Feedback: Because this is the first time the patient has taken penicillin, she is likely to have limited knowledge about the drug. She may not understand the importance of taking the medication as ordered to increase effectiveness of the drug or to report adverse effects. because the patient has not started the drug yet, there is no way to know what adverse effects, if any, she will experience. Only if she develops acute pain related to GI effects of the drug would this be appropriate. If GI symptoms develop it may lead to imbalanced nutrition, but that remains to be seen. No indication about constipation exists.

The patient will receive ranitidine (Zantac) 150 mg PO at bedtime. Prior to administration, the nurse will inform the patient that common adverse effects related to this medication include what? A) Tremors B) Headache C) Visual disturbances D) Anxiety

B Feedback: Headache, dizziness, somnolence, and mental confusion may occur with H2 antagonists. Visual disturbances, tremors, and anxiety are not normally associated with ranitidine.

A nurse practitioner is teaching a health class in the local high school. The NP informs the class about hepatitis B. What occupation does the NP inform the class is at the greatest risk for contracting hepatitis B? A) Policemen B) Health care workers C) Educators D) Fire fighters

B Feedback: Health care workers are at especially high risk for contracting hepatitis B due to needle sticks and contact with the blood of infected patients. Policemen, educators, and fire fighters are not considered at high risk for contracting hepatitis B although they do face some risk because of contact with blood and body fluids.

The nurse develops a teaching plan for a 77-year-old patient who has been prescribed loperamide PRN. The nurse's priority teaching point is what? A) May cause hallucinations or respiratory depression B) Take drug after each loose stool C) Drug remains in the bowel without being absorbed into the bloodstream D) Avoid pregnancy and breast-feeding while taking drug.

B Feedback: Loperamide is taken repeatedly after each loose stool. Teaching the patient when to take the drug is the priority teaching point. Paregoric, and not loperamide, can cause hallucinations and respiratory depression. The drug is absorbed systemically. It is unlikely a 77-year-old patient will get pregnant or breast-feed so this is not the highest priority.

The nurse will question an order for bismuth salts (Pepto-Bismol) in a patient with what condition? A) Rheumatoid arthritis B) Allergy to aspirin C) Hypertension D) Viral gastroenteritis

B Feedback: Pepto-Bismol has aspirin in it and should not be given to a patient with an allergy to aspirin. There is no contraindication for a patient with rheumatoid arthritis, hypertension, or viral gastroenteritis.

The nurse is providing patient teaching before discharging a patient home. The patient is taking ciprofloxacin (Cipro). What would the nurse teach this patient is the best way to prevent crystalluria caused by ciprofloxacin (Cipro)? A) Eliminate red meat and seafood from the diet. B) Encourage at least 2 liters of fluid per day. C) Avoid caffeine and alcohol. D) Spend time in the sun each day to optimize vitamin D levels.

B Feedback: Provide the following patient teaching: Avoid driving or operating dangerous machinery because dizziness, lethargy, and ataxia may occur; try to drink a lot of fluids and maintain nutrition (very important), even though nausea, vomiting, and diarrhea may occur. There is no need to eliminate red meat, seafood, caffeine, or alcohol from the diet, although alcohol may increase the risk of GI irritation. Patients should be taught to avoid the sun due to possible photosensitivity.

The nurse is providing counseling to a woman who is HIV positive and has just discovered that she is pregnant. Which anti-HIV drug is given to HIV-infected pregnant women to prevent transmission of the virus to the infant? a. Acyclovir (Zovirax) b. Zidovudine (Retrovir) c. Ribavirin (Virazole) d. Foscarnet (Foscavir)

B Zidovudine, along with various other antiretroviral drugs, is given to HIV-infected pregnant women and even to newborn babies to prevent maternal transmission of the virus to the infant. The other drugs are non-HIV antiviral drugs.

When reviewing the health history of a patient who will be receiving antacids, the nurse recalls that antacids containing magnesium need to be used cautiously in patients with which condition? a. Peptic ulcer disease b. Renal failure c. Hypertension d. Heart failure

B Both calcium- and magnesium-based antacids are more likely to accumulate to toxic levels in patients with renal disease and are commonly avoided in this patient group. The other options are incorrect.

