Pharmacology Week 13 Lesson Assessment

An adult patient receiving a vaccine for varicella asks when a booster will be required. Which response would the nurse provide? "A booster will be required in 10 years." "You will need another dose in 6 months." "The vaccine against varicella is good for life." "You must receive the varicella vaccine every year."

"A booster will be required in 10 years." Vaccine against varicella has a duration of about 10 years

A nurse is caring for a patient with rheumatoid arthritis (RA) who is prescribed leflunomide. The patient is currently taking metformin and pioglitazone for type 2 diabetes, lisinopril for hypertension, and simvastatin for dyslipidemia. Which drug is expected to interact with leflunomide? Lisinopril Metformin Pioglitazone Simvastatin

Pioglitazone Pioglitazone is metabolized by CYP28C and may be increased because leflunomide's metabolite, teriflunomide, inhibits CYP2C8.

A newborn received a hepatitis B (HBV) vaccine. At which age will the child receive the next dose? 1 month old 4 months old 6 months old 12 months old

1 month old

A 6-year-old child who weighs 45 pounds is prescribed griseofulvin 20 mg/kg/day PO in divided doses as treatment of tinea cruris. What is the prescribed daily dosage in milligrams?

409 Determine child's weight in kilograms: 45/2.2 = 20.45 kg; multiply dosage by weight: 20 mg x 20.45 kg = 409 mg

In which phase of the cell cycle do most antimetabolites affect cells? Mitosis G2 phase S phase G1 phase

S phase Most antimetabolites affect cells during the S phase of the cell cycle. The S phase is the synthesis of DNA replication and 23 pairs of chromosomes.

A patient is prescribed rituximab for chronic lymphocytic leukemia. Which condition would the nurse teach the patient to seek immediate medical care? Chest pain Night sweats Myalgia Cephalgia

Chest pain Rituximab can cause cardiotoxicity. Chest pain can be an indication of myocardial infarction. The patient should always seek immediate medical care for chest pain. Night sweats, myalgias and cephalgia are common side effects of rituximab.

Which symptoms of overdose would a nurse include when teaching about the administration of diphenhydramine to a parent of a 6-year-old child? Select all that apply. Death Seizures Hallucinations Cerebrovascular accident Stevens-Johnson syndrome

Death Seizures Hallucinations

A patient receiving targeted antineoplastic drug reports not wanting to eat at mealtimes. Which action would the nurse take first? Determine the reason for not wanting to eat. Encourage small frequent meals. Tell the patient to take the drug with food. Notify the health care provider.

Determine the reason for not wanting to eat. The nurse should encourage small frequent meals if the patient is experiencing appetite loss, but first the nurse should determine why the patient does not want to eat, It could be related to stomatitis or anorexia.

A patient receiving chemotherapeutic drugs complains of mouth lesions and inability to eat or swallow. The nurse notes the patient has opioid analgesic, topical anesthetic, antiemetic, and sedative prescribed. Which drug would the nurse most likely provide? Opioid analgesic Topical anesthetic Antiemetic Sedative

Topical anesthetic The nurse will most likely provide a topical anesthetic for the lesions to decrease the pain. Mouth lesions (stomatitis) are common side effects of chemotherapeutic drugs. Topical anesthetic numbs the mouth without unwanted side effects.

When teaching an adolescent patient about the application of topical terbinafine, the patient asks, "Does putting the medication on my rash hurt?" Which response would the nurse provide? "No, there is no discomfort associated with the drug." "Covering the application site with plastic kitchen wrap will prevent pain." "Application of topical terbinafine can cause burning, stinging, and tingling" "There is some discomfort associated with drug application, so stop the drug as soon as the lesions disappear."

"Application of topical terbinafine can cause burning, stinging, and tingling" Side effects of topical terbinafine include dryness, redness, itching, burning, peeling, rash, stinging, and tingling.

A patient receiving erlotinib asks why it is important to prevent the formation of blood vessels. Which response would the nurse provide? "Blood vessels allow nutrients to reach the cancer cells." "Blood vessels allow cancer cells to receive oxygen." "Blood vessels prevent the apoptosis of cancer cells." "Blood vessels allow cancer cells travel to distant sites."

"Blood vessels allow cancer cells travel to distant sites." Cancer cells can develop new blood vessels to attach to existing blood vessels for survival. Blood vessels allow cancer cells to metastasize to distant sites. Erlotinib, an angiogenesis inhibitor, prevents the formation of new blood vessels.

Which statement made by the patient indicates a need for further teaching regarding doxorubicin, an antitumor antibiotic? "I do not have to worry about infection because the drug is an antibiotic." "I will notify my doctor if the injection site becomes red." "I will need to avoid large crowds." "If I start having trouble breathing, I will notify my doctor."

"I do not have to worry about infection because the drug is an antibiotic." The patient will need more information regarding doxorubicin. Even though the antitumor chemotherapeutic class is considered an antibiotic, it does not treat infection. All chemotherapeutic drugs, including antitumor antibiotics, will suppress the immune system, which increases the risk for infection.

A nurse provides teaching to a male patient receiving chemotherapeutic drugs. Which statements made by the patient indicate an understanding of potential side effects of chemotherapeutic drugs? Select all that apply. "I will use a soft toothbrush to brush my teeth." "I may need to take stool softeners to avoid constipation." "When I have an appetite, I will make sure to eat large amounts of high-protein food." "I should use an alcohol-based mouthwash to kill germs." "I will bank some of my sperm so I still have the option of having children in the future."

