Immune Medications

The nurse is caring for a client that is receiving aminoglycoside. The nurse knows to assess the client for which of the following adverse effects? Select all that apply. A. Ototoxicity B. Nephrotoxicity C. Vomiting D. Heart burn E. Fever

A, B - Ototoxicity is an adverse effect of aminoglycoside use. Ototoxicity would present as hearing problems, ringing in the ears, and balance problems. Nephrotoxicity is an adverse effect of aminoglycoside use. The client should be watched for nephrotoxicity which would present as decreased urinary output, fluid retention, nausea, weakness, and confusion. Vomiting, heart burn, and fever could occur, but are not adverse effects related to aminoglycoside use.

The nurse has been asked to give clindamycin to a client. For what type of infection is clindamycin effective? Select all that apply. A. Bone infection B. Bacterial septicemia C. Sinusitis D. Gynecological infection E. Brain abscess

A, B, D - Clindamycin can be used in bone and joint infections, head and neck infections, preoperative prophylaxis, gynecological infections, intra-abdominal infections, pneumonia, and infections of the skin and soft tissue. Brain abscess infections are usually treated with a ceftin antibiotic, metronidazole, or vancomycin. Sinusitis is often viral, so antibiotics are not prescribed.

The client has an order for penicillin for strep throat. Before giving the medication, the nurse notes some drug-drug interactions and should contact the provider if the client is taking which of the following medications? Select all that apply. A. Potassium supplements B. Aldactone C. Acetaminophen D. Captopril E. Ibuprofen

A, B, D - Penicillin increases potassium in the body. ACE inhibitors, potassium sparing diuretics, and potassium supplements given concurrently with penicillin can cause these levels to become dangerously high. Acetaminophen and ibuprofen does not affect potassium levels, and is safe to take concurrently with penicillins.

A nurse is caring for a client receiving carbapenems and knows that drug-induced seizure activity is increased in which of the following client populations? A. Renal impaired B. Pediatric C. Hepatic impaired D. Drug users E. Older adults

A, B, E - Renal impaired patients are at an increased risk for drug-induced seizures because the kidneys can not excrete as well so medication builds up in the body. Carbapenems can cause CNS toxicity and seizures and the pediatric population is more at risk. The older adult population is at an increased risk for drug-induced seizures because they do not metabolize medications as well. Carbapenem is metabolized in the renal system so the liver is not involved. If the drug was metabolized by the liver then a hepatic impaired client would be at risk. Drug use does not increase the risk of seizures from carbapenem medications.

The nurse reviews a client's vancomycin trough result prior to giving the next dose. The level is 8 mcg/mL. For which of the following reasons is the nurse concerned? Select all that apply. A. The client is receiving inadequate drug therapy B. The client is at risk of nephrotoxicity C. The client is at an increased risk for bacterial resistance D. The client is receiving a drug that was mixed in error by the pharmacy E. The client could develop an opportunistic infection

A, C - If the trough is too low, the client is not receiving adequate antibiotic coverage and the infection may worsen. A therapeutic vancomycin trough is 10-20 mcg/mL. If the value is below this range, the pathogen can develop resistance to the drug. The client is at risk of nephrotoxicity when the level is above 20 mcg/mL. The client is not responding to the drug at the dose that is being administered, but this does not mean that the pharmacy made an error. An opportunistic infection occurs when a client's immune system is compromised, not when a drug is at a sub-therapeutic level in the body.

The infusion nurse understands that immunoglobulins are effective against which of the following? Select all that apply. A. Myasthenia Gravis B. Disseminated intravascular coagulation C. Varicella-zoster D. Rheumatoid Arthritis E. Cystic fibrosis

A, C - Intravenous immune globulin (IVIG) therapy is often used for neuroimmunologic disorders such as myasthenia gravis. Immunoglobulins are used to treat varicella zoster. Treatment for DIC is specific to the situation. It may include plasma for a client who has used up clotting factors, or blood thinner medication for a client whose blood is clotting. Rheumatoid arthritis is treated with disease-modifying antirheumatic drugs (DMARDs), such as methotrexate and hydroxychloroquine. Cystic fibrosis treatment centers on symptom management, and includes respiratory treatments, enzymes, and nutritional supplements.

