Exam #2 Pharm (9,10,11,8, 108, 67,68)

The nurse is caring for a patient prescribed abacavir [Ziagen] to treat human immunodeficiency virus (HIV) infection. To reduce the potential fatal hypersensitivity reaction, which recommendation is suggested prior to initiating abacavir drug therapy?

Genetic screening **Gene variants that affect the immune system can increase the risk of severe hypersensitivity reaction to the drug abacavir [Ziagen]. The FDA recommends screening for the variant gene code HLA-B*5701 before a patient uses this drug. If the test is positive, abacavir should be avoided.

The nurse is caring for a patient with epilepsy who is on anticonvulsant therapy and is also breast-feeding. Which patient teaching instruction should minimize the risk to the baby?

"Avoid drugs that have a long half-life." **Dosing immediately after breast-feeding minimizes the drug concentration in milk. Drugs with a shorter half-life are excreted by the mother more quickly. If possible, drugs should be avoided during breast-feeding; however, patients with chronic illnesses, such as epilepsy, may require medication for their own health. The maternal fluid intake is not related to medication safety during breast-feeding.

Ch 11

Drug Therapy in Geriatric Patients

Which statement by an 18-year-old woman vaccinated with Gardasil indicates that more teaching is necessary?

"This vaccination will cure the HPV infection I got when I was 16." **Gardasil does not prevent against an HPV infection that was present before vaccination. All of the other statements are true.

When administering a medication known to be metabolized by the liver, the nurse will closely monitor for adverse drug reactions in which patient?

A 3-month-old infant **Neonates are especially sensitive to drugs that are eliminated primarily by hepatic metabolism. When these drugs are used, dosages must be reduced. The capacity of the liver to metabolize many drugs increases rapidly about 1 month after birth and approaches adult levels a few months later. The liver has matured completely by 1 year of age.

Which statement about intramuscular (IM) administration is incorrect?

Absorption of IM drugs becomes slower and more erratic in infancy than in neonates. **Drug absorption following IM injection in the neonate is slow and erratic. Delayed absorption is due in part to low blood flow through muscle during the first days of postnatal life. By early infancy, absorption of IM drugs becomes more rapid than in neonates and adults.

A nurse prepares to administer a newly prescribed medication to a 22-year-old woman. The insert in the medication package states, "Category X." Select the nurse's best action.

Ask the patient, "When was your last menstrual period?" **Category X means that the drug will be harmful to the fetus if the patient is pregnant. The patient may not know she is pregnant; therefore, asking her when her last menstrual period occurred gives the nurse a better indication of whether the patient might be pregnant.

The nurse identifies which immune system cells as responsible for the production of antibodies required for humoral immunity?

B lymphocytes **Humoral immunity refers to immune responses mediated by antibodies produced by B lymphocytes. Macrophages and T lymphocytes are involved in cell-mediated immunity, in which these cells directly attack targets. Neutrophils phagocytize bacteria and foreign particles.

Ch 68

Childhood Immunization

Before giving the hepatitis B vaccine (HepB), it is most important for the nurse to ask the patient whether he or she is allergic to what?

Baker's yeast **Before giving HepB, it is most important for the nurse to assess the patient for a history of allergy to baker's yeast.

When evaluating the laboratory results of a patient with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), the nurse identifies a deficiency of what as the most reliable indicator of the status of the patient's immune system?

CD4+ T lymphocytes **CD4 cells (helper T cells) are essential to cellular-mediated immunity, because they attack and kill target cells. However, they are the targeted cells of HIV attack, and their loss results in a high risk of death from opportunistic infection. B lymphocytes and macrophages have roles in immune responses but are not the targeted cells in HIV/AIDS. Platelets play a role in blood clotting.

Ch 108

Complementary and Alternative Therapy

The nurse will monitor which laboratory result closely when administering medications to an older adult patient while assessing for adverse drug reactions (ADRs)?