The nurse teaches the patient to best maintain optimal GI function by including what in the daily routine? A) Exercise, adequate sleep, and avoiding caffeine B) Proper diet, fluid intake, and exercise C) Proper diet, avoiding alcohol, and cautious use of laxatives D) Avoiding prescription medications, increased fluid intake, and vigorous exercise

B Feedback: The best way to maintain gastrointestinal (GI) function is through proper diet including optimizing fiber intake, adequate fluid intake, and exercise, which will stimulate GI activity. Drugs should only be used when normal function cannot be maintained. Options A, C, and D are not correct.

The school nurse is preparing a lecture on hepatitis B for a health class in high school. What is an important teaching point for the nurse to include about the transmission of hepatitis B? (Select all that apply.) A) Hepatitis B is transmitted through the bite of an insect. B) Hepatitis B is transmitted through sexual contact. C) Hepatitis B is transmitted through blood-to-blood contact. D) Hepatitis B is transmitted from the mother to her unborn baby. E) Hepatitis B is transmitted through nonsexual household contact.

B, C, D Feedback: Hepatitis B is transmitted from one person to another through sexual contact, blood-to-blood contact, or perinatally. It is not transmitted through casual contact. Several studies involving more than 1,000 uninfected, nonsexual household contacts with persons with hepatitis B infection (including siblings, parents, and children) have shown no e

The nurse is reviewing the medication history of a patient who will be taking a sulfonamide antibiotic. During sulfonamide therapy, a significant drug interaction may occur with which of these drugs or drug classes? (Select all that apply.) a. Opioids b. Oral contraceptives c. Sulfonylureas d. Antihistamines e. Phenytoin (Dilantin) f. Warfarin (Coumadin)

B, C, E, F Sulfonamides may potentiate the hypoglycemic effects of sulfonylureas in diabetes treatment, the toxic effects of phenytoin, and the anticoagulant effects of warfarin, which can lead to hemorrhage. Sulfonamides may also reduce the efficacy of oral contraceptives.

The nurse is administering an amphotericin B infusion. Which actions by the nurse are appropriate? (Select all that apply.) a. Administering the medication by rapid IV infusion b. Discontinuing the drug immediately if the patient develops tingling and numbness in the extremities c. If adverse effects occur, reducing the IV rate gradually until they subside d. Using an infusion pump for IV therapy e. Monitoring the IV site for signs of phlebitis and infiltration f. Administering premedication for fever and nausea g. Knowing that the intravenous solution for amphotericin B will be cloudy h. Knowing that muscle twitching may indicate hypokalemia

B, D, E, F If the patient develops tingling and numbness in the extremities (paresthesias), discontinue the drug immediately. An infusion pump is necessary for the infusion, and the nurse will monitor the IV site for signs of phlebitis and infiltration. Premedication to reduce the adverse effects of fever, malaise, and nausea may be ordered. The IV solution must be clear and without precipitates; and muscle weakness, not twitching, may indicate hypokalemia. The medication must be administered at the rate recommended and stopped, not slowed, if adverse reactions occur.

The clinic nurse is caring for a 78-year-old male patient who is taking a proton pump inhibitor. What condition is this patient at increased risk for developing? A) Sickle cell anemia B) Megaloblastic anemia C) Pernicious anemia D) Iron deficiency anemia

C Feedback: The use of proton pump inhibitors and H2 blockers in older adults has been associated with decreased absorption of vitamin B12 and the development of pernicious anemia. The use of proton pump inhibitors does not increase the risk of sickle cell, megaloblastic, or iron deficiency anemias.

The nurse is monitoring for therapeutic results of antibiotic therapy in a patient with an infection. Which laboratory value would indicate therapeutic effectiveness of this therapy? a. Increased red blood cell count b. Increased hemoglobin level c. Decreased white blood cell count d. Decreased platelet count

C Decreased white blood cell counts are an indication of reduction of infection and are a therapeutic effect of antibiotic therapy. The other options are incorrect.

The nurse is preparing a patient for discharge with a prescription for sucralfate (Carafate) and teaches the patient to take the medication when? A) With meals B) With an antacid before breakfast C) 1 hour before or 2 hours after meals and at bedtime D) After each meal

C Feedback: Administer drug on an empty stomach, 1 hour before or 2 hours after meals and at bedtime, to ensure therapeutic effectiveness of the drug. Administer antacids, if ordered, between doses of sucralfate and not within 30 minutes of taking the drug. Options A, B, and D are not correct.