"I will use a soft toothbrush to brush my teeth." "I may need to take stool softeners to avoid constipation." "I will bank some of my sperm so I still have the option of having children in the future." Chemotherapeutic drugs can cause anorexia. The patient should eat small, frequent, high-calorie foods, not large amounts. Chemotherapeutic drugs can cause stomatitis. Alcohol-based mouthwashes can irritate the lesions.

A patient who was diagnosed with rheumatoid arthritis (RA) 7 years ago is currently managed with weekly oral methotrexate, hydroxychloroquine taken twice daily, and etanercept 50 mg SC weekly. The patient is currently experiencing a worsening of RA symptoms and has tried numerous tumor necrosis factor (TNF)-α antagonists with minimal success. The rheumatologist decides to start abatacept 125 mg SC weekly after a loading dose and discontinue therapy with etanercept. Which instructions would a nurse include when teaching a patient about the administration of the newly prescribed abatacept? Select all that apply. "Inject abatacept into the abdomen, thighs, or upper arm." "Rotate injection sites, avoiding areas that are bruised, hard, or red." "Expect to observe improvements within a few days of starting abatacept." "You may experience changes in blood pressure, injection site reactions, headaches, and dizziness with abatacept." "You will be closely monitored for potential development of heart failure and demyelinating disorders such as seizures."

"Inject abatacept into the abdomen, thighs, or upper arm." "Rotate injection sites, avoiding areas that are bruised, hard, or red." "You may experience changes in blood pressure, injection site reactions, headaches, and dizziness with abatacept." Abatacept is a disease-modifying antirheumatic drug (DMARD) that takes several weeks to months to show significant improvement. Abatacept can be administered subcutaneously. New onset or worsening of heart failure and demyelinating disorders such as seizures are concerns with TNF-α antagonists.

Which instructions by the nursing student in regard to podofilox administration require further intervention? Select all that apply. "Only apply to warts identified by a health care provider." "Wash hands before and after administration of podofilox." "Use the applicator once, dipping into the solution just enough to wet it." "It is okay to engage in sexual intercourse on the days podofilox is applied." "Soak the affected area for about 5 minutes in warm water to soften treatment area."

"It is okay to engage in sexual intercourse on the days podofilox is applied." "Soak the affected area for about 5 minutes in warm water to soften treatment area." Patients should avoid sexual intercourse on the days that podofilox has been applied. Soaking the affected area in warm water for 5 minutes before treatment applies to salicylic acid, not podofilox.

A patient receiving vincristine asks why it must be given intravenously. Which response would the nurse provide to the patient? "Intravenous drug administration has fewer side effects." "Intravenous administration allows the drug effects to peak in 1 day." "Oral administration has a faster onset." "Oral administration has a low absorption rate."

"Oral administration has a low absorption rate." Vincristine is 100% absorbed with IV administration. The absorption would be low or erratic when taken by mouth.

A patient with multiple myeloma received cyclophosphamide at 0900. Which time would the nurse expect the drug to peak? 0930 1100 1300 1500

1100 Cyclophosphamide peaks in 1 to 3 hours

A patient weighing 165 pounds is prescribed isotretinoin 0.5 mg/kg/day PO divided BID. How many milligrams per dose will the patient receive? Report answer out to two decimal places

18.75 mg 165 lb / 2.2 = 75 kg; 75 x 0.5 = 37.5 mg; 37.5 mg / 2 = 18.75 mg per dose.

A 13-month-old child received the hepatitis A (HAV) vaccine. Which is the youngest age the child can receive the next dose? 15 months old 17 months old 19 months old 22 months old

19 months old Two doses of HAV vaccine can be administered at 12 to 24 months with 6 to 18 months between doses. The child received the first HAV vaccine at 13 months old. The earliest the child can receive the second dose is 6 months later, at 19 months old.

Which patients does a nurse determine can safely receive topical salicylic acid therapy for the common wart? Select all that apply. A 1-year-old child An 8-year-old child with the flu A 47-year-old patient with hypertension A 55-year-old patient with type 2 diabetes A 33-year-old patient with an allergy to aspirin

A 47-year-old patient with hypertension A 55-year-old patient with type 2 diabetes Type 2 diabetes does not pose a concern for treatment with topical salicylic acid. However, if the patient has any peripheral neuropathy, the patient should be referred to a health care provider as there may be difficulty with healing. This patient could safely receive therapy. Even though salicylic acid is topical, children with the flu are at risk for Reye syndrome if they receive salicylic acid. Children less than 2 years old cannot safely receive treatment with topical salicylic acid. A patient with a true aspirin allergy should not receive therapy with topical salicylic acid as this drug contains aspirin.

Which patient would a nurse determine cannot safely receive therapy with leflunomide? A 38-year-old patient with hypothyroidism A 49-year-old patient with end-stage liver disease A 58-year-old patient with type 2 diabetes A 66-year-old patient with NYHA Class I heart failure

A 49-year-old patient with end-stage liver disease Leflunomide can cause hepatotoxicity so it is not safe to use in a patient with end-stage liver disease.