The community health nurse is conducting an educational session to teach about tuberculosis in an HIV positive population. Which of the following is accurate regarding extrapulmonary tuberculosis? Select all that apply. A. Extrapulmonary tuberculosis is more likely to affect persons who are immunocompromised B. Extrapulmonary tuberculosis refers to TB that has traveled to the brain C. Extrapulmonary tuberculosis is more likely to be seen in children than adults D. Extrapulmonary tuberculosis is often misdiagnosed E. Extrapulmonary tuberculosis is more manageable than pulmonary TB

A, C, D - Extrapulmonary tuberculosis occurs when a client has pulmonary tuberculosis and the body is not able to mount a significant immune response. The illness spreads to the kidneys, bone, and brain. At-risk populations for this condition includes persons who are immunocompromised and children. It is common to be misdiagnosed when this condition is present. For example, a person with extrapulmonary TB in the bones may complain of pain, and be diagnosed with a bone bruise or sprain. Extrapulmonary TB can be present in the brain, bones, and kidneys. A person with extrapulmonary TB still has the primary TB infection in the lungs.

A nurse receives in report that a client will be discharged with a prescription for oral fluoroquinolone and knows that the client would have which of the following types of infections? Select all that apply. A. Sexually transmitted infections B. Ear infections C. Urinary tract infections D. Respiratory infections E. HSV

A, C, D - Fluoroquinolone treats gram-positive infections that cause sexually transmitted infections, urinary tract infections, and respiratory infections. Fluoroquinolones are not indicated for ear infections. HSV is herpes simplex virus and although it is a sexually transmitted infection, it is a virus, which is not treated with antibiotics and instead with an antiviral called acyclovir.

The nurse is reviewing assigned clients. The nurse anticipates administering anti-viral medications to which of the following patients? Select all that apply. A. Smallpox B. Pneumonia C. Herpes D. HIV/AIDS E. Clostridium difficile

A, C, D - Smallpox and herpes are treated with antiviral medication. HIV/AIDS is treated with antiretroviral medication. Clostridium difficile is treated with antibiotics and antifungals. Pneumonia is treated with antibiotics, not antivirals.

A client has been prescribed metronidazole for an infection. The nurse should counsel this client not to take this drug if he has which of the following conditions? Select all that apply. A. Alcohol intoxication B. Diabetes C. Prolonged Q-T interval D. Numbness or tingling in the hands and feet E. Liver disease

A, C, D, E - Metronidazole is an antibiotic medication taken to control infections but it can cause some significant side effects and the patient should not take the drug if certain conditions are present. These include heart arrhythmias, such as a prolonged Q-T interval, liver disease, neuropathy and acute alcohol intoxication. Metronidazole does not affect blood sugar.

A nursing student is studying antifungals and knows that antifungals have which of the following suffixes? Select all that apply. A. -FUNGIN B. -FRON C. -AZIN D. -AZOLE E. -APRIL

A, D - Antifungals have -AZOLE & -FUNGIN suffixes.

A nursing student is caring for a client receiving sulfonamides. The student is reviewing this drug class with the nurse and correctly states that the drug is contraindicated in which of the following client populations? Select all that apply. A. Pregnant women B. Older adult females C. Girls between 12-16 years old D. Infants E. Males

A, D - Sulfonamide use is contraindicated in this population. Sulfonamides can cause adverse effects to an unborn fetus and an infant. Sulfonamides compete with bilirubin for binding to serum albumin. This causes free bilirubin levels to rise in the presence of sulfonamides. This puts the fetus and infant at risk for hyperbilirubinemia, jaundice, and kernicterus.

A nurse is giving a client education on tetracycline use and asks about other medications that the client takes. The nurse would be concerned by which of the following other medications being used with tetracyclines? Select all that apply. A. Iron B. Tylenol C. Probiotics D. Antacids E. Oral anticoagulants

A, D, E - Iron preparations and antacids interact with tetracyclines, reducing effectiveness. Oral anticoagulants interact with tetracyclines. Tetracyclines will cause an increase in bleeding time, so caution needs to be taken for a client on anticoagulants. Probiotics do not interact and would be good for the client to take since tetracyclines can alter the intestinal flora. Tylenol does not interact with tetracyclines.

What's an adverse reaction to aminoglycosides? A. Peripheral nerve toxicity B. Cardiotoxicity C. Hepatotoxicity D. Toxic megacolon

A. Adverse reactions to aminoglycosides include neuromuscular reactions, ranging from peripheral nerve toxicity to neuromuscular blockade, ototoxicity, and renal toxicity.

The nurse notes that a client will be receiving a lincosamide antibiotic for an anaerobic infection. Which of the following types of infection is considered to be anaerobic? A. Peritonitis B. Pharyngitis C. Otitis media D. Cellulitis

A. Anaerobic bacteria do not require oxygen for growth, so they are not common on the outside of the body or near a rich blood supply.

The preceptee correctly explains to the nurse that the mechanism of action of anti-tubercular medications is which of the following? A. Inhibiting protein synthesis in the mycobacterium B. Building up mycobacterium cell walls C. Creating gaps in the mycobacterium synapses D. Preventing neurotransmitter release between the bacterial cells

A. Anti-tubercular medication inhibits protein synthesis, which prevents RNA/DNA replication. This prevents the bacteria from communicating with each other.

