Lilley 36,37, Evolve questions for NUR140 Pharm - Ch.38, 39, 40 antibiotics, NCLEX Pharma Ch 41 AntiTubercular, Chapter 42 - Antifungal Drugs Elsevier Questions, Pharm chapter 43, Lilley Ch 44, Pharm. Ch. 45 (Antineoplastic Drugs Part 1), Chapter 46,...
The nurse is assessing a patient who is about to receive antifungal drug therapy. Which problem would be of most concern? a. Endocrine disease b. Hepatic disease c. Cardiac disease d. Pulmonary disease
Answer: B
When teaching a patient about the potential drug interactions with antiprotozoal drugs, the nurse will include information about: a. acetaminophen. b. warfarin. c. decongestants. d. antibiotics.
Answer: B
What conditions are considered contradictions for use of antifungal medications? (Select all that apply.) a. Heart failure b. Kidney failure c. Pancreatic failure d. Liver failure e. Respiratory failure
C, D
A patient is being treated for oral candidiasis. Which medication will the nurse anticipate administering? a. Amantadine b. Griseofulvin c. Oseltamivir d. Nystatin
D
List common infection sites (note primary site).
Lungs primary, can then be passed to other locations such as GI, GU, etc.
Which information should the nurse include in discharge teaching for a client prescribed doxycycline (Vibramycin)? -"Take the medication with milk to minimize gastrointestinal upset." -"Apply sunscreen or wear protective clothing when outdoors." -"Take the medication until you have no fever and feel better." -"Keep the remainder of the medication in case of recurrence."
"Apply sunscreen or wear protective clothing when outdoors." Photosensitivity is a common adverse effect of doxycycline, a tetracycline antibiotic. The client should avoid direct sun exposure and tanning bed use while taking this medication. Exposure to the sun can cause severe burns.
Which client statement regarding his or her diagnosis of HIV infection indicates a need that further teaching is necessary? -"I must take these medications exactly as prescribed for the rest of my life." -I don't need to use condoms as long as I take my medication as prescribed." -"I will notify my health care provider immediately if I bruise or bleed more easily than normal." -"I should remain upright for 30 minutes after taking my zidovudine to prevent esophageal ulceration."
"I don't need to use condoms as long as I take my medication as prescribed." Antiretroviral drugs do not stop the transmission of HIV, and clients need to continue standard precautions and safe sex practice, including condom use. Potential serious adverse effects of zidovudine are bone marrow suppression and esophageal ulceration.
The nurse is providing education to a client who is prescribed metronidazole (Flagyl) for trichomoniasis. What client statement indicates that the client understood the teaching? "I won't get this again because I have had it once." "I will have my partner evaluated and treated." "I will stop taking the medication when the discharge stops." "I can continue to have intercourse as long as we use condoms."
"I will have my partner evaluated and treated." Inform the client taking metronidazole for a sexually transmitted infection to avoid sexual intercourse until the prescriber states otherwise. The partner, and any sexual partners possibly exposed, need to be evaluated and treated if positive. All other statements would require further teaching by the nurse.
Which client statement indicates to the nurse that the client understands the discharge teaching for ethambutol (Myambutol)? "Constipation will be a problem, so I will increase the fiber in my diet." "This medication may cause my bodily secretions to turn red-orange-brown." "Dizziness and drowsiness are common adverse effects with this drug." "I will need to have my vision checked periodically while I am taking this drug.
"I will need to have my vision checked periodically while I am taking this drug." Ethambutol can cause optic neuritis. Ophthalmologic examinations should be performed periodically to assess visual acuity.
A nurse teaching a client receiving allopurinol (Zyloprim) should include which information? "Increase your fluid intake to 3 L per day." "This medication may cause your urine to turn orange." "Include salmon and organ meats in your diet on a weekly basis." "Take the medication with an antacid to minimize GI distress."
"Increase your fluid intake to 3 L per day." Clients taking allopurinol should be informed to increase fluid intake to 3 L per day, avoid hazardous activities if dizziness or drowsiness occurs with the medication, and avoid the use of alcohol and caffeine because these drugs will increase uric acid levels and decrease the levels of allopurinol.
The client asks the nurse about the use of herbal and dietary supplements to treat arthritis pain. What is the nurse's best response? "High doses of vitamins and minerals have been used for many years to help maintain joint health." "There really are no safe herbal treatments for pain. Your best action would be to take your prescription medications." "Ginkgo biloba has shown tremendous benefit as an antiinflammatory drug and is used to treat the symptoms of pain." "There is evidence that glucosamine sulfate with chondroitin does decrease joint stiffness and pain. Discuss this with your health care provider."