Which patients diagnosed with rheumatoid arthritis (RA) would a nurse determine can safely receive therapy with methotrexate? Select all that apply. A 33-year-old pregnant patient A 34-year-old breastfeeding patient A 44-year-old patient with chronic hepatitis B A 49-year-old patient with hypertension A 55-year-old patient with active pneumonia A 56-year-old patient with dyslipidemia

A 49-year-old patient with hypertension A 56-year-old patient with dyslipidemia Because of hepatotoxicity and risk for infection, patients with acute or chronic hepatitis B or C should not receive methotrexate. Patients with an active infection should not receive methotrexate because the drug causes immunosuppression. This drug can be passed through the breast milk to the nursing infant. Pregnancy is an absolute contraindication to treatment with methotrexate because it is teratogenic. Pregnancy should be avoided if either partner is receiving therapy, for at least 3 months after discontinuation in males and for at least one ovulatory cycle in women.

Which patients does a nurse determine cannot safely receive an amoxicillin/clavulanate dose of 875 mg/125 mg for impetigo? Select all that apply. A 5-year-old patient A patient with liver failure A patient with hypertension A patient with an intolerance to ciprofloxacin A patient with a creatinine clearance of 25 mL/min

A 5-year-old patient A patient with liver failure A patient with a creatinine clearance of 25 mL/min The dose of amoxicillin/clavulanate of 875 mg/125 mg is the adult, not pediatric, dose. An intolerance to ciprofloxacin does not pose a concern for treatment with amoxicillin/clavulanate. There is not cross-sensitivity between the two drug classes (i.e., fluoroquinolones and beta-lactams). A patient with a creatinine clearance of less than 30 mL/min cannot safely receive amoxicillin/clavulanate as a dose of 875 mg/125 mg.

Which patient would be appropriate for the nurse to recommend aspirin in reducing pain or fever associated with vaccines? A child who received an influenza vaccine A child who received meningococcal vaccine A child who received human papillomavirus (HPV) vaccine A child who received a hepatitis B (HBV) vaccine

A child who received meningococcal vaccine Meningococcal vaccine contains bacterial particles rather than viral. Aspirin use for this child poses minimal risk for Reye's syndrome.

For which patient would vaccines with live viruses be contraindicated? A patient receiving antimicrobials A patient receiving chemotherapy A patient receiving another vaccine with live virus An adult patient taking aspirin for arthritis

A patient receiving chemotherapy Vaccines containing live viruses are contraindicated in patients who are immunosuppressed, such as those receiving chemotherapy. The risk for infection with the virus is greatly enhanced.

Which patients does a nurse determine cannot safely receive treatment with prednisone? Select all that apply. A patient with hypothyroidism A patient with a varicella infection A patient with benign prostatic hyperplasia A patient receiving the live influenza vaccine A patient with gastroesophageal reflux disease

A patient with a varicella infection A patient receiving the live influenza vaccine The administration of live vaccines with prednisone is a contraindication. It may increase vaccine side effects, potentiate virus replication, and decrease antibody response to the vaccine. Varicella is a contraindication to treatment with prednisone. A nurse would recognize the patient cannot be safely treated.

Which patients does a nurse determine cannot safely receive clobetasol for psoriasis? Select all that apply. A patient with psoriasis in the axillae A patient with psoriasis on the chest A patient with both poison ivy and psoriasis A patient with both psoriasis and contact dermatitis A patient with a bacterial infection in a psoriatic lesion

A patient with psoriasis in the axillae A patient with a bacterial infection in a psoriatic lesion Clobetasol should not be used on the face, in the groin or in the axillae. Therefore, if the patient has psoriasis in the axillae, another treatment alternative would be selected. A patient with a bacterial infection in a psoriatic lesion should not receive clobetasol. The corticosteroid could worsen the bacterial infection. It should be treated with an antimicrobial agent before the corticosteroid.

Which patients does a nurse determine cannot safely receive treatment with etanercept for psoriasis? Select all that apply. A patient with sepsis A patient with hypertension A patient with active herpes zoster A patient with rheumatoid arthritis A patient with alcoholic cirrhosis

A patient with sepsis A patient with active herpes zoster A patient with sepsis or active herpes zoster cannot safely receive etanercept because the drug is an immunosuppressant. As a result, the patient may not be able to clear the infection.

Which type of immunity would a patient obtain after receiving a hepatitis B vaccine? Passive artificial immunity Passive natural immunity Active natural immunity Active artificial immunity

Active artificial immunity Active artificial immunity occurs after receiving a hepatitis B vaccine. The body produces antibodies against hepatitis B viruses.

Which outcome does a nurse anticipate will occur as a result of a drug interaction with amoxicillin/clavulanate if the patient is also receiving allopurinol and the angiotensin-converting enzyme inhibitor, enalapril? Enalapril: Additive blood pressure lowering effects Enalapril: Reduced blood pressure lowering effects Allopurinol: Increased risk for skin rash Allopurinol: Decreased efficacy of amoxicillin/clavulanate

Allopurinol: Increased risk for skin rash When administering amoxicillin/clavulanate with allopurinol, the allopurinol increases the patient's risk for developing a skin rash.

A patient is prescribed temsirolimus for advanced renal cell cancer. Before the administration of temsirolimus, which substance would the nurse most likely administer? Antiemetic Antihistamine Packed red blood cells Intravenous immunoglobulin (IV Ig)

Antihistamine Hypersensitivity reactions are common with temsirolimus. An antihistamine should be administered 30 minutes before starting temsirolimus to minimize hypersensitivity reactions.

Match the chemotherapeutic drug to its class. Antimetabolites Plant alkaloids Antitumor antibiotics Alkylating drugs Tamoxifen Cyclophosphamide Doxorubicin Flurouracil Vincristine

Antimetabolites- Flurouracil Plant alkaloids- Vincristine Antitumor antibiotics- Doxorubicin Alkylating drugs- Cyclophosphamide

A nurse is disposing of urine from a patient who is receiving chemotherapeutic drugs. Which action would the nurse take to decrease the risk for occupational exposure? Dispose the urine in an enclosed container. Apply a face shield. Have the patient dispose of the urine. Dispose of the urine in a biohazard container.