The nurse is caring for a client receiving an antifungal and knows that which of the following interactions occur with this drug class? A. Decrease in anticoagulant effectiveness B. Increase in contraceptive effectiveness C. Increase in anticoagulant effectiveness D. Increase in hypoglycemic effectiveness

A. Anticoagulant effectiveness is decreased with antifungal drug use.

The nurse knows that which of the following is true of the mechanism of action of antiviral medications? A. They inhibit replication B. They interfere with fungal DNA synthesis C. They inhibit protein synthesis D. They prevent synthesis of folic acid

A. Antiviral medications inhibit replication of the virus, which either kills or suppresses the virus by blocking the activity of polymerase enzymes.

A student nurse is studying various anti-infectives and understands that carbapenems end in which of the following suffix? A. -PENEM B. -ZOLE C. -MYCIN D. -LOL

A. Carbapenems end in -PENEM.

A client is being prescribed doxycyline and the nurse knows that which of the following would be a contraindication for this client? A. Pregnancy B. Renal failure C. Peptic ulcer disease D. History of headaches

A. Doxycycline is a tetracycline. This medication can cause birth defects and developmental problems to the fetus. It is contraindicated for pregnancy.

The nurse is assigned to a client who is beginning drug treatment for tuberculosis. Which of the following statements by the nurse is correct regarding this condition? A. "You will be taking a course of antibiotics for 6-9 months" B. "You will need to follow airborne precautions until symptoms improve" C. "You will need a Mantoux test every 6 months once treatment ends in order to determine whether the disease has returned" D. "I will teach you how to give yourself the medication as an intramuscular injection, then you can demonstrate it back to me"

A. Drug treatment for tuberculosis extends over 6-9 months. The client will need regular monitoring and follow up visits to ensure they are following the treatment regimen.

A client comes to the office because of side effects of their prescription for tetracycline. The nurse would expect to see which of the following on assessment? A. Discoloration of permanent teeth B. Tooth loss C. Gingivitis D. Additional teeth

A. It is a side effect of tetracycline use. Tetracycline causes teeth to discolor and turn gray.

A student nurse is studying pharmacology and knows that sulfonamides begin with which of the following prefixes? A. SULF- B. SAL- C. SUL- D. SULD-

A. Sulfonamides begin with SULF-.

A client is prescribed a sulfonamide. The nurse notes that the client also takes warfarin. The nurse notifies the healthcare provider because of which effect that will occur when these two medications are taken concurrently? A. Warfarin effects are increased B. Warfarin effects are decreased C. Sulfonamide effects are decreased D. Sulfonamide effects are increased

A. Sulfonamides cause increases in warfarin effects.

A client taking sulfonamides is experiencing side effects. The nurse recognizes that which of the following is not a side effect caused by sulfonamide use? A. Constipation B. Diarrhea C. Nausea D. Vomiting

A. Sulfonamides cause nausea, vomiting, and diarrhea. Constipation is not a side effect of sulfonamide use.

A nurse is caring for a client that is receiving a carbapenem antibiotic and knows that this antibiotic is used to treat which of the following types of infections? A. Upper and lower respiratory infection B. Fever of 100F or greater C. Cold D. Local infections

A. This is a severe/complicated infection and carbapenems treat severe/complication infections.

A client is taking the following medications and knows that the new prescription of erythromycin will enhance the effects of which of the following medications? A. Warfarin B. Propofol C. Tylenol D. Lisinopril

A. Warfarin is potentiated by macrolide use and erythromycin is a macrolide. Macrolides may increase INR by inhibiting warfarin's metabolism.

The nurse caring for a client who is taking an aminoglycoside should monitor the client for which adverse effects of the medication? Select all that apply. 1. Seizures 2. Ototoxicity 3. Renal toxicity 4. Dysrhythmias 5. Hepatotoxicity

Answer: 2, 3, 4 Rationale: Aminoglycosides are administered to inhibit the growth of bacteria. Adverse effects of this medication include confusion, ototoxicity, renal toxicity, gastrointestinal irritation, palpitations or dysrhythmias, blood pressure changes, and hypersensitivity reactions. Therefore, the remaining options are incorrect.

The nurse is caring for a postrenal transplantation client taking cyclosporine. The nurse notes an increase in one of the client's vital signs, and the client is complaining of a headache. What vital sign is most likely increased? 1. Pulse 2. Respirations 3. Blood pressure 4. Pulse oximetry

Answer: 3 Rationale: Hypertension can occur in a client taking cyclosporine, and because this client is also complaining of a headache, the blood pressure is the vital sign to be monitored most closely. Other adverse effects include infection, nephrotoxicity, and hirsutism. Options 1, 2, and 4 are unrelated to the use of this medication.

