Chapter 32 - 35 Review Questions

A 24-year-old patient reports taking acetaminophen (Tylenol) fairly regularly for headaches. The nurse knows that a patient who consumes excessive acetaminophen per day or regularly consumes alcoholic beverages should be observed for what adverse effect? 1. Hepatic toxicity 2. Renal damage 3. Thrombotic effects 4. Pulmonary damage

1 Rationale: Excessive doses of acetaminophen or regular consumption of alcohol may increase the risk of hepatic toxicity when acetaminophen is used. Options 2, 3, and 4 are incorrect. Renal or pulmonary toxicity and thrombotic events are not adverse effects associated specifically with acetaminophen.

The nursing plan of care for a patient receiving oprelvekin (Neumega) should include careful monitoring for symptoms of which adverse effect? 1. Fluid retention 2. Severe hypertension 3. Impaired liver function 4. Sever diarrhea

1 Rationale: Oprelvekin (Neumega) may cause significant fluid retention, which may be particularly detrimental to a patient with cardiac or renal disease. Options 2, 3, and 4 are incorrect. Severe hypotension, impaired liver function, or severe diarrhea are not associated with oprelvekin therapy and other causes should be investigated if they occur.

A patient has been diagnosed with tuberculosis and is prescribed Rifater (Pyrazinamide with isoniazid and rifampin). While the patient is on this medication, what teaching is essential? (Select all that apply) 1. "It is critical to continue therapy for at least 6 to 12 months." 2. "Two or more drugs are used to prevent tuberculosis bacterial resistance." 3. "There drugs may also be used to prevent tuberculosis." 4. "No special precautions are required." 5. "After 1 month of treatment, the medication will be discontinued."

1, 2, 3 Rationale: In order to effectively treat the TB bacterium, it is critical that the medicine be taken for 6 to 12 months and possibly as long as 24 months. Antitubercular drugs such as pyrazinamide, isoniazid (INH), and rifampin are also used for prevention and treatment of patients who convert from a negative TB test to a positive, although single drug use is most often prescribed in that situation. Multiple drug therapy is necessary because the Mycobacteria grow slowly, and resistance is common. Using multiple drugs in different combinations during the long treatment period lowers the potential for resistance and increases the chances for successful therapy. Options 4 and 5 are incorrect. Precautions to avoid adverse effects are required, and the drugs will be required much longer than 1 month.

An older adult patient diagnosed with iron-deficiency anemia will be taking ferrous sulfate (Feosol). The nurse will teach which of the required administration guidelines to the patient? (Select all that apply) 1. Take the tablets on an empty stomach if possible. 2. Increases fluid intake, dietary intake, and dietary fiber while taking this medication. 3. If liquid preparations are used, dilute with water or juice and sip through a straw placed in the back of the mouth. 4. Crush or dissolve sustained-released tablets in water if they are too big to swallow. 5. Take the drug at bedtime for best results.

1, 2, 3 Rationale: Iron preparations should be taken on an empty stomach, diluted, and taken through a straw if liquid preparations are used, and extra fluid and fiber will help prevent constipation. Options 4 and 5 are incorrect. Sustained-release medications are specially formulated to absorb slowly and should never be crushed or dissolved. Iron preparations do not need to be taken only at bedtime.

The nurse would question an order for peginterferon alfa-2a (Pegasys) if the patient had which of the following conditions? (Select all that apply) 1. Pregnancy 2. Renal disease 3. Liver disease 4. Malignant melanoma

1, 2, 4 Rationale: Pregnancy and renal or liver disease are contraindications to the use of immunostimulant drugs such as peginterferon alfa-2a (Pegasys). Options 3 and 5 are incorrect. Chronic hepatitis and malignant melanoma are indications for use of these drugs.

When planning to teach the patient about the use of epoetin alfa (Epogen, Procrit), the nurse would give which of the following instructions. 1. Eating raw fruits and vegetables must be avoided. 2. Frequent rest periods should be taken to avoid excessive fatigue. 3. Skin and mucous membranes should be protected from traumatic injury. 4. Exposure to direct sunlight must be minimized and sunscreen used when outdoors.

2 Rationale: Epoetin alfa (Epogen, Procrit) is ordered to treat anemia and the patient with anemia may experience periods of excessive fatigue and weak- ness related to the diminished oxygen-carrying capacity from low RBC counts. Adequate rest periods should be planned and patients taught to avoid overexertion until the epoetin alfa has had therapeutic effects and the RBC counts improve. Options 1, 3, and 4 are incorrect. Avoiding fresh fruits or vegetables is not necessary for a patient who is taking epoetin alfa but may be appropriate for a patient with low WBC counts. Patients with anemia do not necessarily have low platelet counts (thrombocytopenia) and do not need to routinely avoid activities that may cause direct tissue injury. Limiting direct sun exposure and wearing sunscreen are excel- lent health practices but are not required as part of epoetin alfa therapy.