Creatinine clearance **Drug accumulation secondary to reduced renal excretion is the most important cause of ADRs in the elderly. Creatinine clearance, not serum creatinine levels, is the proper index of renal function in older adult patients.

Ch 9

Drug Therapy During Pregnancy and Breast Feeding

Ch 10

Drug Therapy in Pediatric Patients

A patient asks the nurse for a supplement that can be used to prevent motion sickness during a vacation cruise. The nurse suggests which supplement?

Ginger root (Zingiber officinale) **Ginger root is used to suppress nausea and vomiting caused by motion sickness and morning sickness and also for postoperative nausea and vomiting. It may be involved in the blockade of serotonin receptors located in the chemoreceptor trigger zone of the brain. Garlic, coenzyme Q-10, and feverfew are not used to suppress nausea and vomiting.

Which characteristic of the immune system produces faster and prolonged symptoms after initial exposure to an antigen?

Memory **During the initial immune system response, B and T lymphocytes recognizing the antigen proliferate and new cells become memory cells. This increases the pool of cells able to respond quicker and for a longer time on reexposure. Diversity, time limitation, and selectivity for antigens of nonself are other characteristics of the immune system responses but are not specific to memory.

The nurse is preparing the discharge teaching plan for a patient who had a mechanical valve replacement and has been prescribed coumadin. The nurse reviews the patient's medication history and notes the patient is taking the herbal supplement glucosamine to treat osteoarthritis. Which instructions should the nurse give to this patient?

Notify the healthcare provider immediately if you experience any signs of bleeding. **Glucosamine may increase the risk of bleeding in patients taking anticoagulants such as coumadin. The nurse should educate the patient about the signs of bleeding. Glucosamine is widely used to treat osteoarthritis of the knee, hip, and wrist. Increasing vitamin K intake may decrease the effect of Coumadin.

Which statement regarding adverse reactions during pregnancy is false?

One in five children is born with a malformation related to drug use during pregnancy. **Less than 1% of all birth defects are caused by drugs. All of the other statements are true.

A nurse administers Gardasil, the human papillomavirus (HPV) vaccine, to an 11-year-old girl. The nurse informs the parent that routine screening with which diagnostic test is needed?

Pap Test **Routine screening with a Pap test is still necessary, because Gardasil protects against four types of HPV, which may leave those vaccinated at risk for cervical cancer from other types of HPV. In addition, Gardasil does not eliminate preexisting HPV infection, which is a risk for cancer from an infection that was present before the vaccine was given. Screening tests for beta hCG or chlamydia and a mammogram are not needed in this situation, because Gardasil does not provide protection against pregnancy, chlamydia, or breast cancer.

Which intervention would the nurse choose to minimize the risk of drug toxicity in neonates and infants?

Reduce the amount of drug given. **The albumin in neonates and infants has a lower binding capacity for medication. A lower binding capacity leaves more of the free drug available for action; therefore, a lower dose is required to prevent toxicity.

The nurse is caring for a group of older adult patients who are all receiving multiple medications. The nurse understands that it is essential to individualize each patient's therapy. Which is the best rationale for this practice?

Renal function declines with age, leading to decreased drug excretion. **Renal function declines in older adults, leading to decreased excretion and potential drug accumulation. Although absorption may be delayed in older adults, the percentage absorbed does not change. Most older adult patients have increased body fat and decreased lean mass. Hepatic metabolism tends to decline with age.

Ch 67

Review of the Immune System

The nurse is reading a genetic research study. The study discusses how genetic variants can directly affect the metabolism of clopidogrel [Plavix], reducing the antiplatelet response. The nurse understands reduced efficacy of clopidogrel can increase the risk of which cardiovascular event? (Select all that apply.)

Stroke Myocardial infarction **A variant in the gene code for CYP2C19 reduces clopidogrel antiplatelet effects, which increases the patient's risk of cardiovascular events such as stroke and myocardial infarction.

Which information on the product label of an herbal supplement would comply with the regulations established by the Dietary Supplement Health and Education Act (DSHEA)?