The nurse is caring for a client who has been taking a sulfonamide and should monitor for signs and symptoms of which adverse effects of the medication? Select all that apply. 1. Ototoxicity 2. Palpitations 3. Nephrotoxicity 4. Bone marrow suppression 5. Gastrointestinal (GI) effects 6. Increased white blood cell (WBC) count

Answer: 3, 4, 5 Rationale: Adverse effects of sulfonamides include nephrotoxicity, bone marrow suppression, GI effects, hepatotoxicity, dermatological effects, and some neurological symptoms including headache, dizziness, vertigo, ataxia, depression, and seizures. Options 1, 2, and 6 are unrelated to these medications.

The nurse is assigned to care for a client with cytomegalovirus retinitis and acquired immunodeficiency syndrome who is receiving foscarnet, an antiviral medication. The nurse should monitor the results of which laboratory study while the client is taking this medication? 1. CD4+ T cell count 2. Lymphocyte count 3. Serum albumin level 4. Serum creatinine level

Answer: 4 Rationale: Foscarnet is toxic to the kidneys. The serum creatinine level is monitored before therapy, two or three times per week during induction therapy, and at least weekly during maintenance therapy. Foscarnet also may cause decreased levels of calcium, magnesium, phosphorus, and potassium. Thus, these levels also are measured with the same frequency.

The client with acquired immunodeficiency syndrome and Pneumocystis jiroveci infection has been receiving pentamidine. The client develops a temperature of 101° F (38.3° C). The nurse continues to assess the client, knowing that this sign most likely indicates which condition? 1. That the dose of the medication is too low 2. That the client is experiencing toxic effects of the medication 3. That the client has developed inadequacy of thermoregulation 4. That the client has developed another infection caused by leukopenic effects of the medication

Answer: 4 Rationale: Frequent adverse effects of this medication include leukopenia, thrombocytopenia, and anemia. The client should be monitored routinely for signs and symptoms of infection. Options 1, 2, and 3 are inaccurate interpretations.

Which food should the patient receiving antitubercular therapy avoid? A. Red wine B. Chocolate C. Coffee D. Eggs

B. The patient taking antitubercular therapy should avoid fish (such as tuna) and products containing tyramine (such as aged cheese, beer, and chocolate) because the drug has some MAO inhibitor activity.

Which implementation step is appropriate for a patient who's taking zidovudine for an HIV infection? A. Anticipate the need for dosage adjustment for impaired hepatic function. B. Administer the drug every 4 hours, around the clock. C. Administer one dose daily. D. Monitor the patient's cardiac status.

B. Zidovudine is usually administered over 1 hour at a constant rate and is given every 4 hours around the clock.

The nurse is administering a cephalosporin to a client following a sinus infection. Which of the following are side effects associated with this medication? Select all that apply. A. Blood clotting tendencies B. Constipation C. Vaginal candidiasis D. Abdominal cramps E. Diarrhea

C, D, E - Antibiotics inhibit the growth of bacteria, and cephalosporin administration can lead to diarrhea, abdominal cramping, and yeast infections or superinfections when natural flora are inhibited. There is a risk for nephrotoxicity, and headaches, dizziness and lethargy are also reported with this class of antibiotics. When natural flora are inhibited, it can lead to diarrhea and cramping. Blood clotting and constipation are not a risk of cephalosporins

The nurse is caring for a 70-year-old client who has just started PO ciprofloxacin for a urinary tract infection. Which of the following statements by the client demonstrates understanding of this drug? Select all that apply. A. "After I take this antibiotic, I will be free from bladder infections" B. "I had an allergic reaction to a sulfa drug, so I cannot take this antibiotic" C. "I'll take this medication with a full glass of water" D. "If I have pain or swelling near my heel or calf, I will call my doctor right away" E. "I'm going to stay out of the sun while taking this drug"

C, D, E - Ciprofloxacin is a fluoroquinolone antibiotic. This drug should be used with caution in older adults, especially older adults with any renal or hepatic disorders. Cipro should be taken with a full glass of water, and the nurse should observe for any CNS effects such as dizziness, depressed feelings, and light sensitivity. Ciprofloxacin carries a risk of tendon rupture, most often in the Achilles tendon. Precautions should be taken to avoid direct sunlight while taking this medication, because it causes an increased sensitivity to the sun.