The nurse is caring for an asymptomatic preschool-aged child who has cystic fibrosis and has been exposed to influenza A before receiving the appropriate immunization. What antiviral medication might the nurse administer to this child? A) Rimantadine (Flumadine) B) Zanamivir (Relenza) C) Oseltamivir (Tamiflu) D) Amantadine (Symmetrel)

C Feedback: Amantadine is indicated for the prevention of respiratory virus infections and can be given to children older than 1 year of age. This would be appropriate in a child with a chronic respiratory illness who could die as the result of developing a respiratory virus. Zanamivir is not indicated for children younger than 7 years of age. Rimantadine is administered as prophylaxis against influenza A virus in children older than 10 years of age. Oseltamivir is indicated for patients who are symptomatic for less than 2 days, but this child is asymptomatic.

When comparing the histamine-2 antagonists to each other the nurse recognizes that cimetidine (Tagamet) is more likely to cause which adverse effect? A) Dizziness B) Headache C) Gynecomastia D) Somnolence

C Feedback: Cimetidine was the first drug in this class to be developed. It has been associated with antiandrogenic effects, including gynecomastia and

The home health nurse is caring for a 72-year-old man in his home. He complains about almost daily diarrhea. The nurse assesses for what common cause of diarrhea in older adults? A) Diabetes B) Hypertensive medications C) Laxative overuse D) Glaucoma

C Feedback: Diarrhea in older adults may result from laxative overuse so the nurse should assess what over-the- counter (OTC) products the patient is using. Diabetes, hypertension medications, and glaucoma are not common causes of diarrhea in patients.

A patient with a duodenal ulcer is receiving sucralfate for short-term treatment. What will the nurse advise the patient to avoid? A) Milk of Magnesia B) Tums C) Aluminum salts D) Proton pump inhibitors

C Feedback: If aluminum salts (AlternaGEL) are taken concurrently with sucralfate, a risk of high aluminum levels and related aluminum toxicity exists. The combination of sucralfate and aluminum salts should be avoided or used with extreme caution. Adverse r

The nurse is providing education for a patient with peptic ulcer disease resulting from chronic nonsteroidal anti-inflammatory drug (NSAID) use who will begin a prescription of misoprostol (Cytotec). The nurse evaluates that the patient understands the actions of this drug when he or she says it does what? A) Reduces the stomach's volume of hydrochloric acid B) Increases the speed of gastric emptying C) Protects the stomach's lining D) Increases lower esophageal sphincter pressure

C Feedback: Misoprostol is a synthetic prostaglandin that, like physiologic prostaglandin, protects the gastric mucosa. NSAIDs decrease prostaglandin production and predispose the patient to peptic ulceration. Misoprostol does not reduce gastric acidity (option A), improve emptying of the stomach (option B), or increase lower esophageal sphincter pressure (option D).

A patient receiving loperamide (Imodium) should be alerted by the nurse to what possible adverse effect? A) Anxiety B) Bradycardia C) Fatigue D) Urinary retention

C Feedback: Patients should be aware that they should not drive or operate machinery while taking loperamide (Imodium) because it can cause fatigue. Anxiety, bradycardia, and urinary retention are not commonly associated with loperamide.

What classification of drugs does the nurse administer to treat peptic ulcers by suppressing the secretion of hydrochloric acid into the lumen of the stomach? A) Antipeptic agents B) Histamine-2 antagonists C) Proton pump inhibitors D) Prostaglandins

C Feedback: Proton pump inhibitors suppress the secretion of hydrochloric acid into the lumen of the stomach. Antipeptic agents coat any injured area in the stomach to prevent further injury. H2 antagonists block the release of hydrochloric acid in response to gastrin. Prostaglandins inhibit secretion of gastrin and increase secretion of the mucous lining of the stomach.

What priority teaching point does the nurse include when instructing patients about the use of antacids? A) Reduce calorie intake to reduce acid production. B) Take before each meal and before bed. C) Be aware of risk of acid rebound with long-term use. D) Consider liquid diet if diarrhea occurs.

C Feedback: Repeated use of antacids can result in rebound acid production because more gastrin is produced when pH of acid level decreases. Patients should be taught that long-term use of antacids requires follow-up care. Calorie and fluid intake does not need to be reduced because it is important to maintain nutrition, especially if diarrhea occurs. Antacids are taken at least 1 hour before or 2 hours after any other drug or meal.

When discussing cephalosporins with the nursing class, the pharmacology instructor explains that this classification of drug is primarily excreted through which organ? A) Lung B) Liver C) Kidney D) Skin

C Feedback: The cephalosporins are primarily metabolized in the liver and excreted in urine. These drugs cross the placenta and enter breast milk. They are not excreted through the lungs, liver, or skin.