Supports the immune system **The DSHEA restricts the wording of labels on product packaging. A label cannot claim to diagnose, treat, cure, or prevent disease. However, the label is allowed to state the product's ability to favorably influence body function or structure. Statements on a label such as "reduces the pain of arthritis," "lowers cholesterol," and "relieves menopausal hot flashes" would not be in compliance with DSHEA regulations.

Why are infants especially sensitive to drugs that affect CNS function?

The blood-brain barrier is not fully developed at birth. **The blood-brain barrier is not fully developed at birth. The other statements are not true.

Which statement about the percentage of oral drug absorption is true?

The percentage absorbed does not usually change with age. **As a rule, the percentage of an oral dose that becomes absorbed does not usually change with age.

According to the FDA Pregnancy Risk categories, which category represents the greatest risk for fetal harm?

X **Drugs in Category X are the most dangerous; these drugs are known to cause human fetal harm, and their risk to the fetus outweighs any possible therapeutic benefit. Drugs in Categories B, C, and D are progressively more dangerous than drugs in Category A and less dangerous than drugs in Category X.

The nurse is working in an immunization clinic. Which patient will the nurse identify as not eligible to receive routine immunizations?

A 4-year-old with a fever and upper respiratory infection **The only true contraindications to receiving vaccines are an anaphylactic reaction to a specific vaccine or vaccine component and moderate or severe illness with or without a fever.

A nurse administers varicella vaccine [Varivax] to a child. The nurse then instructs the parent to avoid giving the child which product for 6 weeks?

Acetylsalicylic acid (aspirin) **Three percent of children may develop a mild, local, varicella-like rash in response to the varicella vaccine; concurrent use of aspirin increases their risk of also developing Reye's syndrome, a serious childhood illness. It is not necessary to avoid foods fortified with vitamin D or foods with citric acid, such as orange juice. Tylenol is recommended for use in children with chickenpox.

Antibodies help promote phagocytosis of bacteria by opsonization, which is described as what?

Coating with antibodies **Opsonization, or the coating of bacteria with antibodies, helps macrophages and neutrophils hold on to bacteria, thereby facilitating phagocytosis. Complement activation, neutralization of toxins and viruses, and binding of antigen to a receptor are not characteristics of opsonization.

A patient receives an immunization with an attenuated vaccine. Which response should a nurse expect if the vaccine produces active immunity?

Endogenous production of antibodies **Attenuated vaccines are made from live microbes that cause the immune system to make endogenous antibodies against the microbe from which the vaccine was made. Because attenuated vaccines are avirulent, they do not cause the illness. Active immunity takes weeks or months to develop; passive immunity is conferred immediately and refers to the administration of preformed antibodies. Attenuated vaccines do not cause more potent immune system responses than killed vaccines.

The nurse is completing an admission assessment for a patient who requires treatment of an anxiety disorder. The patient states "I take the dietary supplement kava every day to help my anxiety and stress." The nurse understands the patient is at risk for which serious adverse effect?

Hepatoxicity **In the United States, kava is promoted as a natural alternative to benodiazepines to treat anxiety and stress. However, kava has the risk for the serious adverse effect of hepatoxicity, which lead the FDA to issue a public warning in March 2002. Also, in 2002, the Centers for Disease Control and Prevention issued a report on kava-related hepatoxicity.

Ch 8

Individual Variation in Drug Responses

A patient is taking black cohosh (Cimicifuga racemosa) for relief of menopausal symptoms. The nurse should caution her about adverse interactive effects with which conventional medication?

Insulin **Black cohosh may potentiate the hypoglycemic effect of insulin and oral hypoglycemics. In addition, adverse hypotensive effects have been associated with antihypertensive medications. No interactive effects have been reported with docusate sodium, aspirin, or furosemide.

While reviewing a patient's laboratory results, the nurse identifies an increase in eosinophils. The patient most likely has which condition?