During the nursing assessment, the patient states that he's taking digoxin, furosemide, a tranquilizer, and amoxicillin. Which medication would cause a drug interaction with the antihistamine the practitioner prescribed? A. Digoxin B. Furosemide C. Tranquilizer D. Amoxicillin

C. Antihistamines can interact with many drugs, sometimes with life-threatening consequences. They may increase the sedative and respiratory depressant effects of CNS depressants, such as tranquilizers and alcohol.

The nurse is providing first-dose medication teaching to a client who is about to begin taking an antiviral medication. The nurse teaches the client that this type of medication is most likely to affect all of the following body systems except which? A. The central nervous system B. The gastrointestinal system C. The integumentary system D. The hematologic system

C. Antivirals mainly affect the GI system, the central nervous system, kidneys, and blood.

If a client is taking an antifungal medication and thiazide diuretics, which of the following electrolyte disturbances would the nurse expect to find? A. Hypocalcemia B. Hyperkalemia C. Hypercalcemia D. Hypermagnesemia

C. Both antifungals and thiazide diuretics cause hypercalcemia, so when used concurrently, the nurse must monitor calcium levels closely.

The nurse is preparing to administer clindamycin intravenously to a client. The nurse knows that the most common adverse effect associated with clindamycin administration is which of the following? A. Skin rash B. Renal toxicity C. Gastrointestinal symptoms D. Sore throat

C. Clindamycin is especially associated with nausea, vomiting, pseudomembranous colitis, and C-diff associated diarrhea.

The nurse is caring for a client with a staph infection. The client has an order for clindamycin. The nurse knows that this antibiotic fights bacteria in which of the following ways? A. Inhibiting uptake of ATP in the cell B. Inhibiting ribosomes from building proteins C. Inhibiting protein synthesis D. Inhibiting cell wall synthesis

C. Clindamycin is part of the lincosamide family of antibiotics. This type of medication stops RNA/DNA communication, and therefore stops protein synthesis.

A nurse is reviewing a client's history before giving fluoroquinolone and would be concerned about administrating it to the client if which of the following was seen in the client history? A. Migraines B. Urinary tract infections C. Dysrhythmias D. Pneumonia

C. Dysrhythmias can be caused and amplified by fluoroquinolones.

A client receiving sulfonamides starts to have an adverse reaction. The nurse realizes that the client is also taking sulfonylureas and knows that which of the following reactions can occur from from this drug interaction? A. Hyperglycemia B. Hypertension C. Hypoglycemia D. Hypotension

C. Hypoglycemia can occur as an interaction of sulfonamide and sulfonylurea use.

A nursing student is explaining macrolides to the class. The student explains that macrolides work in which of the following ways? A. Alters DNA B. Alters RNA C. Inhibition of protein synthesis D. Halts replications

C. Macrolides inhibit protein synthesis and are bacteriostatic so this kills the bacteria.

The nurse is caring for a client who must take methotrexate. The client also has an order for penicillin. Which of the following is a reason the nurse should notify the provider in this situation? A. Penicillin binds with methotrexate, which causes both drugs to become ineffective B. Penicillin is not adequately absorbed when methotrexate is given C. Penicillin interferes with methotrexate metabolism, resulting in methotrexate toxicity D. The combination of the two medications causes severe diarrhea

C. Penicillin taken concomitantly with methotrexate increases the level of methotrexate in the body. The concurrent administration of these two medications should be avoided. If it is absolutely necessary for a client to take both, the nurse must monitor for signs of methotrexate toxicity, including fever, chills, sore throat, malaise, and evidence of bleeding.

The student nurse recognizes all of the following to be antiviral medications except which? A. Zanamivir B. Amantadine C. Sulfasalazine D. Valacyclovir

C. Sulfasalazine is a sulfonamide medication, not an antiviral medication.

The client has a CT scan with IV contrast ordered. The nurse reviews the client's allergies and notes the client is allergic to peanuts, penicillin, and sulfa drugs. What should the nurse do next? A. Do not send the client to CT because an allergy to sulfa is a contraindication to getting IV contrast B. Send the client to CT because an allergy to penicillin is related to IV contrast but will not have a severe effect C. Send the client to CT because the allergies listed don't contraindicate getting IV contrast D. Do not send the client to CT because an allergy to peanuts is a contraindication to getting IV contrast

C. The client's allergies are not contraindicated for IV contrast. Shellfish and iodine allergies would mean that IV contrast is contraindicated.

A nurse is caring for a client with allergies to penicillins, NSAIDs, and sulfa drugs. The nurse withholds which medication for clarification from the provider? A. Azithromycin B. Acetaminophen C. Advil D. Ciprofloxacin

C. This drug is an NSAID. The nurse should hold the medication and ask the client about the severity of allergy, as well as ask the provider if they would like to change the medication to something else.