What is the priority reason for the nurse to consider questioning an order for tetracycline in a child younger than 8 years of age? A) Children younger than 8 years of age cannot take tetracyclines. B) Weight-bearing joints have been impaired in young animals given the drugs. C) Tetracyclines can damage developing teeth and bone in children younger than 8 years of age. D) Liver and kidney function may be damaged when it is given to children under 8 years of age.

C Feedback: Use tetracyclines with caution in children younger than 8 years of age because they can potentially damage developing bones and teeth. Although the drug does not cause damage to liver and kidneys, it may be contraindicated in patients with hepatic or renal dysfunction because it is concentrated in the bile and excreted in the urine. Fluoroquinolones, not tetracyclines, are generally contraindicated for use in children (i.e., those younger than 18 years of age) because weight-bearing joints have been impaired in young animals given the drugs. Clindamycin (Dalacin C) warrants monitoring hepatic and renal function when it is given to neonates and infants. Trimethoprimsulfamethoxazole (Nu-Cotrimox) is used in children, although children younger than 2 months of age have not been evaluated. Children under 8 years of age can take tetracycline, but it should be used with caution.

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

C Pyridoxine (vitamin B6) may be beneficial for isoniazid-induced peripheral neuropathy. The other options are incorrect. DIF: COGNITIVE LEVEL:

. A patient has a urinary tract infection. The nurse knows that which class of drugs is especially useful for such infections? a. Macrolides b. Carbapenems c. Sulfonamides d. Tetracyclines

C Sulfonamides achieve very high concentrations in the kidneys, through which they are eliminated. Therefore, they are often used in the treatment of urinary tract infections.

The nurse is reviewing the medication administration record of a patient who is taking isoniazid (INH). Which drug or drug class has a significant drug interaction with isoniazid? a. Pyridoxine (vitamin B6) b. Penicillins c. Phenytoin (Dilantin) d. Benzodiazepines

C Taking INH with phenytoin will cause decreased metabolism of the phenytoin, leading to increased drug effects. Pyridoxine is often given with isoniazid to prevent peripheral neuropathy. The other options are incorrect.

A young adult calls the clinic to ask for a prescription for "that new flu drug." He says he has had the flu for almost 4 days and just heard about a drug that can reduce the symptoms. What is the nurse's best response to his request? a. "Now that you've had the flu, you will need a booster vaccination, not the antiviral drug." b. "We will need to do a blood test to verify that you actually have the flu." c. "Drug therapy should be started within 2 days of symptom onset, not 4 days." d. "We'll get you a prescription. As long as you start treatment within the next 24 hours, the drug should be effective."

C These drugs need to be started within 2 days of influenza symptom onset; they can be used for prophylaxis and treatment of influenza. The other options are incorrect.

When reviewing the allergy history of a patient, the nurse notes that the patient is allergic to penicillin. Based on this finding, the nurse would question an order for which class of antibiotics? a. Tetracyclines b. Sulfonamides c. Cephalosporins d. Quinolones

C Allergy to penicillin may also result in hypersensitivity to cephalosporins. The other options are incorrect.

A 75-year-old woman comes into the clinic with complaints of muscle twitching, nausea, and headache. She tells the nurse that she has been taking sodium bicarbonate five or six times a day for the past 3 weeks. The nurse will assess for which potential problem that may occur with overuse of sodium bicarbonate? a. Constipation b. Metabolic acidosis c. Metabolic alkalosis d. Excessive gastric mucus

C Excessive use of sodium bicarbonate may lead to systemic alkalosis. The other options are incorrect.

The nurse is providing discharge teaching to a patient who is being sent home on oral tetracycline (Sumycin). What instructions should the nurse include? A) Take the medication only once a day. B) Check pulse rate and hold the drug if lower than 60 beats per minute (bpm) C) Take the drug on an empty stomach. D) Take the medication with 2 ounces of water.

C Feedback: Tetracycline should be taken on an empty stomach 1 hour before or 2 hours after meals with a full 8 ounces of water to ensure full absorption. Tetracycline is usually taken at least once every 12 hours. Checking the pulse and holding the dose if below 60 bpm is an action specific to the use of cardiac glycosides.

. A patient is receiving his third intravenous dose of a penicillin drug. He calls the nurse to report that he is feeling "anxious" and is having trouble breathing. What will the nurse do first? a. Notify the prescriber. b. Take the patient's vital signs. c. Stop the antibiotic infusion. d. Check for allergies.