To best monitor for therapeutic effects from filgrastim (Granix, Neupogen), the nurse will assess which laboratory finding? 1. Hemoglobin and hematocrit 2. White blood cell or absolute neutrophil counts 3. Serum electrolytes 4. Red blood cell count

2 Rationale: Filgrastim stimulates granulocytes (WBCs). Options 1, 3, and 4 are incorrect. Filgrastim does not stimulate RBC production, affect Hgb or Hct, or have a direct effect on serum electrolytes.

The nurse is evaluating drug effects in a patient who has been given interferon alfa-2b (Intron-A) for hepatitis B and C. Which of the following is a common adverse effect? 1. Depression and thoughts of suicide 2. Flulike symptoms of fever, chills, or fatigue 3. Edema, Hypotension, and tachyacardia 4. Hypertension, renal or hepatic insufficiency

2 Rationale: Interferon alfa-2b (Intron-A) commonly causes flulike symptoms in up to 50% of patients receiving the drug. Options 1, 3, and 4 are incorrect. Depression with suicidal thoughts, hypo- or hypertension, tachycardia, edema, and renal or hepatic insufficiency are not common adverse effects of the drug.

A patient will be discharged after surgery with a prescription for penicillin. When planning at-home instructions, what will the nurse include? 1. Penicillin's can be taken while breast-feeding. 2. The entire prescription must be finished. 3. All penicillin's can be taken without regard to eating. 4. Some possible side effects include abdominal pain and constipation

2 Rationale: Many people will discontinue medication after improvement is noted. All antibiotic regimens must be completed to prevent recurrence of infection unless allergy or significant adverse effects occur that warrant discontinuing or changing the drug used. Options 1, 3, and 4 are incorrect. Some penicillins (e.g., amoxicillin) should be taken with meals, whereas all others should be taken 1 hour before or 2 hours after meals. Penicillins should be used with caution during breast-feeding. Penicillins, along with other antibiotics, tend to cause diarrhea and not constipation.

A 32-year-old female has been started on amoxicillin (Amoxil, Trimox) for severe UTI. Before sending her home with this prescription, the nurse will provide which instruction? 1. Teach her to wear sunscreen. 2. Ask her about oral contraceptive use and recomend an alternative method for the duration of the ampicillin course. 3. Assess for hearing loss. 4. Recommend taking the pill with some antacid to prevent gastrointestinal upset.

2 Rationale: Penicillin antibiotics such as amoxicillin (Amoxil, Trimox) may significantly decrease the effectiveness of oral contraceptives and another method of birth control should be suggested during the time the drug is taken. Options 1, 3, and 4 are incorrect. Sunburning and hearing loss are not adverse effects commonly associated with penicillin.

A patient with a history of hypertension is to start drug therapy for rheumatoid arthritis. Which of the following drugs would be contraindicated, or used cautiously, for this patient? (Select all that apply.) 1. Aspirin 2. Ibuprofen (Advil, Motrin) 3. Acetaminophen (Tylenol) 4. Naproxen (Aleve) 5. Methylprednisolone (Medrol)

2, 4, 5 Rationale: NSAIDs such as ibuprofen and naproxen have been shown to increase the risk of serious thrombotic events, MI, and stroke which can be fatal. These drugs should be used cautiously or avoided in patients with HTN. Corticosteroids such as methylprednisolone may cause fluid retention, which may increase the patient's blood pressure. Cautious and frequent monitoring will be required if the patient takes this drug. Options 1 and 3 are incorrect. Aspirin or acetaminophen will not increase the patient's blood pressure. Acetaminophen would only provide pain relief without treating the underlying inflammation associated with RA.

A patient diagnosed with pernicious anemia is to start cyanocbalamin (Nascobal) injections. Which of the following patient statements demonstrates an understanding of the nurse's teaching? (Select all that apply) 1. "I need to be careful to avoid infections." 2. "I will need to take this drug for the rest of my life." 3. "I should increase my intake of foods that contain vitamin B12." 4. I need to take the liquid preparation through a straw." 5. "I may be able to switch over to nasal sprays once my vitamin B12 levels are normal."

2, 5 Rationale: The patient with pernicious anemia is unable to absorb vitamin B12 from the stomach and must take lifelong supplements of the vitamin. Once vitamin levels reach normal, a weekly nasal spray may be ordered. Options 1, 3, and 4 are incorrect. Because patients with pernicious anemia lack a factor (intrinsic factor) that allows gastric absorption of vitamin B12, oral use is not effective and increasing the amount of foods containing the vitamin will not be effective. Patients with pernicious anemia have a decrease in RBCs, not WBCs, and are not at increased risk for infections.