Apply a face shield. Masks with a face shield should be worn by the nurse when there is a danger of splashing of body fluids, such as urine, to minimize the risk for occupational exposure.

A nurse is caring for a patient with pneumonia who is taking amoxicillin/clavulanate, albuterol inhaler, prednisone, aspirin, and lisinopril. The patient has developed itchy, red wheals. Which drugs taken by this patient are most often associated with urticaria? Select all that apply. Aspirin Lisinopril Prednisone Albuterol inhaler Amoxicillin/clavulanate

Aspirin Lisinopril Amoxicillin/clavulanate Urticaria is most often associated with administration of angiotensin-converting (ACE) inhibitors, beta-lactam antibiotics, nonsteroidal antiinflammatory drugs (NSAIDs), and sulfonamides. Therefore aspirin, an NSAID, may be a cause for the patient's hives.

Which instructions would a nurse share with a patient newly prescribed doxycycline for acne? Select all that apply. Avoid sunlight when taking doxycycline. Doxycycline should be taken in its entirety to prevent a superinfection. It should be taken with a full glass of milk. It may be taken with food if nausea occurs. Do not donate blood while receiving doxycycline and 1 month after treatment.

Avoid sunlight when taking doxycycline. Doxycycline should be taken in its entirety to prevent a superinfection. It may be taken with food if nausea occurs. Doxycycline should be taken with a full glass of water, not milk. Dairy products should not be taken concomitantly with doxycycline. Patients should not donate blood while on therapy and for one month after treatment when receiving isotretinoin, not doxycycline.

Match the class of targeted therapy drugs with its mechanism of action. Block communication pathway Prevent the degrading of proteins Assist the immune system Inhibit formation of new blood vessels Monoclonal antibodies Proteasome inhibitors Angiogenesis inhibitors Kinase inhibitors

Block communication pathway - Kinase inhibitors Prevent the degrading of proteins - Proteasome inhibitors Assist the immune system - Monoclonal antibodies Inhibit formation of new blood vessels - Angiogenesis inhibitors

A nurse is caring for a patient diagnosed with rheumatoid arthritis (RA) who has been prescribed leflunomide 100 mg PO daily for 3 days then 10 mg PO daily. Before the patient begins leflunomide, which baseline parameters would the nurse assess? Select all that apply. Blood cell counts Blood pressure Lipid panel Liver function tests Purified protein derivative (PPD) test

Blood cell counts Blood pressure Liver function tests Purified protein derivative (PPD) test There is risk for immunosuppression, thrombocytopenia, and leukopenia with leflunomide. This drug can increase BP and cause edema. Risk for hepatotoxicity. Assess for infection including latent TB.

The nurse preparing to administer chemotherapeutic drugs notes the patient has had a significant drop in neutrophils. The nurse would anticipate administering which product into the patient's plan of care? Red blood cells (RBCs) Platelets Natural killer cells (NKCs) Colony-stimulating factors (CSFs)

Colony-stimulating factors (CSFs) CSFs can be administered to minimize neutropenia, a state of low neutrophils. CSF stimulates the bone marrow to produce neutrophils.

Which factors will a nurse monitor for a therapeutic response in a patient receiving topical nystatin powder? Select all that apply. Consistent size of lesions Decrease in itching Decrease in number of lesions Maceration under the pannus Development of satellite lesions

Decrease in itching Decrease in number of lesions Candida infection of the skin under the pannus occurs when those areas become macerated. This would not be an indicator of a therapeutic response to nystatin therapy. Satellite lesions (outside the advancing edge of candidiasis) are an important diagnostic feature of candidiasis. Satellite lesions should decrease/disappear, not develop, with effective treatment.

Bortezomib is prescribed to a patient who is on prednisone, a hepatic inhibitor. Which change to the dose of bortezomib would the nurse expect? Increased dose of bortezomib Increased dose of prednisone Decreased dose of bortezomib Decreased dose of prednisone

Decreased dose of bortezomib A hepatic inhibitor, such as prednisone, will have an additive effect of bortezomib. The dose of bortezomib will most likely need to be decreased, but the dose of prednisone will not need to be changed.

A 5-year-old child is to receive routine immunizations. Which vaccines would the nurse anticipate administering? Select all that apply. Diphtheria, tetanus, and pertussis (DTaP) Meningococcal Varicella Measles, mumps, and rubella (MMR) Zoster recombinant Inactivated poliovirus

Diphtheria, tetanus, and pertussis (DTaP) Varicella Measles, mumps, and rubella (MMR) Inactivated poliovirus The second dose of meningococcal is recommended at 16 years of age. Zoster recombinant is recommended at 50 years of age.

Which instruction would a nurse include when teaching about the application of wet dressings containing topical aluminum acetate? Dissolve topical powder in normal saline. Discard solution after 72 hours. Filter the solution to eliminate particulate matter. Do not re-insert cloth into reconstituted solution.

Do not re-insert cloth into reconstituted solution. Aluminum acetate solution should be discarded after each use, not after 72 hours. Once the cloth has come into contact with the skin, it should be re-inserted into the reconstituted solution for reuse. Topical powder in solutions should only be dissolved in water, not in other solutions such as normal saline.

