Exam 4 Info + PrepUs

A parent has informed the nurse that she has been applying an over the counter antifungal to her infant's buttocks and perineal region for a rash. What question related to safety should the nurse ask the parent?

"Are there any open wounds on the areas where you're putting the ointment?"

During an assessment of a client experiencing diarrhea, which question is appropriate for the nurse in determining the possible cause of the diarrhea?

"Can you tell me what you ate the last 24 hours?"

A female patient has been administered metoclopramide (Reglan) for nausea. Which statements indicates that she has understood the teaching provided by the nurse?

"I may experience drowsiness with this medication."

A female client is prescribed ranitidine in addition to the antacid that she already takes for gastric reflux. Which statement made by the client indicates that she understood the teaching provided about taking these medications?

"I should take ranitidine 2 hours before or after my antacid dosage."

A 60-year-old man has scheduled a follow-up appointment with his primary care provider stating that the omeprazole (Prilosec) which he was recently prescribed is ineffective. The client states, "I take it as soon as I feel heartburn coming on, but it doesn't seem to help at all." How should the nurse best respond to this client's statement?

"Prilosec will help your heartburn but it's not designed to provide immediate relief of specific episodes of heartburn."

A client is being discharged with a prescription for a senna preparation. Which statement should be included in the teaching plan about the medication?

"The medication might change the color of your urine."

A female client has GERD and is taking ranitidine (Zantac). She continues to have gastric discomfort and asks whether she can take an antacid. Which is an appropriate response by the nurse?

"Yes, but be sure to wait at least 2 hours to take the antacid after you take the ranitidine."

A client is receiving mefloquine as part of a treatment for malaria asks the nurse about becoming pregnant. Which response by the nurse would be most appropriate?

"You need to avoid pregnancy during the therapy and for 2 months after completion."

The nurse is providing health education for a client who has been prescribed atovaquone (Malarone) prior to leaving on a tropical vacation. The nurse should state:

"You'll have to take this drug each day, starting before you leave on your trip."

A nurse is teaching a client about antidiarrheal medications. What statement is included in the teaching? Select all that apply.

"Young children and elderly are at risk for serious fluid and electrolyte disturbances." "Episodes of diarrhea is a defense mechanism of the body." "Diarrhea may be acute or chronic."

A client is prescribed a proton pump inhibitor to treat erosive gastritis. How soon will the client's symptoms be resolved?

1-2 weeks

When administering chloroquine, the nurse would be most concerned about exacerbating the underlying disease of which patient?

A 27-year-old woman who has psoriasis NOT: 21 y/o with GI distress EXP: Patients with a history of psoriasis or porphyria who take chloroquine can experience an acute and severe exacerbation of their disease. Patients with gastrointestinal distress or blood dyscrasias may also have exacerbations of the disease because of chloroquine, but the exacerbations tend to be less acute than in patients with a history of psoriasis or porphyria. People who smoke and consume alcohol are at risk for toxic effects from chloroquine, but a prudent nurse would be less concerned about this patient when compared to the other patient scenarios.

The nurse at an overseas military base supervises the care of hundreds of clients who are service members receiving antimalarial prophylaxis. Which client should the nurse prioritize for referral to the provider?

A client who reports feeling dizzy several times per day while taking the medication

Surfactant laxatives - docusate sodium (Colace)

Adds fat and water to soften stool Give with full glass of water

Nursing considerations of antacids

Administer 1-3 hours after meals and at bedtime Admin 2 hours after other oral meds

A client has been diagnosed with malaria and will begin treatment promptly. How can the nurse best attack the Plasmodium protozoa at the different stages of its life cycle?

Administer combination therapy as prescribed

A client receiving drug therapy for a fungal infection reports being nauseated and requests that the dose be decreased or medication changed. Which statement should form the basis of the nurse's response to the client's request?

Antifungal drugs that are effective for this disease without being excessively toxic to human cells are limited.