"There is evidence that glucosamine sulfate with chondroitin does decrease joint stiffness and pain. Discuss this with your health care provider." There is evidence that clients would benefit from glucosamine and chondroitin supplements to decrease the pain of osteoarthritis. However, they should always be used in consultation with a health care provider.
A client prescribed azithromycin (Zithromax) expresses concern regarding GI upset that was experienced when previously prescribed an erythromycin antibiotic. What is the nurse's best response? -"Take an over-the-counter antiemetic to lessen the nausea." -"I will call the health care provider and request a different antibiotic." -"Stop taking the drug if you experience heartburn and diarrhea." -"This drug is like erythromycin with less gastrointestinal adverse effects."
"This drug is like erythromycin with less gastrointestinal adverse effects." Azithromycin is a newer macrolide antibiotic. It has a longer duration of action, as well as fewer and less severe GI adverse effects than erythromycin.
Discuss diagnostic tests.
*PPD - Mantoux skin test checked 48-72 hours later for induration generally over 10mm (sometimes under 5mm for people from out of the country) *X-ray of lungs looking for lesions in the lungs. *Acid fast bacilli smear (AFB) x3 - the need of a true specimen can be obtained through deep suction if can not cough up a specimen.
Bacterial resistance to antibiotics can occur with which situations? (Select all that apply.) 0 Antibiotics that are prescribed to treat a viral infection 0 Clients stop taking an antibiotic when they feel better. 0 Antibiotics that are prescribed according to culture and sensitivity reports 0 Microorganisms arriving from foreign countries and overseas ports 0 Taking an antibiotic and an antiviral medication at the same time
-Antibiotics that are prescribed to treat a viral infection Not completing a full course of antibiotic therapy can allow bacteria that are not killed but have been exposed to the antibiotic to adapt their physiology to become resistant to that antibiotic. Administering antibiotics to treat viral infections is not effective and may expose small amounts of bacteria that may be present to the antibiotic and therefore risk the development of resistance. -Clients stop taking an antibiotic when they feel better. Not completing a full course of antibiotic therapy can allow bacteria that are not killed but have been exposed to the antibiotic to adapt their physiology to become resistant to that antibiotic. Administering antibiotics to treat viral infections is not effective and may expose small amounts of bacteria that may be present to the antibiotic and therefore risk the development of resistance.
Before administration of any antiviral medication, what nursing responsibilities would be performed? (Select all that apply.) -Monitor for medication adverse effects -History of medication use -Documentation of known allergies -Baseline vital signs -Head-to-toe physical assessment
-History of medication use Before administering an antiviral drug, perform a thorough head-to-toe physical assessment and take a medical and medication history. Document any known allergies before use of these and any other medications. Also assess the client's nutritional status and baseline vital signs because of the profound effects of viral illnesses on physiologic status, especially if the client is immunocompromised. Assess and document any contraindications, cautions, and drug interactions associated with all of the antiviral drugs. Monitoring for adverse effects would occur after the medication has been administered. -Documentation of known allergies Before administering an antiviral drug, perform a thorough head-to-toe physical assessment and take a medical and medication history. Document any known allergies before use of these and any other medications. Also assess the client's nutritional status and baseline vital signs because of the profound effects of viral illnesses on physiologic status, especially if the client is immunocompromised. Assess and document any contraindications, cautions, and drug interactions associated with all of the antiviral drugs. Monitoring for adverse effects would occur after the medication has been administered. -Baseline vital signs Before administering an antiviral drug, perform a thorough head-to-toe physical assessment and take a medical and medication history. Document any known allergies before use of these and any other medications. Also assess the client's nutritional status and baseline vital signs because of the profound effects of viral illnesses on physiologic status, especially if the client is immunocompromised. Assess and document any contraindications, cautions, and drug interactions associated with all of the antiviral drugs. Monitoring for adverse effects would occur after the medication has been administered. -Head-to-toe physical assessment Before administering an antiviral drug, perform a thorough head-to-toe physical assessment and take a medical and medication history. Document any known allergies before use of these and any other medications. Also assess the client's nutritional status and baseline vital signs because of the profound effects of viral illnesses on physiologic status, especially if the client is immunocompromised. Assess and document any contraindications, cautions, and drug interactions associated with all of the antiviral drugs. Monitoring for adverse effects would occur after the medication has been administered.