C Hypersensitivity reactions are characterized by wheezing; shortness of breath; swelling of the face, tongue, or hands; itching; or rash. The nurse should immediately stop the antibiotic infusion, have someone notify the prescriber, and stay with the patient to monitor the patient's vital signs and condition. Checking for allergies should have been done before the infusion.

At 0900, the nurse is about to give morning medications, and the patient has asked for a dose of antacid for severe heartburn. Which schedule for the antacid and medications is correct? a. Give both the antacid and medications at 0900. b. Give the antacid at 0900, and then the medications at 0930. c. Give the medications at 0900, and then the antacid at 1000. d. Give the medications at 0900, and then the antacid at 0915.

C Medications are not to be taken, unless prescribed, within 1 to 2 hours of taking an antacid because of the impact on the absorption of many medications in the stomach.

The nurse is administering one of the lipid formulations of amphotericin B. When giving this drug, which concept is important to remember? a. The lipid formulations may be given in oral form. b. The doses are much lower than the doses of the older drugs. c. The lipid formulations are associated with fewer adverse effects than the older drugs. d. There is no difference in cost between the newer and older forms.

C Newer lipid formulations of amphotericin B have been developed in an attempt to decrease the incidence of its adverse effects and increase its efficacy. However, the lipid formulations are more costly.

A patient who is diagnosed with shingles is taking topical acyclovir, and the nurse is providing instructions about adverse effects. The nurse will discuss which adverse effects of topical acyclovir therapy? a. Insomnia and nervousness b. Temporary swelling and rash c. Burning when applied d. This medication has no adverse effects

C Transient burning may occur with topical application of acyclovir. The other options are incorrect.

The nurse is counseling a woman who will be starting rifampin (Rifadin) as part of antitubercular therapy. The patient is currently taking oral contraceptives. Which statement is true regarding rifampin therapy for this patient? a. Women have a high risk for thrombophlebitis while on this drug. b. A higher dose of rifampin will be necessary because of the contraceptive. c. Oral contraceptives are less effective while the patient is taking rifampin. d. The incidence of adverse effects is greater if the two drugs are taken together.

C Women taking oral contraceptives and rifampin need to be counseled about other forms of birth control because of the impaired effectiveness of the oral contraceptives during concurrent use of rifampin

When would it be appropriate for the nurse to administer a cathartic laxative to the patient? (Select all that apply.) A) Partial small-bowel obstruction B) Appendicitis C) After having a baby D) After a myocardial infarction (MI) E) After anthelmintic therapy

C, D, E Feedback: Laxative, or cathartic, drugs are indicated for the short-term relief of constipation; to prevent straining when it is clinically undesirable (such as after surgery, myocardial infarction, or obstetric delivery); to evacuate the bowel for diagnostic procedures; to remove ingested poisons from the lower gastrointestinal (GI) tract; and as an adjunct in anthelmintic therapy when it is desirable to flush helminths from the GI tract. They are not indicated when a patient has an appendicitis or a partial small-bowel obstruction.

The nurse is preparing an infusion of amphotericin B for a patient who has a severe fungal infection. Which intervention is appropriate regarding the potential adverse effects of amphotericin B? a. Discontinuing the infusion immediately if fever, chills, or nausea occur b. Gradually increasing the infusion rate until the expected adverse effects occur c. If fever, chills, or nausea occur during the infusion, administering medications to treat the symptoms d. Before beginning the infusion, administering an antipyretic and an antiemetic drug

D Almost all patients given the drug intravenously experience fever, chills, hypotension, tachycardia, malaise, muscle and joint pain, anorexia, nausea and vomiting, and headache. For this reason, pretreatment with an antipyretic (acetaminophen), antihistamines, and antiemetics may be conducted to decrease the severity of the infusion-related reaction. The other options are incorrect.

A 79-year-old patient is receiving a quinolone as treatment for a complicated incision infection. The nurse will monitor for which adverse effect that is associated with these drugs? a. Neuralgia b. Double vision c. Hypotension d. Tendonitis and tendon rupture

D A black-box warning is required by the U.S. Food and Drug Administration for all quinolones because of the increased risk for tendonitis and tendon rupture with use of the drugs. This effect is more common in elderly patients, patients with renal failure, and those receiving concurrent glucocorticoid therapy (e.g., prednisone). The other options are not common adverse effects.