A nurse is caring for a client who asks why she has been prescribed posaconazole following kidney transplantation. The nurse responds that posaconazole is used as prophylaxis to prevent:

Aspergillus infection. azoles can also work on candida

An antacid has been added to the treatment regimen for a client on multiple medications. When is the best time for the nurse to administer the antacid?

At bedtime

A 67-year old client with a history of chronic illness is undergoing penicillin therapy. Client age and health history indicate an increased susceptibility to pseudomembranous colitis. Which symptoms should a nurse monitor for when caring for this client? Select all that apply.

Bloody diarrhea Rectal bleeding Abdominal cramping

Side effect of clarithromycin

Distortion of taste, nausea, diarrhea, high resistance

Nursing considerations of Sucralfate

Do not use within two hours of other medications

Nursing considerations for cimetidine

Don't take with antacids Inform HCP of bleeding No alcohol, smoking, or NSAIDs Elevate HOB

Anticholinergic effects

Drowsiness Urinary retention Dizziness

A client with amebiasis has been prescribed a seven-day course of metronidazole. What intervention should the nurse prioritize when providing anticipatory guidance about potential adverse gastrointestinal effects?

Eat small meals several times per day. EXP: Diarrhea and dyspepsia are potential adverse effects of metronidazole. The client may benefit from eating small amounts of food more frequently, rather than three larger meals each day. Constipation is not expected, so increasing fiber intake and using stool softeners is not recommended. The dangers of reducing fluid intake nearly always outweigh any potential benefits; fluid reduction is not recommended as a means of preventing or treating diarrhea.

A client reports frequent constipation. The nurse would identify what risk factors as potential contributors? Select all that apply.

Female gender Use of anticholinergic drugs Advanced age

Adverse effects of cimetidine

Gynecomastia CNS effects bc crosses BBB Chronic - pneumonia Increased toxicity risk of meds bc it's a hepatic inhibitor

A client began antimalarial prophylaxis four days ago and reports a rash on the thorax and arms that emerged shortly after starting the medication. What is the nurse's best action?

Have the client monitor the rash and seek care if it worsens. EXP: Antimalarials have the potential to cause a rash. The fact that the client has had the rash for three days suggests that it is unrelated to any severe hypersensitivity response. Consequently, there is no need to seek emergency care and the medication does not necessarily need to be changed. A topical corticosteroid would unlikely to resolve this adverse effect and the nurse should refrain from recommending one.

Issue with use of nitroimidazoles

High resistance

Which of the following would a nurse expect to administer if the goal of therapy is to block the release of hydrochloric acid in the stomach?

Histamine-2 Receptor Antagonist

Which assessment datum serves to contraindicate the use of an antiemetic agent?

History of chronic liver dysfunction

A patient who has been on penicillin therapy for several days has developed inflamed oral mucous membranes and swelling in the tongue and the gums. The primary health care provider has diagnosed it as a fungal superinfection of the oral cavity resulting in impaired oral mucous membranes. Which of the following interventions should the nurse perform?

Inspect mouth and gums regularly.

Which statement would be correct for a client regarding the administration of an antifungal medication?

Instruct the client to complete the entire drug therapy even if a dose is missed.

How does adding a beta-lactamase inhibitor agent help achieve a therapeutic effect when prescribed for otitis media?

It extends the spectrum of antibacterial activity of penicillin.

A client is prescribed aztreonam. What is the major advantage of this monobactam over the aminoglycosides in treating P. aeruginosa?

It has lower risk for hearing loss and kidney damage

Bulk forming laxatives

Keeps water in the stool Takes 1-3 days to take action Esophageal or intestinal obstruction Methylcellulose (Citrucel) psyllium (Metamucil)

Indications for laxatives

Laxative, or cathartic, drugs are indicated to remove ingested poisons from the lower GI tract; as an adjunct in anthelmintic therapy when it is desirable to flush helminths from the GI tract; to prevent straining when it is clinically undesirable (such as after surgery, myocardial infarction, or obstetric delivery); for the short-term relief of constipation; and to evacuate the bowel for diagnostic procedures. Lubricants ease defecation without stimulating the movement of the GI tract. GI stimulants provide more generalized GI stimulation, resulting in an overall increase in GI activity and secretions.