The nurse is assigned to a client taking a glycopeptide antibiotic for MRSA. The nurse is most concerned when the client complains of which of the following? A. Watery diarrhea B. Decreased hearing ability C. Wheezing D. Decreased urine output

C. Wheezing indicates a potential anaphylactic reaction to the antibiotic. This client will need immediate intervention to maintain an open airway.

A nurse administers diphenhydramine to a 9 year old client for hives. The client becomes hyperactive, jittery and tachycardic. What type of drug reaction is this client experiencing? A. Tolerance B. Toxic C. Allergic D. Idiosyncratic

D. An idiosyncratic drug reaction is one that is unusual or abnormal for the medication in question. Diphenhydramine (Benadryl) often produces drowsiness. However, it is possible for children to experience the opposite - hyperactivity, jitteriness, excitement, and tachycardia. This is considered an idiosyncratic reaction. Tolerance occurs when a client requires a higher dose of a drug to produce the same effect. This may have been evidenced by seeing no change in the client's original symptoms despite medicating them. Toxicity is typically evidenced by extreme versions of the medications usual effects. In this case, being overly drowsy or increased CNS depression would have indicated toxicity. Allergic reactions are characterized by swelling, itching, hives, and possible angioedema

A nurse is caring for a client that is taking carbapenems and having some adverse gastrointestinal effects. The nurse is reviewing the client's side effects and knows that all except which of the following are gastrointestinal effects of carbapenems? A. Diarrhea B. Nausea C. Vomiting D. Bloody stools

D. Bloody stools are not an adverse effect that would be caused by carbapenems use.

A nurse is caring for a client receiving fluoroquinolones for a respiratory infection. The client begins to have severe burning pain. This concerns the nurse because the nurse knows that which of the following types of ruptures could be occurring as a side effect of this medication? A. Femoral B. Brachial C. Radial D. Aortic

D. Fluoroquinolones can use tear or rupture to the aorta as a cardiovascular side effect.

The nurse is caring for a client who is taking a glycopeptide antibiotic and monitors for signs of which adverse effect of this medication? A. Glaucoma B. Constipation C. Prolonged QT D. Ototoxicity

D. Glycopeptide antibiotics such as vancomycin can cause ototoxicity. A sign of ototoxicity is tinnitus, or ringing in the ears. This can occur 4 hours after administration of the antibiotic, or several weeks after the antibiotic course is finished.

The nurse is preparing to administer the first dose of clindamycin to a client with cellulitis. The nurse notes a client history of recurrent clostridium difficile, and confirms that the client has had this condition several times in the past 6 months. Which of the following actions by the nurse is correct? A. Hold the dose and return the dose to pharmacy B. Administer the dose and monitor the client C. Administer the dose and clarify with the provider D. Hold the dose and clarify with the provider

D. Lincosamide antibiotics are contraindicated in clients with gastrointestinal conditions.

A client is being prescribed an antibiotic medication erythromycin. The nurse explains that the medication is from which class of medications? A. Penicillins B. Tetracyclines C. Cephalosporins D. Macrolides

D. Macrolides are a class of antibiotic that includes erythromycin, azithromycin and clarithromycin.

A client receiving macrolides knows that this requires close monitoring. The nurse knows to monitor levels by which of the following? A. Respiratory secretions B. Urine testing C. Sputum testing D. Blood testing

D. Macrolides are monitored with blood work. Especially liver enzymes for liver toxicity.

A student nurse is studying pharmacology and knows that macrolides end is which of the follow suffix? A. -THROBIN B. -PENAM C. -PRIL D. -THROMYCIN

D. Macrolides end in -THROMYCIN.

The nurse is assigned to a client with tuberculosis who begins to experience a seizure. Which of the following is a potential reason for this? A. The tuberculosis has progressed to TB meningitis B. The client is taking rifampin and has developed a hypersensitivity reaction to the drug C. The client is taking multiple nephrotoxic drugs and has gone into renal failure D. The client is taking isoniazid and has neurotoxicity from the drug

D. One of the most common treatments for TB is isoniazid, which carries a risk for CNS toxicity. This can present in the form of a seizure or coma, and can manifest just 30 minutes after a dose of the drug.

A client presents to the emergency room with an abscess that was previously treated but is not responding to penicillin. The nurse knows the next line of antibiotics will be which of the following? A. Granulocyte colony-stimulating factor B. Ganciclovir C. Gatifloxacin D. Gentamicin

D. This medication is an anti-infective that is the next step in treatment for gram negative bacteria when penicillins are ineffective.