A patient is admitted with a fever of 102.8° F (39.3° C), origin unknown. Assessment reveals cloudy, foul-smelling urine that is dark amber in color. Orders have just been written to obtain stat urine and blood cultures and to administer an antibiotic intravenously. The nurse will complete these orders in which sequence? a. Blood culture, antibiotic dose, urine culture b. Urine culture, antibiotic dose, blood culture c. Antibiotic dose, blood and urine cultures d. Blood and urine cultures, antibiotic dose

D Culture specimens should be obtained before initiating antibiotic drug therapy; otherwise, the presence of antibiotics in the tissues may result in misleading culture and sensitivity results. The other responses are incorrect.

A nonnucleoside reverse transcriptase inhibitor has direct effects on the HIV virus activities within the cell. What drug is a nonnucleoside reverse transcriptase inhibitor? A) Econazole nitrate (Spectazole) B) Oxaliplatin (Eloxatin) C) Olanzapine (Zyprexa) D) Efavirenz (Sustiva)

D Feedback: The nonnucleoside reverse transcriptase inhibitors now available include: delavirdine (Rescriptor), efavirenz (Sustiva), and nevirapine (Viramune). Econazole nitrate is an antifungal cream, olanzapine is an atypical antipsychotic, and oxaliplatin is an antineoplastic agent.

The nurse will assess the patient for which potential contraindication to antitubercular therapy? a. Glaucoma b. Anemia c. Heart failure d. Hepatic impairment

D Results of liver function studies (e.g., bilirubin level, liver enzyme levels) need to be assessed because isoniazid and rifampin may cause hepatic impairment; severe liver dysfunction is a contraindication to these drugs. In addition, the patient's history of alcohol use needs to be assessed.

A patient has been taking antitubercular therapy for 3 months. The nurse will assess for what findings that indicate a therapeutic response to the drug therapy? a. The chronic cough is gone. b. There are two consecutive negative purified protein derivative (PPD) results over 2 months. c. There is increased tolerance to the medication therapy, and there are fewer reports of adverse effects. d. There is a decrease in symptoms of tuberculosis along with improved chest x-rays and sputum cultures.

D A therapeutic response to antitubercular therapy is manifested by a decrease in the symptoms of tuberculosis, such as cough and fever, and by weight gain. The results of laboratory studies (culture and sensitivity tests) and the chest radiographic findings will be used to confirm the clinical findings of resolution of the infection.

A patient who is HIV- positive has been receiving medication therapy that includes zidovudine (Retrovir). However, the prescriber has decided to stop the zidovudine because of its doselimiting adverse effect. Which of these conditions is the dose-limiting adverse effect of zidovudine therapy? a. Retinitis b. Renal toxicity c. Hepatotoxicity d. Bone marrow suppression

D Bone marrow suppression is often the reason that a patient with HIV infection has to be switched to another anti-HIV drug such as didanosine. The two drugs can be taken together, cutting back on the dosag

The nurse is reviewing the medication orders for a patient who will be receiving gentamicin therapy. Which other medication or medication class, if ordered, would be a potential interaction concern? a. Calcium channel blockers b. Phenytoin c. Proton pump inhibitors d. Loop diuretics

D Concurrent use of aminoglycosides, such as gentamicin, with loop diuretics increases the risk for ototoxicity. The other drugs and drug classes do not cause interactions.

A patient newly diagnosed with HIV is receiving patient teaching from the clinic nurse about antiviral medications. What would the nurse tell the patient needs to be reported to a health care provider? A) Dizziness B) Constipation C) Vomiting D) Rash

D Feedback: All options provided have the potential to be an adverse effect of antiviral medications prescribed to treat HIV. Most can be managed through diet or over-the-counter medications but a rash needs to be reported immediately because it could indicate a potentially serious reaction and requires immediate intervention.

What drug combination will the nurse normally administer most often to treat a gastric ulcer? A) Antibiotics and histamine-2 antagonists B) H2 antagonists, antibiotics, and bicarbonate salts C) Bicarbonate salts, antibiotics, and ZES D) Antibiotics and proton pump inhibitors

D Feedback: Currently, the most commonly used therapy for gastric ulcers is a combination of antibiotics and proton pump inhibitors that suppress or eradicate Helicobacter pylori. H2 receptor antagonists are used to treat duodenal ulcers. Bicarbonate salts are not used. ZES is the abbreviation for ZollingerEllison syndrome and not a drug.