Nursing considerations for antacids

Magnesium hydroxide - caution in renal impairment Aluminum hydroxide - good in renal failure, avoid in HTN, HF Calcium carbonate - constipation, burping, heartburn Sodium bicarbonate - not good for PUD, avoid sodium load in HTN, HF

Best environment for amoxicillin

Neutral pH - caution with use of PPI

Pro of famotidine

No antiandrogenic effects (no gynecomastia) Doesn't inhibit hepatic enzymes

Info about Misoprostol (Cytotec)

Prostaglandin E Prevents NSAID induced gastric ulcers Does NOT prevent duodenal ulcers Pregnancy category X

An 80-year-old woman is receiving treatment with oral fluconazole for a fungal infection Following yesterday's and today's dose, she reports an upset stomach to the charge nurse. How should the nurse at the facility best respond to the woman's report? -Arrange for the client to receive intravenous fluconazole on an outpatient basis. -Assess the client for signs and symptoms of an infusion reaction. -Stop administering the fluconazole and inform the client's physician. -Provide food along with the fluconazole when administering it in the future.

Provide food along with the fluconazole when administering it in the future.

A client has returned home from a vacation and is receiving antiprotozoals for malaria. The client's temperature is 102.3°F (39.1°C) and the client is disoriented. The client reports dizziness and nausea. What nursing action should the nurse prioritize?

Raising side rails and addressing the client's risk for falls

Long term risks of PPI use

Risk of fractures Hypomagnesemia C. Diff Vitamin B12 deficiency Acute interstitial nephritis Lupus erythematosus events

Side effect of tetracycline

Stains teeth

A child has been taking mebendazole for the past 3 weeks after being diagnosed with roundworm. The nurse will determine the efficacy of the child's treatment by referencing what diagnostic test?

Stool for ova and parasites exp: The nurse obtains a stool sample for culture for ova and parasites after 3 weeks of drug administration. A negative stool culture is the optimum outcome of drug therapy since it confirms complete eradication of the parasite and that any "worm burden" is now nonexistent. Colonoscopy, liver enzyme levels, and rectal swabs are not used to ascertain whether treatment has been successful since they are not focused on the parasites themselves

Nursing considerations - PPIs

Take before meals Don't crush or chew

A client, scheduled to begin chemotherapy for the treatment of breast cancer, is anxious about the possibility of experiencing nausea. When explaining the physiology of nausea and vomiting, the nurse should include what informational statement?

The chemoreceptor trigger zone (CTZ) is composed of neurons in the fourth ventricle.

A client has made an appointment at a travel clinic seeking antimalarial prophylaxis. What aspect of the client health is most likely to contraindicate the use of antimalarials?

The client drinks eight to ten alcoholic drinks per day.

An older adult client has been diagnosed with candidiasis and prescribed fluconazole. What aspect of the client's health status should warrant close monitoring by the nurse?

The client has atrial fibrillation and takes warfarin daily

The nurse is providing report on a client who is receiving amphotericin B for the treatment of a systemic fungal infection. What assessment finding should the nurse prioritize?

The client's AST and ALT levels are above reference ranges for the first time

A client is being treated for histoplasmosis with amphotericin B. The nurse has completed a comprehensive assessment of the client and should report what assessment finding?

The client's urine output is 75 mL over six hours

How is constipation best defined?

The infrequent and painful expulsion of hard, dry stools

Side effect of bismuth

Turns tongue and stools black

The nurse is caring for a 23-year-old female client who uses oral contraceptives and has been prescribed ampicillin for treatment of a respiratory infection. What information is most important for the nurse to share with this client?

Use a type of barrier birth control while you are taking this antibiotic.

A male client has been receiving promethazine for nausea that occurred following chemotherapy. Recently it has been discovered that this client has developed liver dysfunction. The nurse anticipates that the health care provider will do what to treat this client's nausea?