Which teaching points would a nurse provide a patient newly prescribed etanercept for psoriasis? Select all that apply. Do not receive live (attenuated) vaccines during treatment. Injection site reactions decrease with continued therapy. Report persistent fever to the health care provider. Do not receive recombinant vaccines. Avoid calcium-containing products while receiving therapy.

Do not receive live (attenuated) vaccines during treatment. Injection site reactions decrease with continued therapy. Report persistent fever to the health care provider. Patients treated with etanercept may have recombinant vaccines including hepatitis B, human papillomavirus, whooping cough, pneumococcal, meningococcal, and shingles vaccines. Only live vaccines pose a concern with etanercept. Patients should be informed that injection-site reactions generally occur in the first month of treatment and decreases in frequency during continued therapy. Patients should be instruction to not receive live (attenuated) vaccines during treatment with etanercept (these include measles, mumps and rubella [MMR]; smallpox; chickenpox; rotavirus; and yellow fever) because they may potentiate virus replication, increase vaccine side effect, and decrease the patient's antibody response to vaccine. The avoidance of calcium-containing products is a concern with doxycycline, not etanercept.

Which teaching instructions will a nurse provide to a patient who has been prescribed topical erythromycin? Select all that apply. Do not use topical erythromycin near the eyes, mouth, or nose. A thin layer of the product should be applied to the affected areas. Wash your hands before and after application of topical erythromycin. You may notice burning, itching, peeling, and irritation on areas where you apply topical erythromycin. Use a skin cleanser with alcohol or an astringent before applying topical erythromycin to enhance absorption.

Do not use topical erythromycin near the eyes, mouth, or nose. A thin layer of the product should be applied to the affected areas. Wash your hands before and after application of topical erythromycin. You may notice burning, itching, peeling, and irritation on areas where you apply topical erythromycin. Patients should be advised to avoid skin cleansers with alcohol or that are astringents because they can worsen irritation.

Which targeted antineoplastic drugs would most likely interact with St. John's wort? Select all that apply. Erlotinib Sorafenib Bortezomib Temsirolimus Rituximab

Erlotinib Sorafenib Bortezomib Temsirolimus St. John's wort can decrease the bioavailability of erlotinib, sorafenib and bortexomib. St. John's wart increases the bioavailability of Temsirolimus. St. John's wort has no known interaction with rituximab.

A female patient has been prescribed doxycycline for acne. She takes ethinyl estradiol/norgestrel, an oral contraceptive, and hydrocodone. Which outcome does the nurse anticipate may occur as a result of an interaction with doxycycline? Hydrocodone: Increased central nervous system (CNS) depression Hydrocodone: Decreased CNS depression Ethinyl estradiol/norgestrel: Increased efficacy Ethinyl estradiol/norgestrel: Decreased efficacy

Ethinyl estradiol/norgestrel: Decreased efficacy Doxycycline may reduce the efficacy of oral contraceptives such as ethinyl estradiol/norgestrel. The patient should be instructed to use a backup method of contraception such as condoms.

A patient diagnosed with metastatic pancreatic cancer is prescribed fluorouracil as part of a combination regimen with oxaliplatin, leucovorin, and irinotecan. Which treatment cycle would the nurse expect fluorouracil to be repeated? Once a week Every 2 weeks Once a month Every 2 months

Every 2 weeks Chemotherapeutic drugs are administered in cycles followed by a rest period. Fluorouracil as part of a combination therapy is administered every 2 weeks.

A nurse caring for a patient prescribed diphenhydramine for dermatitis recalls the drug's duration of action is 4 to 8 hours. This means the interval between doses would most likely follow which schedule? Every 2 to 4 hours Every 4 to 6 hours Every 6 to 8 hours Every 8 to 10 hours

Every 4 to 6 hours Adults and children over the age of 12 can take 25 mg to 50 mg of oral diphenhydramine every 4 to 6 hours. Two to 4 hours is the peak of diphenhydramine.

Which patient parameters will a nurse ensure are assessed before a 29-year-old female begins therapy with methotrexate for psoriasis? Select all that apply. Fluid intake Blood pressure Pregnancy test Liver function tests Complete blood count

Fluid intake Pregnancy test Liver function tests Complete blood count Fluid intake of the patient is important to assess in a patient who will be initiated on methotrexate. In fact, the patient should be advised to increase fluid intake to 2 to 3 L/day, unless contraindicated, in order to prevent urate deposits and calculi formation. Because this patient is of childbearing age, a pregnancy test should be assessed because the drug is contraindicated during pregnancy due to fetal malformations. Liver function tests should be assessed at baseline and periodically throughout treatment because methotrexate can be hepatotoxic. Complete blood count should be assessed at baseline and periodically throughout treatment because methotrexate may decrease hemoglobin and white blood cell, red blood cell, and platelet counts.

A patient whose diet consists of fried foods is prescribed sorafenib. Which information on the drug-food interactions would the nurse provide to the patient? High-fat foods decrease the bioavailability of sorafenib. The bioavailability of sorafenib is not affected by food. Any food will increase the level of free sorafenib. Milk will help decrease nausea and vomiting.

High-fat foods decrease the bioavailability of sorafenib. The bioavailability of sorafenib is reduced with high-fat food, which can cause the disease to progress. Sorafenib should be taken on an empty stomach, preferably 1 hour before or 2 hours after a meal. Milk, especially fatty milk, will decrease the bioavailability of sorafenib.

Oral cyclophosphamide 700 mg is prescribed to a patient weighing 125 pounds. Which action would the nurse take first? Decrease the dose. Hold the drug. Notify the health care provider. Notify the pharmacist.