Parasitic worms **Eosinophils destroy foreign particles that have been coated with antibodies of the immunoglobulin E (IgE) class; their usual target is parasitic worms. They also increase in response to immediate hypersensitivity reactions. Immune deficiency, bacterial invasion, and hemorrhaging are not conditions in which eosinophils are increased.

A teratogenic drug, such as methotrexate, is most likely to cause learning deficits during which phase of fetal development?

Second and third trimesters **Exposure to teratogens during the second and third trimesters usually disrupts function rather than producing obvious anatomic abnormalities. Exposure to teratogens during the first 2 weeks of pregnancy usually results in an "all-or-nothing" response that may result in fetal death. Exposure during the remainder of the first trimester may result in anatomic malformations.

A 3-year-old child is scheduled to receive pneumococcal vaccine (PCV). Which condition should the nurse recognize as a contraindication to the vaccine in this child?

Temperature of 103°F **PCV is a type of killed vaccine that is composed of killed microbes or microbial components. PCV vaccination is recommended for children younger than 5 years. Certain contraindications apply to all vaccines, including PCV. A vaccine should not be administered to a child with moderate to severe illness with or without a fever. Autism, premature birth, and pregnancy of the child's mother are not contraindications for PCV vaccination.

Which is not a reason for the decline in hepatic drug metabolism with age?

Poor diet **Rates of hepatic drug metabolism tend to decline with age. Principal reasons are reduced hepatic blood flow, reduced liver mass, and decreased activity of some hepatic enzymes. Diet is important but is not a principal reason for reduced hepatic drug metabolism.

A nursing student is caring for a patient who has been taking morphine sulfate for pain for 2 weeks. The nursing student shows an understanding of pharmacodynamic tolerance by describing it to the instructor in what way?

"It is a condition in which the patient requires increased doses of morphine sulfate to achieve pain relief." **Pharmacodynamic tolerance is the phenomenon of decreased responsiveness to a drug as a result of repeated drug administration. Tachyphylaxis is a reduction in drug responsiveness as a result of repeated dosing over a short time. Metabolic tolerance results from accelerated drug metabolism and not repeated dosages; therefore, the minimum effective concentration is not affected. The placebo effect is a drug response caused by psychologic factors and not by the drug's biochemical or physiologic properties.

A nurse is educating a breast-feeding patient about her medications. Which statements by the nurse are true? (Select all that apply.)

-"Drugs taken by lactating women can be excreted in breast milk." -"If drug concentrations in milk are high enough, a pharmacologic effect can occur in the infant." -"Most drugs can be detected in milk, but concentrations are usually too low to cause harm." **Drugs taken by lactating women can be excreted in breast milk. If drug concentrations in milk are high enough, a pharmacologic effect can occur in the infant, raising the possibility of harm. Unfortunately, very little systematic research has been done on this issue. Most drugs can be detected in milk, but concentrations are usually too low to cause harm. Although nearly all drugs can enter breast milk, the extent of entry varies greatly.

The nurse is teaching young parents about medication administration in their child. Which statements are appropriate to include in the teaching plan? (Select all that apply.)

-"Guard against spills and spitting to ensure that your child gets an accurate dose." -"This calibrated spoon will help your child get an accurate dose." -"Keep a medication record to make sure you do not give more than one dose at a time." **Spills and spitting are common causes of inaccurate dosing in children. It is often helpful to mix medication with food or juice to mask the taste when allowed. Calibrated spoons and medication records can improve accuracy. To prevent overdosing, parents should estimate the amount a child spits out and replace only that amount.

The nurse identifies varicella vaccination as contraindicated in which patients? (Select all that apply.)

-A patient who is pregnant -A 21-year-old patient with an allergy to neomycin -A 12-year-old patient with an allergy to gelatin -A 10-year-old patient who receives chemotherapy for the treatment of leukemia **All of the answer options, except for an 8-year-old patient with asthma, are considered contraindications to varicella vaccination

The nurse understands drug response varies from one individual to another. What are examples of individual variations? (Select all that apply.)