Discuss patient teaching for a patient being treated for TB.
-How transmission of TB occurs, how to prevent spreading it. -Difference between LTBI to active TB -Signs & symptoms to be aware of -Importance of respiratory isolation & use of masks -Infection period and how it starts 3 months prior to symptoms occurring. -medications used, side effects, testing, precautions, & toxicity
The nurse is aware that viruses can enter the body through various routes. Through which routes can viruses enter the body? (Select all that apply.) 0 Localized allergic reaction to medication 0 Inhalation through the respiratory tract 0 Transplacentally from mother to infant 0 Through an animal bite 0 Ingestion via the gastrointestinal (GI) tract
-Inhalation through the respiratory tract Viruses can enter the body through at least four routes: (1) inhalation through the respiratory tract, (2) ingestion via the GI tract, (3) transplacentally via mother to infant, and (4) inoculation via skin or mucous membranes. The inoculation route can take several forms, including sexual contact, blood transfusions, sharing of syringes or needles, organ transplantation, and animal bites (including human, animal, insect, spider, and others). Viruses cannot enter the body through an allergic reaction caused by medication. -Transplacentally from mother to infant Viruses can enter the body through at least four routes: (1) inhalation through the respiratory tract, (2) ingestion via the GI tract, (3) transplacentally via mother to infant, and (4) inoculation via skin or mucous membranes. The inoculation route can take several forms, including sexual contact, blood transfusions, sharing of syringes or needles, organ transplantation, and animal bites (including human, animal, insect, spider, and others). Viruses cannot enter the body through an allergic reaction caused by medication. -Through an animal bite Viruses can enter the body through at least four routes: (1) inhalation through the respiratory tract, (2) ingestion via the GI tract, (3) transplacentally via mother to infant, and (4) inoculation via skin or mucous membranes. The inoculation route can take several forms, including sexual contact, blood transfusions, sharing of syringes or needles, organ transplantation, and animal bites (including human, animal, insect, spider, and others). Viruses cannot enter the body through an allergic reaction caused by medication. -Ingestion via the gastrointestinal (GI) tract Viruses can enter the body through at least four routes: (1) inhalation through the respiratory tract, (2) ingestion via the GI tract, (3) transplacentally via mother to infant, and (4) inoculation via skin or mucous membranes. The inoculation route can take several forms, including sexual contact, blood transfusions, sharing of syringes or needles, organ transplantation, and animal bites (including human, animal, insect, spider, and others). Viruses cannot enter the body through an allergic reaction caused by medication.
When assessing for adverse effects to Rifamate (combination isoniazid and rifampin), the nurse would monitor which laboratory values? (Select all that apply.) • Liver function tests • Complete blood cell count • Sputum cultures • Uric acid levels • Cholesterol
-Liver function tests -Complete blood cell count Rifamate can lead to impairment of liver function as well as hematologic disorders. Assessment of sputum cultures confirms the diagnosis but is not related to adverse effects. The drug does not affect uric acid levels or cholesterol.
Which types of antiviral drugs are used to treat HIV infection? (Select all that apply.) -Nonnucleoside reverse transcriptase inhibitors -Protease inhibitors -Neuraminidase inhibitors -Fusion inhibitors -Reverse transcriptase inhibitors
-Nonnucleoside reverse transcriptase inhibitors Neuraminidase inhibitors are used in the treatment of the influenza virus. -Protease inhibitors Neuraminidase inhibitors are used in the treatment of the influenza virus. -Fusion inhibitors Neuraminidase inhibitors are used in the treatment of the influenza virus. -Reverse transcriptase inhibitors Neuraminidase inhibitors are used in the treatment of the influenza virus.
Quinolones are a class of antibiotics known for several significant complications. Which are possible adverse effects with these drugs? (Select all that apply.) 0 Prolongation of the QT interval 0 Ototoxicity 0 Nephrotoxicity 0 Tendon rupture 0 Abnormal cartilage development in children
-Prolongation of the QT interval Quinolones are not used in prepubescent children because of the risk of cartilage development issues. Quinolones may also cause a cardiac effect that involves prolongation of the QT interval on the electrocardiogram. The use of these medications can result in tendonitis or ruptured tendons in adults. Nephrotoxicity and ototoxicity are not associated with quinolones. -Tendon rupture Quinolones are not used in prepubescent children because of the risk of cartilage development issues. Quinolones may also cause a cardiac effect that involves prolongation of the QT interval on the electrocardiogram. The use of these medications can result in tendonitis or ruptured tendons in adults. Nephrotoxicity and ototoxicity are not associated with quinolones. -Abnormal cartilage development in children Quinolones are not used in prepubescent children because of the risk of cartilage development issues. Quinolones may also cause a cardiac effect that involves prolongation of the QT interval on the electrocardiogram. The use of these medications can result in tendonitis or ruptured tendons in adults. Nephrotoxicity and ototoxicity are not associated with quinolones.