A nurse is preparing to administer a hepatitis B Vaccination to a patient. Which of the following would cause the nurse to withhold the vaccination and check with the healthcare provider? 1. The patient smokes cigarettes, one pack per day. 2. The patient is frightened by needles and injections. 3. The patient is allergic to yeast and yeast products. 4. The patient has hypertension.

3 Rationale: An allergy to yeast or yeast products is a contraindication to the hepatitis B vaccination. Options 1, 2, and 4 are incorrect. Smoking, HTN, and a fear of needles or injections are not contraindications for the drug. These conditions may be managed with appropriate health teaching.

Darbepoetin (Aranesp) is ordered for each of the following patients. The nurse would question the order for which condition? 1. A patient with chronic renal failure. 2. A patient with AIDS who is receiving anti-AIDS drug therapy. 3. A patient with hypertension. 4. A patient on chemotherapy for cancer.

3 Rationale: Darbepoetin (Aranesp) and other similar drugs should not be used or are used cautiously in the patient with HTN because they may increase the blood pressure. Options 1, 2, and 4 are incorrect. Chronic renal failure, AIDS, and cancer chemotherapy are all indications for the use of darbepoetin.

What important information should be included in the patient's education regarding taking ciprofloxacin (Cipro) 1. The drug can cause discoloration of the teeth. 2. Fluid intake should be decreased to prevent urine retention. 3. Any heel or lower leg pain should be reported immediately. 4. The drug should be taken with an antacid to reduce gastric effects.

3 Rationale: Fluoroquinolones such as ciprofloxacin (Cipro) have been associated with an increased risk of tendinitis and tendon rupture. Any heel or lower leg pain should be reported immediately for evaluation. Options 1, 2, and 4 are incorrect. Ciprofloxacin will not cause discoloration of the teeth, and fluids should be encouraged during use of the drug. Taking antacids concurrently with ciprofloxacin may significantly impair absorption of the drug.

The patient has been taking aspirin for several days for headache. During the assessment, the nurse discovers that the patient is experiencing ringing in the ears and dizziness. What is the most appropriate action by the nurse? 1. Question the patient about history of sinus infections. 2. Determine whether the patient has mixed the aspirin with other medications. 3. Tell the patient not to take any more aspirin. 4. Tell the patient to take the aspirin with food or milk.

3 Rationale: High doses of aspirin can produce side effects of tinnitus, dizziness, headache, and sweating. These symptoms should be reported to the health care provider. Options 1, 2, and 4 are incorrect. Sinus infections may cause dizziness if the eustachian tubes are blocked but should not cause tinnitus. The nurse should assess whether any of the patient's medications also contain aspirin, but most OTC combination remedies include acetaminophen and not aspirin. Taking aspirin with food or milk may decrease the incidence of GI upset but will not prevent tinnitus.

The nurse is counseling a mother regarding atipyretic choices for her 8-year-old daughter. When asked why aspirin is not a good drug to use, what should the nurse tell the mother? 1. it is not as good an antipyretic as is acetaminophen. 2. It may increase fever in children under age 10. 3. It may produce nausea and vomiting. 4. It increases the rest of Reye's syndrome in children under 19 with viral infections.

4 Rationale: Aspirin and salicylates are associated with an increased risk of Reye's syndrome in children under 19, especially in the presence of viral infections. Options 1, 2, and 3 are incorrect. Acetaminophen is not significantly different from aspirin or salicylates for the treatment of fever. Use of aspirin or salicylates should not increase fever although it may cause nausea or vomiting related to GI irritation; however, it is not contraindicated in children specifically for this reason.

A 55-year-old female patient is receiving cyclosporine (Neoral, Sandimmune) after a heart transplant. The patient exhibits a white blood cell count of 12,000 cells/mm3, a sore throat, fatigue, and a low-grade fever. The nurse suspects which of the following conditions? 1. Transplant rejection 2. Hear failure 3. Dehydration 4. Infection

4 Rationale: Due to immune system suppression by the cyclosporine (Neoral, Sandimmune), infections are common. While the WBC count is slightly elevated, this drug suppresses the function of the immune cells (T-cells) and does not suppress bone marrow production of WBCs. Options 1, 2, and 3 are incorrect. Prevention of transplant rejection is a therapeutic indication for the use of cyclosporine. The patient's symptoms of sore throat and low-grade fever are not symptomatic of heart failure or dehydration.