-Age -Genetic makeup -Gender -Diet -Failure to take medication as prescribed **All of the responses are examples of individual variations in drug responses.

When a pregnant woman has been exposed to a known teratogen, what is the first step in identifying risks for malformation? (Select all that apply.)

-Determine exactly when the drug was taken. -Determine exactly when the pregnancy began **When a pregnant woman has been exposed to a known teratogen, the first step is to determine exactly when the drug was taken and exactly when the pregnancy began. Other information is helpful but not necessary.

Which factors may contribute to unintentional nonadherence? (Select all that apply.)

-Forgetfulness -Failure to comprehend instructions -Inability to pay for medications **Forgetfulness, failure to comprehend instructions (because of intellectual, visual, or auditory impairment), and inability to pay for medications can contribute to unintentional nonadherence. Unpleasant side effects and the belief that the drug is not needed are factors that contribute to intentional nonadherence.

The patient is prescribed warfarin [Coumadin] to treat deep vein thrombosis. The nurse is teaching the patient about dietary supplements that have the potential to interfere with coumadin therapy. What herbs should the nurse include in the teaching? (Select all that apply.)

-Garlic -Ginger Root -Gingko biloba **Garlic, ginger root, and gingko biloba can increase the risk of bleeding in patients receiving anticoagulants or antiplatelet drugs.

Which blood cells produced in the bone marrow participate in providing cellular-mediated and humoral immunity? (Select all that apply.)

-Granulocytes -T lymphocytes -B lymphocytes **The bone marrow produces all blood products from a pluripotent stem cell, from which mature cells are derived after maturation. Granulocytes have an immune phagocytic function, and T and B lymphocytes provide antibody and cell-mediated immune functions. Erythrocytes have no immune role but provide an oxygen-carrying function. Platelets have a role in blood clotting.

Older adult patients are at high risk for adverse drug reactions (ADRs). Which measures can reduce the incidence of ADRs? (Select all that apply.)

-Taking a thorough drug history, including over-the-counter (OTC) medications -Monitoring clinical response and laboratory results to help determine proper dosage -Regularly monitoring patients for drug-drug and drug-nutrient interactions -Helping patients to avoid prescriptions for drugs on the Beers list **A thorough drug history and careful monitoring can help reduce ADRs. Nurses should help patients use the simplest regimen possible to reduce the risk of ADRs. Monitoring patients for interactions reduces ADRs. The Beers list identifies drugs with a high likelihood of causing adverse effects in the elderly.

For a drug to be a proven teratogen, which criteria must be met? (Select all that apply.)

-The drug must cause a characteristic set of malformations. -The drug must act only during a specific window of vulnerability. -The incidence of malformations should increase with increasing dosage and duration of drug exposure. **To prove that a drug is a teratogen, three criteria must be met: The drug must cause a characteristic set of malformations; the drug must act only during a specific window of vulnerability (eg, weeks 4 through 7 of gestation); and the incidence of malformations should increase with increasing dosage and duration of exposure. Drugs are not tested in pregnant women. Studies in animals may be of limited value, in part because teratogenicity may be species-specific.

Which statements about transdermal absorption are correct? (Select all that apply.)

-The stratum corneum of the infant's skin is very thin. -Blood flow to the skin is greater in infants than in older patients. -Infants are at increased risk of toxicity from topical drugs. -Absorption through the skin is more rapid and complete with infants. **Drug absorption through the skin is more rapid and complete with infants than with older children and adults because the stratum corneum of the infant's skin is very thin and blood flow to the skin is greater in infants than in older patients. Because of this enhanced absorption, infants are at increased risk of toxicity from topical drugs.

When the immune system fails to provide immunity by discerning self from nonself, which autoimmune condition can develop? (Select all that apply.)

-Ulcerative colitis -Graves' disease -Psoriasis **Autoimmune disorders may develop when the immune system becomes unable to discriminate between self and nonself and attacks its own cells. This is made possible by major histocompatibility complex (MHC) molecules, which play a role in the activation of T cells and are the basis for determining self and nonself. Heart failure and gouty arthritis are not related to immune system functions.