Hold the drug. The nurse should first hold the drug, then notify the health care provider. Cyclophosphamide 700 mg is more than the usual dose of 1 to 5 mg/kg. One hundred and twenty-five pounds is equal to 57 kg. Therefore the maximum dose based on the usual dosing regimen is 285 mg, not 700 mg.

A patient asks the nurse what is in the tetanus-diphtheria (Td) vaccine. Which information would the nurse provide? Inactivated toxins Live bacteria Attenuated virus Plant toxins

Inactivated toxins

A patient who has been on sorafenib for advanced renal cancer started taking St. John's wort for depression. Which effects would the nurse assess as a result of the drug-herbal interaction? Increased proliferation of cancer cells Increased side effects of sorafenib Prolonged QT interval Decreased metabolism of sorafenib

Increased proliferation of cancer cells St. John's wort can decrease the availability of sorafenib by increasing the metabolism of sorafenib allowing the cancer cells to proliferate.

A nurse is caring for a patient prescribed tofacitinib extended-release 11 mg PO daily who is also receiving methotrexate, HCTZ, and ethinyl estradiol/levonorgestrel. Which teaching point would the nurse provide to the patient about administration? It cannot be crushed or chewed. It should be given 2 hours before all other drugs. It should be taken with food to increase absorption. It should be taken on an empty stomach to enhance absorption. NOT SURE

It cannot be crushed or chewed. Extended-release formulations like tofacitinib cannot be crushed or chewed. This would destroy the formulation, which is designed to release the drug over the course of the day. Tofacitinib may be taken with or without food. There are no concerns with administering tofacitinib with the other drugs.

Which side effects will a nurse counsel a patient to monitor for while receiving griseofulvin? Select all that apply. Itching Gastrointestinal (GI) upset Headaches Elevated blood pressure Fatigue, dark urine, and nausea

Itching Gastrointestinal (GI) upset Headaches Fatigue, dark urine, and nausea Fatigue, dark urine, and nausea are signs and symptoms of hepatotoxicity, a potential side effect associated with griseofulvin. Itching or pruritus may occur with griseofulvin treatment.

Which disease-modifying antirheumatic drug (DMARD) requires a "washout" if it needs to be quickly removed from the body? Etanercept Methotrexate Leflunomide Tofacitinib

Leflunomide Leflunomide and its metabolite, teriflunomide, have a prolonged half-life (i.e., 18 to 19 days), requiring a washout by either activated charcoal or cholestyramine if accelerated removal from the body is warranted. Etanercept has an elimination half-life of 72 to 132 hours. Methotrexate has an elimination half-life of 3 to 10 hours. Tofacitinib's elimination half-life is 3 hours for the immediate-release formulation and 6 hours for the extended-release formulation.

Which instructions would a nurse include when teaching a patient about the application of topical tacrolimus? Select all that apply. It is okay to swim right after application. Re-evaluate if symptoms persist longer than 4 weeks. Limit sun exposure during treatment. Cover with dressing to prevent the drug from rubbing off. Use only on the area of the body that has eczema.

Limit sun exposure during treatment. Use only on the area of the body that has eczema. Patients should limit or avoid sun exposure when receiving topical tacrolimus due to a risk for skin tumors.Patients should be re-evaluated if symptoms persist longer than 6 weeks.

A nurse is caring for a patient with rheumatoid arthritis who has been prescribed abatacept. Which drug-drug product can be safely administered to a patient who is receiving abatacept? Anakinra Etanercept Methotrexate Measles, mumps, and rubella (MMR) vaccine

Methotrexate Abatacept can be safely administered with other nonbiologic disease-modifying antirheumatic drugs (DMARDs) such as methotrexate. The administration of live vaccines is not recommended while receiving or for 3 months after discontinuation of abatacept and should be given before initiation of abatacept if feasible. Etanercept and anakinra cannot be safely administered with other biologics like abatacept because of a risk for serious infections.

Which disease-modifying antirheumatic drug (DMARD) may be given orally, subcutaneously, or intramuscularly? Abatacept Etanercept Methotrexate Tofacitinib

Methotrexate Methotrexate may be given by either the oral, subcutaneous, or intramuscular routes with slight differences in pharmacodynamic and pharmacokinetic parameters anticipated. Tofacitinib is for oral administration only. It may be given in immediate-release or extended-release formulations. Etanercept is for subcutaneous administration only. Abatacept is approved for both intravenous and subcutaneous administration in patients with rheumatoid arthritis.

A patient is prescribed vincristine for Hodgkin's lymphoma. On further questioning, the nurse discovers the patient has plant allergies, specifically to periwinkle. Which action would the nurse take? Administer the drug. Administer an antihistamine. Notify the health care provider. Conduct an allergy test before administering vincristine.

Notify the health care provider. Hypersensitivity to any component of a drug is an absolute contraindication, and the nurse should notify the health care provider. Vincristine contains vinca alkaloids, which are made from periwinkle plants.

Which instructions would a nurse provide to a patient prescribed acyclovir cream for a cold sore? Select all that apply. Only apply to area with symptoms. Do not touch lesions with bare fingers. Space doses evenly throughout the day. Avoid rubbing in the cream so that the blisters do not break. Continue therapy for prescribed length to ensure a cure.

Only apply to area with symptoms. Do not touch lesions with bare fingers. Space doses evenly throughout the day. The cream should be rubbed in until it disappears. However, the patient should be cautioned to gently rub in the cream to avoid breaking the blisters. It is important for patients to realize that acyclovir does not cure herpes simplex infections; it just controls symptoms. However, the patient should adhere to the prescribed treatment length in order to clear the infection.