Which of the following statements by a patient who is taking cyclosporine (Neoral, Sandimmune) would indicate the need for more teaching by the nurse? 1. "I will report any reduction in urine output to my health care provider." 2. "I will wash my hands frequently." 3. "I will take my blood pressure at home every day." 4. "I will take my cyclosporine at breakfast with a glass of grapefruit juice."

4 Rationale: Grapefruit juice increases cyclosporine levels 50% to 200%, resulting in drug toxicity. Options 1, 2, and 3 are incorrect. These statements reflect an understanding of the nurse's teaching. Hand washing is important to prevent infection. Renal toxicity and HTN are adverse effects of cyclosporine therapy.

A 5-year-old child is due for prekindergarten immunizations. After interviewing her mother, which of the following responses may indicate a possible contraindication for giving this preschooler a live vaccine (e.g., measles, mumps, and rubella [MMRJ]) at this visit and would require further exploration by the nurse? 1. Her cousin has the flu. 2. The mother has just finished her series of hepatitis B vaccines 3. Her arm became very sore after her last tetanus shot. 4. They are caring for her grandmother who has just finished her second chemotherapy treatment for breast cancer.

4 Rationale: Live vaccines may be contraindicated when patients present an exposure risk of the infectious agent to immunocompromised people such as those on chemotherapy or immunosuppressant therapy. Options 1, 2, and 3 are incorrect. Assuming that the cousin has a normal and active immune system, the cousin's flu would not be a contraindication. The mother would not be at risk and because she has received recent vaccinations, assessment of her immune system would have been completed at that time. Localized soreness or tenderness is a potential (mild) adverse effect of immunizations and can be managed symptomatically.

While educating the patient about hydrocortisone (Cortef), the nurse would instruct the patient to contact the health care provider immediately if which of the following occurs? 1. There is a decrease of 1 kg (2 lb) in weight. 2. There is an increase in appetite. 3. There is tearing of the eyes. 4. There is any difficulty breathing.

4 Rationale: Side effects that need to be reported immediately include difficulty breathing; heartburn; chest, abdomen, joint, or bone pain; nosebleed; blood in sputum when coughing, vomitus, urine, or stools; fever; chills or signs of infection; increased thirst or urination; fruity breath odor; falls; or mood swings. Options 1, 2, and 3 are incorrect. An increase in weight due to fluid retention may occur but not a decrease in weight. An increase in appetite is a common effect from corticosteroids. An increase in tearing of the eyes is not associated with corticosteroids.

The nurse is admitting a patient with rheumatoid arthritis. The patient has been taking prednisone (orasone) for an extended time. During the assessment, moon-shaped face, bruising, and an abnormal contour of the shoulder. What does the nurse conclude based on these findings? 1. These are normal reactions with the illness. 2. These are probably birth defects. 3. These are symptoms of myasthenia gravis. 4. These are symptoms of adverse drug effects from the prednisone.

4 Rationale: Signs and symptoms of bruising and a characteristic pattern of fat deposits in the cheeks (moon face), shoulders (buffalo hump), and abdomen are common adverse effects associated with long-term prednisone use. Options 1, 2, and 3 are incorrect. These symptoms are not indicative of the disease process, birth defects, or myasthenia gravis.

A patient has been prescribed tetracycline. When providing information regarding this drug, the nurse should include what information about tetracycline? 1. It is classified as a narrow-spectrum antibiotic with minimal adverse effects. 2. It is used to treat a wide variety of disease processes. 3. It has been identified to be safe during pregnancy. 4. It is contraindicated in children younger than 8 years.

4 Rationale: Tetracycline has the ability to cause permanent mottling and discoloration of teeth and there- fore is not advised for children younger than 8 years of age. Options 1, 2, and 3 are incorrect. Tetracyclines have one of the broadest spectrums of the antibiotics, and all antibiotics have significant adverse effects. Tetracycline is contraindicated in pregnancy.

Superinfentions are an adverse effect common to all antibiotic therapy. Which of the following best describes a superinfection? 1. Am initial infection so overwhelming that it requires multiple antimicrobial drugs to treat successfully. 2. Bacterial resistance that create infections that are difficult to treat and are often resistant to multiple drugs. 3. Infections requiring high-dose antimicrobial therapy with increased chance of organ toxicity. 4. The overgrowth of normal body flora or of opportunistic organisms such as viruses and yeast no longer held in check by normal, beneficial flora

4 Rationale: When normal host flora are de- creased or killed by antibacterial therapy, opportunistic organisms such as viral and fungal infections may occur. Options 1, 2, and 3 are incorrect. Bacterial resistance and organ toxicity may be adverse drug effects of anti- bacterial therapy but do not describe superinfections. The use of multiple antibiotics for severe infections is a therapeutic use of the drugs.