A client has a vancomycin trough of 22 mcg/mL. Which of the following is of primary concern to the nurse? A. Clostridium Difficile B. Red man syndrome C. Dizziness D. Nephrotoxicity

D. This trough is above the therapeutic range of 10-20 mcg/mL. This client is at risk for nephrotoxicity, or acute kidney injury, which could result in short-term dialysis, or in extreme cases, kidney transplantation. This would be the primary concern for the nurse.

A nurse is caring for a client requiring an antibiotic and the healthcare provider wants to prescribe a carbapenem drug. The nurse knows that which of the following drugs is not a carbapenem antibiotic? A. Meropenem (Merrem) B. Doripenem (Doribax) C. Imipenem-cilastatin (Primaxin) D. Vancomycin (Vancocin)

D. Vancomycin is a glycopeptide.

A client who is human immunodeficiency virus seropositive has been taking stavudine. The nurse should monitor which most closely while the client is taking this medication? 1. Gait 2. Appetite 3. Level of consciousness 4. Gastrointestinal function

Answer: 1 Rationale: Stavudine is an antiretroviral used to manage human immunodeficiency virus infection in clients who do not respond to or who cannot tolerate conventional therapy. The medication can cause peripheral neuropathy, and the nurse should monitor the client's gait closely and ask the client about paresthesia. Options 2, 3, and 4 are unrelated to this medication.

Ketoconazole is prescribed for a client with a diagnosis of candidiasis. Which interventions should the nurse include when administering this medication? Select all that apply. 1. Restrict fluid intake. 2. Monitor liver function studies. 3. Instruct the client to avoid alcohol. 4. Administer the medication with an antacid. 5. Instruct the client to avoid exposure to the sun. 6. Administer the medication on an empty stomach.

Answer: 2, 3, 5 Rationale: Ketoconazole is an antifungal medication. There is no reason for the client to restrict fluid intake; in fact, this could be harmful to the client. The medication is hepatotoxic, and the nurse monitors liver function. It is administered with food (not on an empty stomach), and antacids are avoided for 2 hours after taking the medication to ensure absorption. The client is also instructed to avoid alcohol. In addition, the client is instructed to avoid exposure to the sun, because the medication increases photosensitivity.

Amikacin is prescribed for a client with a bacterial infection. The nurse instructs the client to contact the primary health care provider (PHCP) immediately if which occurs? 1. Nausea 2. Lethargy 3. Hearing loss 4. Muscle aches

Answer: 3 Rationale: Amikacin is an aminoglycoside. Adverse effects of aminoglycosides include ototoxicity (hearing problems), confusion, disorientation, gastrointestinal irritation, palpitations, blood pressure changes, nephrotoxicity, and hypersensitivity. The nurse instructs the client to report hearing loss to the PHCP immediately. Lethargy and muscle aches are not associated with the use of this medication. It is not necessary to contact the PHCP immediately if nausea occurs. If nausea persists or results in vomiting, the PHCP should be notified.

The nurse is reviewing the results of serum laboratory studies drawn on a client with acquired immunodeficiency syndrome who is receiving didanosine. The nurse interprets that the client may have the medication discontinued by the health care provider if which elevated result is noted? 1. Serum protein level 2. Blood glucose level 3. Serum amylase level 4. Serum creatinine level

Answer: 3 Rationale: Didanosine can cause pancreatitis. A serum amylase level that is increased to 1.5 to 2 times normal may signify pancreatitis in the client with acquired immunodeficiency syndrome and is potentially fatal. The medication may have to be discontinued. The medication is also hepatotoxic and can result in liver failure.

A nurse is preparing to administer tetracycline to a client with a urinary tract infection. Which of the following is a contraindication to using this drug? Select all that apply. A. Stomach ulcers B. Chronic kidney disease C. Pregnancy D. Clostridium difficile infection E. Acne

B, C, D - Tetracycline can cause kidney damage so it should be avoided in those with chronic kidney disease. Tetracycline can cause birth defects so it should be avoided in pregnant clients. Tetracycline can cause alter intestinal flora. If a patient has C. diff, they should not take tetracycline. Tetracycline is commonly prescribed for stomach ulcers and acne.

The nurse is caring for a client who is receiving penicillin. For which of the following side effects should the nurse monitor? Select all that apply. A. Renal failure from taking the medication B. A decrease in WBCs and platelets C. Allergic reaction such as anaphylaxis D. Constipation from taking the drug E. Pseudomembranous colitis with diarrhea

B, C, E - A client may have fever, rash or pruritus with penicillin use. Penicillin also decreases WBC, platelets, and red blood cells as well. Penicillin carries a risk of allergic reactions, including anaphylaxis and hypersensitivity. GI effects, including diarrhea, sore mouth and 'furry tongue' are also common adverse effects of penicillins. Penicillin are known to cause diarrhea, but not constipation. Penicillin does not cause nephrotoxicity.