A patient diagnosed with leukemia is to receive imatinib. Before initiating imatinib, the nurse would ensure the patient is positive for which chromosomal abnormality? CD20+ Ph+ CYP3A4+ 26S

Ph+ Imatinib is indicated for patients with Ph+ chromosome, not CD20+ or 26S. CYP3A4+ is a hepatic isoenzyme for metabolism.

Before receiving therapy with griseofulvin, which patient parameters will a nurse ensure are assessed in a 27-year-old female patient? Select all that apply. Pregnancy status Allergy to penicillin Abnormal liver function tests History of systemic lupus erythematosus (SLE) History of diabetes or pre-diabetes

Pregnancy status Allergy to penicillin Abnormal liver function tests History of systemic lupus erythematosus (SLE) Because this patient is of childbearing age, it is important to assess her pregnancy status. Griseofulvin should be avoided during pregnancy due to possible risk for teratogenicity. A reliable form(s) of birth control should be used during treatment and for 1 month after the drug is stopped. Male patients should wait 6 months after the end of treatment to attempt conception. Griseofulvin is derived from a species of penicillin; therefore patients should be assessed specifically for allergy to penicillin. Griseofulvin can cause liver failure; therefore it is important to monitor liver function tests. SLE can be exacerbated by griseofulvin. Therefore it is important to assess the patient's history to avoid worsening of the condition.

Match the treatment to the characteristic description its infectious integumentary disorder. Pustules that scab over with a characteristic honey-colored crust Grouped vesicles with an erythematous base Hard, rough, horny papules Small erythematous papule around a hair shaft that becomes scaly Acyclovir Salicylic acid Topical terbinafine Griseofulvin Nystatin Mupirocin

Pustules that scab over with a characteristic honey-colored crust - topical terbanafine Grouped vesicles with an erythmatous base - griseofulvin Hard, rough, horny papules - salicylic acid Small erythematous papule around a hair shaft that becomes scaly - nystatin

Which side effects and adverse effects of mupirocin does a nurse teach a patient to monitor for while receiving therapy? Select all that apply. Rash Itching Burning Superinfection Photosensitivity

Rash Itching Burning Superinfection Photosensitivity is not a concern with mupirocin but often is for drugs used to treat dermatologic conditions such as isotretinoin and doxycycline for acne treatment.

A patient is prescribed erlotinib and gemcitabine for pancreatic cancer. Which information would the nurse provide regarding the risk for infection? Risk for infection is the same as when taking one drug. The risk for infection occurs only when the neutrophil count is low. Risk for infection will increase. Risk for infection is higher with intravenous dose of erlotinib.

Risk for infection will increase. Gemcitabine is an antimetabolite, and erlotinib is an angiogenesis inhibitor. Both drugs suppress the immune system, which further increases the risk for infection when taking concomitantly.

When asked which vaccines contain live viruses, which vaccines would the nurse include? Select all that apply. Rotavirus Influenza Diphtheria, tetanus, pertussis (DTaP) Measles, mumps, rubella (MMR) Poliovirus Zoster recombinant

Rotavirus Influenza Measles, mumps, rubella (MMR) Zoster recombinant Vaccine against DTaP consists of toxoids and inactivated bacteria. Vaccine against poliovirus consists of inactivated virus.

Which patient parameters will a nurse ensure are assessed before treatment with acyclovir for herpes simplex? Select all that apply. Blood pressure Respiratory rate Thyroid function Serum creatinine Liver function tests

Serum creatinine Liver function tests Serum creatinine should be assessed at baseline and periodically thereafter in patients receiving acyclovir. Acute renal failure and glomerulonephritis can occur with treatment. Liver function tests should be assessed at baseline and periodically thereafter in patients receiving acyclovir because the drug can increase these levels.

A nurse is caring for a patient who has been prescribed topical aluminum acetate to be used as a compress for poison ivy. Which side effects will the nurse advise the patient may occur from treatment with topical aluminum acetate? Select all that apply. Skin dryness Skin irritation Local infection Burning and stinging Numbness and tingling

Skin dryness Skin irritation Burning and stinging

Match the drug used to treat psoriasis to its class. Super-high-potency corticosteroid Keratoplastic Folic acid antagonist Tumor necrosis factor inhibitor Etanercept Coal tar Clobetasol Methotrexate

Super high potency corticosteroid - Etanercept Keratoplastic - coal tar Folic acid antagonist - methotrexate Tumor necrosis factor inhibitor - clobetasol

Match the disease-modifying antirheumatic drug (DMARD) to its associated drug class. T-cell costimulation modulator Tumor necrosis factor (TNF)-α antagonist Dihydroorotate dehydrogenase inhibitor Janus kinase inhibitor Baricitinib Leflunomide Abatacept Etanercept

T-cell costimulation modulator - Baricitinib Tumor necrosis factor (TNF)-α antagonist - Etanercept Dihydroorotate dehydrogenase inhibitor - Leflunomide Janus kinase inhibitor - Abatacept

Which teaching instructions will a nurse provide to a patient who has been prescribed isotretinoin? Select all that apply. The capsule should be swallowed whole with a full glass of water. Because isotretinoin may cause kidney damage, your renal function should be monitored weekly. Because isotretinoin may reduce your ability to see well in the dark, use caution when driving at night. Wearing contact lenses may be difficult while receiving isotretinoin because it may cause dry eyes. Avoid laser hair removal, waxing, and dermabrasion while receiving isotretinoin and 6 months after completion. Inform your health care provider if you want to participate in strenuous physical activity while receiving isotretinoin.