Use an alternative medication. Exp: Phenothiazines are metabolized in the liver and eliminated in urine. In the presence of liver disease (e.g., cirrhosis, hepatitis), metabolism may be slowed and drug elimination half-lives prolonged, with resultant accumulation and increased risk of adverse effects. Therefore, the drugs should be used cautiously in clients with hepatic impairment. Cholestatic jaundice has been reported with promethazine.

What substances are secreted by chyme? Select all that apply.

Water Mucous Digestive enzymes

A client is being treated for pharyngitis with penicillin V. This nurse caring for this client needs to explain the proper way to take this medication. What would be the best instruction?

You will need to take the medication every 6 hours, evenly spaced during the day.

Common side effects of laxatives

abdominal discomfort and flatulence

The nurse is assessing a client who reports constipation. The use of a medication to treat this problem is contraindicated if the client reports what symptom?

abdominal pain and fever

A patient is administered metoclopramide (Reglan). The patient has an elevated creatinine level. Which of the following is important when administering metoclopramide to this patient?

administer a lower dose

Drugs to treat systemic fungal infections can be toxic to the host and are not used indiscriminately. Which are factors considered before an antifungal is prescribed? (Select all that apply.)

age of client was a culture obtained hepatic function

A patient has been instructed to take metronidazole for intestinal amebiasis. Which instruction should the nurse give to the patient regarding the drug?

avoid intake of alcohol

A client develops itching and burning of the vaginal vault while taking an anti-infective to treat strep throat. What fungal agent has caused the burning and itching?

candida albicans

Beta-lactam antibiotics, such as penicillins and cephalosporins, fight infection by inhibiting development of the causative bacteria. What specific component development do these drugs affect?

cell wall synthesis

A 42-year-old woman with a systemic fungal infection is admitted to the hospital. The nurse practitioner prescribes ketoconazole. The nurse preparing to administer this medication understands that azole antifungals require caution under certain conditions. To which patient would the nurse be especially cautious about administering this drug? Select all that apply.

client with hepatic dysfunction a pregnant woman with a history of headaches

An older adult has been taking a calcium-based antacid on an increasingly frequent basis. When teaching this client, the nurse should include suggestions for the prevention of which adverse effect?

constipation

When reviewing the medical record of a client who is to receive a chemical stimulant laxative, the nurse would monitor the client closely if he had which condition?

coronary artery disease

A client who takes zinc daily is diagnosed with a severe infection and is ordered levofloxacin (Levaquin). The nurse is aware that taking these two drugs may have what affect on the antibiotic?

decreased absorption

The nurse should warn a client taking magnesium- and sodium-containing antacids about which adverse effects?

diarrhea EXP: The nurse should warn a client taking magnesium- and sodium-containing antacids about diarrhea, which can be associated with taking products containing either medication. Constipation is seen with taking aluminum- and calcium-containing antacids. Dehydration can be seen with the use of diuretics. Increased flatulence can be seen with the use of fiber laxatives such as Metamucil.

The nurse practitioner instructs the client to use over-the-counter ranitidine instead of cimetidine. What risk is decreased when using ranitidine over cimetidine?

drug-drug interactions

Which would be most important for the nurse to do when administering a phenothiazine antiemetic to a patient?

institute safety precautions

An adult client has begun treatment with fluconazole. The nurse should recognize the need to likely discontinue the drug if the client develops which sign or symptom?

jaundice

Which of the following would be the proton pump inhibitor of choice for a child with GERD?

lanzoprazole Exp: Lansoprazole is the only proton pump inhibitor approved for use in children and would be the drug of choice.