A new mother required an episiotomy during the birth of her baby. Two days after delivery, the patient is in need of a laxative. What will be the most effective drug for the nurse to administer? A) Bisacodyl (Dulcolax) B) Castor oil (Neolid) C) Magnesium sulfate (epsom salts) D) Docusate (Colace)

D Feedback: Docusate is a stool softener that will make expulsion of stool easier in a traumatized body area following an episiotomy. Care must be taken to choose a mild laxative that will not enter breast milk and not affect the newborn if the mother is nursing. Docusate is the drug of choice from this list because it is mild and will produce a soft stool and decrease the need to strain. The other options would not be appropriate because they do not soften the stool and are harsher laxatives that can enter breast milk.

When caring for a patient diagnosed with a peptic ulcer, the nurse administers omeprazole (Prilosec) along with what antibiotic to eradicate Helicobacter pylori? A) Gentamicin B) Ketoconazole C) Tetracycline D) Amoxicillin

D Feedback: Gastric acid pump or proton pump inhibitors are recommended for the short-term treatment of active duodenal ulcers, gastroesophageal reflux disease, erosive esophagitis, and benign active gastric ulcer; for the long-term treatment of pathologic hypersecretory conditions; as maintenance therapy for healing of erosive esophagitis and ulcers; and in combination with amoxicillin and clarithromycin for the treatment of H. pylori infection. The other options are not antibiotics used to eradicate H. pylori.

What action does the histamine-2 antagonist administered by the nurse have on the human body that will help to prevent peptic ulcer disease? A) Destroys Helicobacter pylori B) Coats and protects the stomach lining C) Increases the pH of the secreted hydrochloric acid D) Reduces the amount of hydrochloric acid secreted

D Feedback: Histamine-2 antagonists are administered to reduce the amount of hydrochloric acid secreted in the stomach, which helps to prevent peptic ulcer disease. H2 antagonists do not act as an antibiotic to kill bacteria (i.e., H. pylori) coat and protect the stomach lining like sucralfate (Carafate), or increase the pH of the secreted hydrochloric acid.

What antidiarrheal would the nurse administer to reduce the volume of discharge from the patient's ileostomy? A) Diphenoxylate (Lomotil) B) Octreotide (Sandostatin) C) Psyllium (Metamucil) D) Loperamide (Imodium)

D Feedback: Loperamide (Imodium), bismuth subsalicylate (Pepto-Bismol), and opium derivatives (paregoric) are indicated for the reduction of volume of discharge from ileostomies. The other options would not serve this purpose.

The nurse administers psyllium hydrophilic mucilloid (Metamucil) expecting it to have what action? A) Slows peristalsis B) Promotes reabsorption of water into bowel C) Has antibacterial properties D) Adds bulk to the stool

D Feedback: Metamucil is a natural substance that forms a gelatin-like bulk of the intestinal contents. This agent stimulates local activity. It is considered milder and less irritating than many other bulk stimulants. Patients must use caution and take it with plenty of water because Metamucil absorbs large amounts of water and produces stools of gelatin-like consistency. It does not slow peristalsis, promote water reabsorption, or have antibacterial properties

A 22-year-old female is diagnosed with mycobacterial tuberculosis. The physician orders rifampin (Rifadin) 600 mg PO daily. What should the nurse question the patient about? A) Her diet B) Sun exposure C) Type of exercise she does D) Use of contact lenses

D Feedback: Some antimycobacterial drugs can cause discoloration of body fluids. The orange tinged discoloration can cause permanent stain to contact lenses. The patient should avoid wearing them while on the antimycobacterial therapy. With antimycobacterial drugs there is not a concern is warranted about photosensitivity or exercise. However, due to the GI adverse effects, the nurse may want to discuss an appropriate diet if the patient experiences GI upset after beginning treatment.

The nurse is caring for a patient with hepatitis B. The patient is taking adefovir (Hepsera). Which medication would the nurse question if it were ordered? A) Cimetidine (Tagament) B) Diltiazem (Cardizem) C) Diphenhydramine (Benadryl) D) Telbivudine (Tyzeka)

D Feedback: Telbivudine is an antihepatitis B agent, and when given with adefovir (Hepsera) can result in severe hepatomegaly with steatosis, sometimes fatal. Cimetidine is a histamine-2 antagonist, diltiazem is a calcium channel blocker, and diphenhydramine is a first-generation antihistamine. These drugs are normally not considered nephrotoxic and could be used with adefovir.