The capsule should be swallowed whole with a full glass of water. Because isotretinoin may reduce your ability to see well in the dark, use caution when driving at night. Wearing contact lenses may be difficult while receiving isotretinoin because it may cause dry eyes. Avoid laser hair removal, waxing, and dermabrasion while receiving isotretinoin and 6 months after completion. Inform your health care provider if you want to participate in strenuous physical activity while receiving isotretinoin. Isotretinoin is not expected to cause kidney damage. It should not be chewed, crushed, or sucked on. Isotretinoin may cause the bones to weaken or thicken abnormally and increase the risk for bone injuries. Laser hair removal, waxing, and dermabrasion should be avoided while taking isotretinoin and for 6 months after as it increases the risk for scars.

A female patient who has been prescribed isotretinoin for acne asks why she must enroll in the iPLEDGE program. Which statement will a nurse provide to help the patient understand the importance of this program as it relates to isotretinoin? The patient pledges to avoid pregnancy before, during, and treatment. The patient pledges to use one form of birth control. The patient will contact the iPLEDGE system by phone every week. The patient must have a negative pregnancy test before treatment.

The patient pledges to avoid pregnancy before, during, and treatment. If a patient chooses to take isotretinoin, they pledge to avoid pregnancy for 1 month before, during, and for 1 month after treatment.

Which statements describe the benefits of treating cancer cells with a combination of different classes of chemotherapeutic drugs? Select all that apply. Therapeutic effect in all phases of cancer cells is increased. Adverse effects are decreased. Development of drug resistance is decreased. Destruction of cancer cells is increased. Length of treatment is decreased.

Therapeutic effect in all phases of cancer cells is increased. Development of drug resistance is decreased. Destruction of cancer cells is increased. Combination therapy with different classes of chemotherapeutic drugs increases adverse effects.

A nurse is caring for a patient with psoriasis who has been prescribed coal tar to be applied four times daily to the arm, wrapping the treated area with dressing. Which rationale does the nurse understand is the reason the health care provider wants to provide occlusive dressing with coal tar? To increase efficacy To minimize side effects To stop the patient picking at the lesion To protect the lesions from water or moisture

To increase efficacy The main rationale for using occlusive dressings with coal tar is to increase absorption and therefore efficacy of the drug.

A patient with rheumatoid arthritis (RA) asks the nurse why he or she was told to take folic acid with methotrexate. Which rationale would the nurse provide? To reduce gastrointestinal and hepatic toxicity To prevent nephrotoxicity To prevent bone loss and fractures To reduce the risk for myocardial infarction and stroke

To reduce gastrointestinal and hepatic toxicity Nephrotoxicity would not be prevented with folic acid supplementation. Folic acid is not expected to prevent bone loss, fracture or reduce risk for MI and stroke

Which disease-modifying antirheumatic drug (DMARD) is beneficial in rheumatoid arthritis (RA) by inhibiting the enzyme Janus kinase? Abatacept Etanercept Methotrexate Tofacitinib

Tofacitinib Methotrexate inhibits dihydrofolate reductase, which interferes with the biosynthesis of purines and pyrimidine. Its exact mechanism of action in RA is unknown. Etanercept is a biologic DMARD that inhibits tumor necrosis factor (TNF)-α to reduce inflammation. Abatacept is a T-cell costimulation modulator.

Which disease-modifying antirheumatic drug's (DMARD's) metabolism occurs through CYP3A4 and is subject to drug interactions involving this isoenzyme? Abatacept Methotrexate Leflunomide Tofacitinib

Tofacitinib Tofacitinib's metabolism is mediated through CYP3A4 and is subject to drug interactions with strong CYP3A4 inhibitors and inducers. Leflunomide is hepatically metabolized; however, its metabolism does not involve CYP3A4. Leflunomide inhibits CYP2C8 and weakly induces CYP1A2. Methotrexate's metabolism is in the liver but does not appear to involve CYP3A4. Abatacept's metabolism is unknown.

Which dosing regimen does a nurse teach the patient to follow for application of podofilox? Twice daily for 3 days, followed by 4 days off. Repeat 4 times. Once daily for 3 days, followed by 4 days off. Repeat 4 times. Twice daily for 4 days, followed by 3 days off. Repeat 3 times. Once daily for 4 days, followed by 3 days off. Repeat 3 times.

Twice daily for 3 days, followed by 4 days off. Repeat 4 times.

Which instructions would a nurse give a patient who has been prescribed mupirocin for impetigo? Select all that apply. Wash hands before and after application. Do not use mupirocin near the eyes, nose, or mouth. Do not cover the medicated areas with gauze dressings. Apply a thin layer of the ointment or cream to affected areas. Report a lack of improvement in 1 to 2 days to the health care provider.

Wash hands before and after application. Do not use mupirocin near the eyes, nose, or mouth. Apply a thin layer of the ointment or cream to affected areas. The patient should report a lack of improvement after 3 to 5 days, not 1 to 2 days, to the health care provider. The patient should be advised to wash hands before administration of mupirocin in order to avoid pathogen entry into the lesions as well as after administration to avoid the transfer of mupirocin to others.

In which time frame does immunity occur after a patient receives a vaccine with a live, attenuated virus? Days Immediately Weeks to months Years

Weeks to months