A client is receiving chloroquine for a diagnosis of extraintestinal amebiasis. The nurse should provide information on which medication that is likely to be administered with chloroquine?

metronidazole

The nurse at a long-term care facility is admitting a new resident who is an older adult. The resident's current medication regimen includes nystatin 1,000,000 units PO t.i.d. The nurse should recognize the need to prioritize what aspect of this resident's care?

mouth care

A client is treating a skin mycosis with a topical antifungal agent in troche form. The nurse would alert the client to what possible adverse effect?

nausea

A client has been admitted to the critical care unit with a diagnosis of peritonitis that has necessitated treatment with gentamicin. As a result, the care team should be cautious when concurrently administering other medications that may cause which?

ototoxicity and nephrotoxicity

A client has been diagnosed with streptococcal pharyngitis. What drug would the nurse expect to be prescribed by the health care provider?

penicillin G Exp: Some strains of streptococci have acquired resistance to penicillin G, although the drug is still effective in many streptococcal infections. It remains the drug of choice for the treatment of streptococcal pharyngitis; for prevention of recurrent attacks in clients who have had previous acute rheumatic fever due to group A streptococcus; and for the treatment of neurosyphilis. Aminopenicillins (e.g., amoxicillin) are the drugs of choice for prevention of bacterial endocarditis due to procedures that produce transient bacteremia. Penicillinase-resistant penicillins (e.g., dicloxacillin) are the drugs of choice for MRSA. Although first-generation cephalosporins such as cephalexin are effective against streptococci species, they are not the drugs of choice.

What is one method that the nurse can teach community members to prevent many parasitic infections?

personal and public hygiene practices

A nurse has administered demeclocycline to a patient. Which of the following adverse reactions should the nurse closely monitor the patient for?

photosensitivity

Misoprostol is a synthetic form of prostaglandin E prescribed to protect the gastric mucosa from erosion and ulceration. The drug is contraindicated in clients who:

pregnant

How does a locally acting antiemetic minimize a client's risk of nausea and vomiting?

prevent distention and stretch stimulation of the GI tract.

The nurse has administered the first dose of a client's newly-prescribed antibiotic. What assessment finding should the nurse interpret as adverse effect that suggests a more serious concern?

rash to the face and trunk

A nurse is assessing a client who is receiving vancomycin intravenously. While the drug is being administered, the client reports a throbbing sensation in the neck and back and paresthesias. The client's blood pressure has dropped and the neck and back are erythematous. The nurse suspects which adverse finding?

red man syndrome Explanation: Red man syndrome is manifested by a drop in blood pressure and reports of throbbing neck or back pain. Additionally, the client develops fever, chills, paresthesia, and erythema (redness) of the neck and back. SJS is manifested by fever, cough, muscular aches and pains, headache, and lesions of the skin, mucous membranes, and eyes; the lesions appear as red wheals or blisters, often starting on the face, in the mouth, or on the lips, neck, and extremities. Toxic epidermal necrosis is manifested by skin lesions resulting from the death of the epidermal layer of the skin. Pseudomembranous colitis is a bacterial superinfection that is manifested by severe bloody diarrhea.

A client is prescribed ranitidine for the treatment of a peptic ulcer disease and gastric reflux. The dosage of this drug should be reduced if the client has:

renal disease

The client has a magnesium-based antacid prescribed for administration before meals. The nurse knows to withhold the medication if the client exhibits what?

renal dysfunction

A critical care nurse is caring for a client taking aminoglycosides. The dosage may need to be adjusted if the nurse finds monitored changes in what system?

renal function

A 72-year-old female clinic patient is started on trimethoprim-sulfamethoxazole for treatment of a urinary tract infection. Prior to administering this drug, the nurse should assess the patient for which of the following conditions?

renal impairment

What begins the digestive process?

saliva

The large intestine absorbs mostly water and which electrolyte?

sodium

What type of laxative would be the first choice for a client diagnosed with hemorrhoids experiencing intense pain when straining to pass stools?

stool softener

What reflex mechanism is triggered by a bolus in the back of the throat?

swallowing

The client is receiving ketoconazole. The nurse should be concerned about a drug-drug interaction on the basis of what other comorbidity?

type 2 diabetes

After teaching a group of students about the reflexes involved in the gastrointestinal tract, the instructor determines that the teaching has been successful when the students identify what as a central reflex?

vomiting

A client has been prescribed a topical antifungal ointment to treat a fungal infection between her breasts. When providing education about this medication, the nurse should encourage the client to:

wash and dry the affected area before applying the ointment.