Which of these patients would the nurse expect to be the best candidate for misoprostol (Cytotec)? A) A 12-year-old with obsessive-compulsive disorder B) A 22-year-old pregnant patient C) A 46-year-old trial lawyer with hypertension D) An 83-year-old man with rheumatoid arthritis

D Feedback: The 83-year-old man with rheumatoid arthritis is most likely to be taking nonsteroidal antiinflammatory drugs (NSAIDs). Misoprostol is indicated for prevention of NSAID induced ulcers in adults at high risk for development of gastric ulcers. The other three patients would not be candidates for this drug.

The nurse would question an order for misoprostol if the patient was diagnosed with what condition? A) Diabetes B) Hypertension C) Arthritis D) Pregnancy

D Feedback: This drug is contraindicated during pregnancy because it is an abortifacient. The other options are not correct.

A student asks the pharmacology instructor if there is a way to increase the benefits and decrease the risks of antibiotic therapy. What would be an appropriate response by the instructor? A) Taking drugs not prescribed for the particular illness tends to maximize risks and minimize benefits. B) Never use antibiotics in combination with other prescriptions or in combination with other antibiotics. C) Maximize antibiotic drug therapy by administering the full dose when the patient has a fever. D) Use antibiotics cautiously and teach patients to complete the full course of an antibiotic prescription.

D Feedback: To prevent or contain the growing threat of drug-resistant strains of bacteria, it is very important to use antibiotics cautiously, to complete the full course of an antibiotic prescription, and to avoid saving antibiotics for self-medication in the future. A patient and family teaching program should address these issues, as well as the proper dosing procedure for the drug (even if the patient feels better) and the importance of keeping a record of any reactions to antibiotics. Thus, taking drugs not prescribed for the particular illness tends to maximize risks and minimize benefits. Also, if the infection is viral, antibacterial drugs are ineffective and should not be used.

A patient is taking omeprazole (Prilosec) for the treatment of gastroesophageal reflux disease (GERD). The nurse will include which statement in the teaching plan about this medication? a. "Take this medication once a day after breakfast." b. "You will be on this medication for only 2 weeks for treatment of the reflux disease." c. "The medication may be dissolved in a liquid for better absorption." d. "The entire capsule must be taken whole, not crushed, chewed, or opened."

D Omeprazole needs to be taken before meals, and an entire capsule must be taken whole, not crushed, chewed, opened, or dissolved in liquid when treating GERD. This medication is used on a long-term basis to maintain healing

. During drug therapy with a tetracycline antibiotic, a patient complains of some nausea and decreased appetite. Which statement is the nurse's best advice to the patient? a. "Take it with cheese and crackers or yogurt." b. "Take each dose with a glass of milk." c. "Take an antacid with each dose as needed." d. "Drink a full glass of water with each dose."

D Oral doses should be given with at least 8 ounces of fluids and food to minimize gastrointestinal upset; however, antacids and dairy products will bind with the tetracycline and make it inactive

During an admission assessment, the patient tells the nurse that he has been self-treating his heartburn for 1 year with over-the-counter Prilosec OTC (omeprazole, a proton pump inhibitor). The nurse is aware that this self-treatment may have which result? a. No serious consequences b. Prevention of more serious problems, such as an ulcer c. Chronic constipation d. Masked symptoms of serious underlying diseases

D Long-term self-medication with antacids may mask symptoms of serious underlying diseases, such as bleeding ulcer or malignancy. Patients with ongoing symptoms need to undergo regular medical evaluations, because additional medications or other interventions may be needed.

A patient newly diagnosed with tuberculosis (TB) has been taking antitubercular drugs for 1 week calls the clinic and is very upset. He says, "My urine is dark orange! What's wrong with me?" Which response by the nurse is correct? a. "You will need to stop the medication, and it will go away." b. "It's possible that the TB is worse. Please come in to the clinic to be checked." c. "This is not what we usually see with these drugs. Please come in to the clinic to be checked." d. "This is an expected side effect of the medicine. Let's review what to expect."

D Rifampin, one of the first-line drugs for TB, causes a red-orange-brown discoloration of urine, tears, sweat, and sputum. Patients need to be warned about this side effect. The other options are incorrect.

A patient is complaining of excessive and painful gas. The nurse checks the patient's medication orders and prepares to administer which drug for this problem? a. Famotidine (Pepcid) b. Aluminum hydroxide and magnesium hydroxide (Maalox or Mylanta) c. Calcium carbonate (Tums) d. Simethicone (Mylicon)

D Simethicone alters the elasticity of mucus-coated bubbles, causing them to break, and is an overthe-counter antiflatulent. The other options are incorrect.

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