The nurse is planning care for a client prescribed once-daily IV gentamicin (Garamycin) therapy. When should the nurse schedule a trough drug level to be drawn? -12 hours after completing the antibiotic infusion -30 minutes after beginning the antibiotic infusion -18 hours after completing the antibiotic infusion -60 minutes after beginning the antibiotic infusion
12 hours after completing the antibiotic infusion Trough serum drug levels should be drawn at least 8 to 12 hours after the medication is infused.
When preparing to administer an intravenous (IV) infusion of metronidazole (Flagyl), the nurse will anticipate infusing the medication over how many minutes? 30 to 60 5 to 10 15 to 30 1 to 5
30 to 60 Infuse IV doses of metronidazole as prescribed and generally are to infuse over 30 to 60 minutes and never as an IV bolus.
A patient visits the health care provider for treatment of tinea pedis (athlete's foot). Which medication would the nurse instruct the patient to use to treat this condition? a. Caspofungin b. Terbinafine c. Amphotericin B d. Voriconazole
A
Discharge teaching to a patient receiving a beta-agonist bronchodilator should emphasize reporting which side effect? A. Tachycardia B. Nonproductive cough C. Hypoglycemia D. Sedation
A
The nurse has provided education to a patient about fungal skin infections. Further patient teaching is necessary when the patient tells the nurse they were prescribed antifungals for which condition? a. Impetigo b. Athlete's foot c. Thrush d. Vaginal yeast infection
A
The nurse would question a prescription for voriconazole if the patient was taking which medication? a. Quinidine b. Captopril c. Clindamycin d. Prednisone
A
What advantage does loratadine (Claritin) have compared with traditional antihistamines such as diphenhydramine (Benadryl)? A. Less sedative effect B. Increase in bronchodilation C. Minimal gastrointestinal upset D. Decreased risk of cardiac dysrhythmias
A
What is the role of corticosteroids in the treatment of acute respiratory disorders? A. They decrease inflammation. B. They directly dilate the bronchi. C. They stimulate the immune system. D. They increase gas exchange in the alveoli.
A
Which laboratory value would the nurse assess before administering zafirlukast (Accolate) to a client? A. Liver enzymes B. Cardiac enzymes C. Renal function tests D. Complete blood count
A
Which statement by a client best indicates an understanding of the teaching on flunisolide (AeroBid)? A. "I will rinse my mouth with water after each use." B. "I will wash the plastic inhaler casing once a month." C. "I will take two puffs to treat an acute asthma attack." D. "I will not use my albuterol inhaler while I am taking AeroBid
A
The anthrax vaccine is recommended for which groups of people? (Select all that apply.) A. Military personnel B. Veterinarians C. Workers who process imported animal hair D. Emergency department health care providers
A , B, C People at risk for exposure to the anthrax bacterium include military personnel, veterinarians, and workers who process imported animal hair.
The nurse should question a prescription to administer acetylsalicylic acid (aspirin) to which client? A 62-year-old patient with a history of stroke A 45-year-old patient with a history of heart attack A 28-year-old patient with a history of sports injury A 14-year-old patient with a history of flulike symptoms
A 14-year-old patient with a history of flulike symptoms Aspirin should never be administered to children with flulike symptoms. The use of aspirin in children with flulike symptoms has been associated with Reye's syndrome.
Which are important for the nurse to monitor in a patient receiving an antifungal medication? (Select all that apply.) a. Creatinine b. Blood urea nitrogen c. Mental status d. Daily weights e. Intake and output
A, B, D, E
When educating the client about immunosuppressant therapy, what information would the nurse include in the teaching? (Select all that apply.) A. "You must take all medications exactly as prescribed." B. "Over-the-counter medications are alright to take as needed." C. "Medications must be taken at the correct time every time to avoid interactions." D. "If you miss a dose of medication, take extra medicine to make up the missed dose." E. "Never stop taking these medications without being instructed by your health care provider."