In addition to vaccination for all children ages 12 through 23 months, hepatitis A vaccination (HepA) is recommended in which situations? (Select all that apply.)

-When a male patient has sex with men -When a patient travels to Central America -When a patient lives in an Alaskan Native village **Hepatitis A is a serious liver infection that may be contracted through fecal-oral transmission from an infected individual. Therefore, men who have sex with men, individuals who live in endemic areas (eg, Alaskan Native villages), and those who live where rates of hepatitis A are high (eg, Central America) should be vaccinated. Vaccination with HepA is not indicated for use specifically in women who have cervical cancer nor in individuals with myocardial disease.

Which statement about renal excretion in infants is true?

Adult levels of renal function are achieved by 1 year. **Adult levels of renal function are achieved by 1 year. Renal blood flow, glomerular filtration, and active tubular secretion are low during infancy. Renal drug excretion is significantly reduced at birth. Drugs that are eliminated primarily by renal excretion must be given in reduced dosage and/or at longer dosing intervals.

The nurse is preparing to give a drug that is not classified according to a Pregnancy Risk Category. What should the nurse do?

Administer the medication, because the nurse knows that it was in use before 1983. **Many drugs are not classified according to the U.S. Food and Drug Administration (FDA) Pregnancy Risk Categories. These drugs were in use before the classification system came into use in 1983. They are considered safe but may not have been studied in controlled trials. The pharmacy cannot assign a pregnancy risk category to a drug.

The nurse is caring for a pregnant patient who has chronic asthma. When administering medications to this patient, the nurse should do what?

Advise the patient that taking asthma medications during pregnancy improves fetal outcomes. **Essentially all drugs can cross the placenta. Renal blood flow increases during pregnancy, which increases the clearance of some drugs, such as lithium. Lack of proof of teratogenicity does not mean that a drug is safe; it only means that the available data are insufficient to make a definitive judgment. Uncontrolled maternal asthma is more dangerous to the fetus than the drugs used to treat it.

Which cells release histamine in response to an allergen?

Basophils **Mast cells and basophils mediate immediate hypersensitivity reactions. Mast cells are derived from basophils. Both cell types release histamine, heparin, and other compounds that cause the rhinitis and itching of immediate hypersensitivity. Neutrophils phagocytize foreign material, such as bacteria. B lymphocytes produce antibodies. CD8 cells are cytolytic T lymphocytes that lyse target cells.

For medications that do not have established pediatric doses, the most common method of extrapolating the appropriate dose is based on which measurement?

Body surface area **Pediatric doses have been established for a few drugs but not for most. For drugs that do not have an established pediatric dose, dosage can be extrapolated from adult doses. The method of conversion employed most commonly is based on body surface area.

The nurse is caring for a 12-year-old boy who weighs 72 pounds. The healthcare provider should make the most precise dosage adjustments for this patient's medications based on what?

Body surface area **Adjustments based on the body surface area account not only for the patient's weight but also for the patient's relative amount of body adiposity.

The nurse is caring for a group of female patients receiving medication therapy. Which factor is of greatest concern with regard to drug therapy in these patients?

Most drug research has been carried out exclusively in male subjects. **For most drugs, not much is known about gender-related differences, because until recently all drug research was done in men.

The nurse recognizes that the supplement echinacea (Echinacea angustifolia) should not be taken as prolonged therapy for patients with which condition?

Tuberculosis **When taken on a short-term basis to suppress inflammation and stimulate the immune system, echinacea has few adverse effects. However, if taken as long-term therapy, it can suppress immune function. It should be avoided in patients with chronic infections, such as tuberculosis, that require optimal immune function. Patients with diabetes, peptic ulcer disease, or glaucoma need not avoid taking echinacea.

The healthcare provider prescribes a medication that is renally eliminated for a patient with acute renal failure. The nurse recognizes the patient is at risk for which altered drug response?