A nurse is caring for a client that is being ordered tetracycline for a tick bite. The nurse knows that which of the following tick bite illnesses are treated with tetracyclines? Select all that apply. A. Tularemia B. Rocky mountain spotted fever C. Anaplasmosis D. Tick paralysis E. Lyme disease

B, E - Rocky mountain spotted fever and Lyme disease are treated with tetracyclines.

A nurse is helping a nursing student to understand aminoglycosides and how to identify which drugs belong to this class. The nurse is correct in saying that aminoglycosides tend to have which of the following suffix? A. -lol B. -mycin C. -pril D. -azole

B. Aminoglycosides have the -mycin suffix. "lol" are beta-blockers, "azole" are antifungals, and "-pril" are ACE inhibitors.

The nurse is caring for an older adult client who is prescribed IV cefazolin for pneumonia. Which of the following labs will be most important for the nurse to monitor due to the client's age? A. Cardiac biomarkers B. Renal function tests C. Liver function tests D. Hemoglobin and hematocrit

B. Cefazolin is a cephalosporin, which can cause kidney toxicity. The older adult client is increasingly susceptible to kidney toxicity, so the nurse will most closely monitor renal function tests in this client to ensure the client is able to metabolize and eliminate this drug appropriately.

A client is receiving fluoroquinolones and takes warfarin. The nurse is aware that these two drugs could cause which of the following reactions? A. An inhibition of anticoagulation B. An increase in oral anticoagulation effects C. A decrease in oral anticoagulation effects D. No effect in oral anticoagulation effects

B. Fluoroquinolones cause an increase in the effects of oral anticoagulants.

A nursing student knows that fluoroquinolones have which of the following types of suffix ending? A. -MYCIN B. -FLOXACIN C. -FOXIN D. -LOL

B. Fluoroquinolones end in -FLOXACIN.

Which drug can cause hypokalemia? A. Digoxin B. Amphotericin B C. Spironolactone D. Lansoprazole

B. Hypokalemia commonly occurs after administration of drugs that increase potassium excretion or depletion. In addition to amphotericin B, these drugs include glucocorticoids, vitamin B12, folic acid, granulocyte-macrophage colony-stimulating factor, and IV solutions containing insufficient potassium.

A client is being prescribed an antifungal medication and the nurse knows that a contraindication for this drug includes which of the following? A. Psoriasis B. Liver failure C. Headache D. Back pain

B. Liver failure is a contraindication for antifungal drug use. Antifungals have toxic effects on the liver.

The nurse is caring for a client receiving aminoglycoside. The nurse knows that which of the following cranial nerve can be damaged by aminoglycoside use? A. 3 B. 8 C. 5 D. 6

B. Ototoxicity is an adverse effect of aminoglycoside. Ototoxicity causes damage to cranial nerve 8. Cranial nerve 8 is vestibulocochlear which is involved in hearing.

A client undergoing treatment for tuberculosis presents to the emergency department complaining of red-tinged discharge from the eyes. Which of the following actions is most appropriate for the nurse to take? A. Place the client on a cardiac monitor B. Reassure the client that this is a side-effect of the TB medication C. Prepare the client for an injection of vitamin K D. Prepare the client for a non-contrast head CT

B. TB treatment includes a combination of Rifampin/Isoniazid. Rifampin can cause a red-orange tint to urine, tears, sweat and sputum. This is not a medical emergency.

The nurse is caring for a client with a lung abscess who has been receiving IV clindamycin for one week. The nurse would be most concerned if the client demonstrated which of the following symptoms? A. Watery diarrhea 10-15 times per day B. Nausea C. Green watery stool with cramping D. A temperature of 38.2 C

C. This is a sign of pseudomembranous colitis, which is a condition with significant morbidity that requires prompt recognition and treatment.

The nurse is administering a lincosamide antibiotic to a client. The nurse knows that all of the following side effects are related to this antibiotic except which? A. Clostridium difficile B. Nausea and vomiting C. Tinnitus D. Metallic taste in the mouth

C. Tinnitus, or ringing in the ears, is not a side-effect of lincosamide antibiotics.

The nurse is caring for a client receiving erythromycin and knows that which of the following would not be treated with this drug class? A. Syphilis B. Gonorrhea C. Trichomoniasis D. Chlamydia

C. Trichomoniasis is not treated with a macrolide drug. Trichomoniasis is treated with metronidazole (Flagyl) or tinidazole (Tindamax).

A client is prescribed voriconazole and the nurse knows this medication is contraindicated in which of the following client populations? A. Older adult clients B. Female clients C. Pregnant clients D. Male clients

C. Voriconazole is a contraindication in pregnant women and can cause damage to the unborn fetus.