Development of drug toxicity **Kidney disease can reduce drug excretion, causing drugs to accumulate in the body. If the dosage is not lowered, the drug may accumulate to toxic levels.

Which statement about drug use among older adults is true?

Drug use among older adults is disproportionately high. **Drug use among older adults is disproportionately high. Older adults consume 33% of the nation's prescribed drugs. Older patients are more sensitive to drugs than are younger adults. Older adults experience more adverse drug reactions.

The nurse is caring for a group of very young patients receiving a variety of medications. Which concept guides the nurse's care of these patients?

Drugs given subcutaneously (SC) remain in the body longer in infants than in adults. **The very young are at risk for drug effects that are more intense and prolonged than those seen in adults. Drugs given by the SC route reach higher levels and remain in the system longer than in adults. Drugs given IV leave the body more slowly in infants than in adults. Gastric emptying time is prolonged in infants. The blood-brain barrier is not fully developed in infants.

What is the Beers list?

Drugs with a high likelihood of causing adverse effects in older adults **The Beers list identifies drugs with a high likelihood of causing adverse effects in older adults.

When assessing for drug effects in the older adult, which phase of pharmacokinetics is the greatest concern?

Excretion **Although pharmacokinetic changes in older adults affect all phases of kinetics, drug accumulation secondary to reduced renal excretion is the most important cause of ADRs in the older adult.

A child receives a vaccine for measles, mumps, and rubella (MMR). Six hours after the injection, the child's parent reports local soreness, erythema, lethargy, and a fever of 101°F to a nurse. Which action should the nurse take?

Give instructions on relieving symptoms with acetaminophen (Tylenol) **Low-grade fever, malaise, and muscle aches are common reactions to the MMR vaccine. Acetaminophen [Tylenol] usually alleviates these problems. Airway constriction, hives, and itching are signs of an anaphylactic reaction. MMR is a live vaccine, but it is attenuated or completely avirulent and does not cause measles in healthy children. Only immunocompromised children are at risk from live vaccines and should not receive them. A Vaccine Adverse Event Report is used by practitioners to report certain unusual events after vaccination; these symptoms are not unusual events for the MMR vaccine.

Which substance serves as the stimulus for macrophage activation in delayed-type hypersensitivity (DTH) reactions?

Inferon gamma **In response to interferon gamma, macrophages increase the production of lysosomes and reactive oxygen, which ultimately kills bacteria residing in the macrophage. IgE is a type of antibody class. Lymphokine is a mediator molecule released by a lymphocyte. Interleukin-1 is a type of cytokine.

Which product did the U.S. Food and Drug Administration (FDA) ban in the United States because of the serious adverse effects of myocardial infarction, stroke, and death?

Ma huang (Ephedra) **Sales of ma huang have been banned in the United States since 2004, making it the first time that a dietary supplement has been ordered off the market. It has been associated with stroke, myocardial infarction, and death. The ban was challenged in 2007, but a rehearing petition was denied. Valerian, St. John's wort, and saw palmetto are currently available for sale in the United States.

When preparing a teaching session for residents at an assisted living facility, the nurse will include what?

The importance of avoiding intentional underdosing **Underdosing, with resulting therapeutic failure, is much more common (90%) than overdosing among the elderly. In most cases (75%), the nonadherence is intentional because of the patient's conviction that the drug is simply not needed or because of unpleasant side effects. Using multiple pharmacies should be avoided, as should doubling missed doses. Doubling a dose could result in intentional overdosing. Reducing protein intake can result in decreased drug binding to albumin; consequently, the amount of free drug is increased, which could result in drug toxicity.

Which of the following is not an example of age-related adverse drug effects?

Toxicity **Like adults, pediatric patients are subject to adverse reactions when drug levels rise too high. In addition, pediatric patients are vulnerable to unique adverse effects related to organ system immaturity and to ongoing growth and development. Among these age-related effects are growth suppression (caused by glucocorticoids), discoloration of developing teeth (caused by tetracyclines), and kernicterus (caused by sulfonamides).