A, C, E Immunosuppressants must be taken exactly as directed and at the exact times and with the exact foods. Adherence to dosing schedules can be very difficult for clients because they are taking multiple medications that must be taken at different times throughout the day. Clients should never stop taking their immunosuppressants without being told to do so by their transplant health care provider. They should always talk to the transplant health care provider before taking any over-the-counter medications or if a scheduled dose is missed.
Which condition is not an anticipated adverse effect of azathioprine (Imuran)? A. Alopecia B. Leukopenia C. Hepatotoxicity D. Thrombocytopenia
A. Common adverse effects of azathioprine include leukopenia, thrombocytopenia, and hepatotoxicity. Alopecia (hair loss) is not an expected adverse effect.
What is the general action of immunosuppressants? A. They inhibit T-lymphocytes. B. They increase antibody response. C. They reduce hepatic metabolism of steroids. D. They increase natural killer cellular activity.
A. Immunosuppressants inhibit T-lymphocyte synthesis, thus preventing an immune response to organ transplants.
The client is being treated with the drug fingolimod (Gilenya). The nurse would expect that this drug is prescribed for what client condition? A. Multiple sclerosis (MS) B. Parkinson's disease C. Guillain-Barré syndrome D. Amyotrophic lateral sclerosis
A. Fingolimod (Gilenya) is an immunosuppressant drug indicated for MS. It is the only oral drug for relapsing forms of MS. It has significant adverse effects, including headache, hepatotoxicity, flulike symptoms, back pain, atrioventricular block, bradycardia, hypertension, and macular edema.
A patient has been prescribed monoclonal antibody therapy for the treatment of rheumatoid arthritis. What known disorder or disease is a contraindication and would alert the nurse to question the order for this class of drugs? A. AIDS B. Hypertensive crisis C. Chronic obstructive pulmonary disease D. Nephrotic syndrome
A. Aids Monoclonal antibodies are usually contraindicated in patients with known active infectious processes due to their immunosuppressive qualities. Use of alemtuzumab is also contraindicated in patients with active systemic infections and immunodeficiency conditions, including AIDS.
What cells are the functional cells of the humoral immune system that mature into immunoglobulins? A. B cells B. Granulocytes C. T cells D. Red blood cells
A. B cells The functional cells of the humoral immune system are the B lymphocytes. When an antigen binds to receptors located on the B cells, a biochemical signal is sent to the B lymphocytes. These B cells then mature into plasma cells, which in turn produce antibodies
Which cells are activated by aldesleukin (interleukin-2)? Which cells are activated by aldesleukin (interleukin-2)? A. T-cells B. Red blood cells C. Undifferentiated cells D. Neutrophils
A. T-Cells Aldesleukin enhances the immune system by stimulating the production and activity of T-cells.
Which statement MOST accurately describes the pharmacodynamics of vaccines? A. Vaccines work by stimulating the humoral immune system. B. Vaccines provide IgG antibodies to protect against infection. C. Vaccines prevent the formation of antibodies against a specific antigen. D. Vaccines work by suppressing the amino acid immunoglobulin sequence.
A. Vaccines work by stimulating the hormonal immune system Vaccines work by stimulating the humoral immune system, which synthesizes immunoglobulins. They also stimulate the formation of antibodies against their specific antigen, providing active immunity.
A patient with low platelets is prescribed a drug to stimulate platelet production. Which drug would the nurse anticipate being prescribed? A. oprelvekin (Neumega) B. epoetin (Epogen) C. aldesleukin (Proleukin) D. interferon beta-1a (Avonex)
A. oprelvekin (Neumega) Oprelvekin stimulates the production of platelets. Epoetin stimulates the production of red blood cells in the bone marrow. Interleukins (aldesleukin) and interferons activate the immune system but do not increase production of white blood cells.
.A patient will be taking fluconazole (Diflucan) 100 mg/day PO for 2 weeks. The patient is unable to swallow tablets, so an oral suspension that contains 10 mg/mL is available. Identify how many milliliters will the nurse administer with each dose.
ANS: (10 xx) = (1 x 100); 10x= 10mL.
1. During an intravenous (IV) infusion of amphotericin B, a patient develops tingling and numbness in his toes and fingers. What will the nurse do first? a. Discontinue the infusion immediately. b. Reduce the infusion rate gradually until the adverse effects subside. c. Administer the medication by rapid IV infusion to reduce these effects. d. Nothing; these are expected side effects of this medication.
ANS: A Once the intravenous infusion of amphotericin B has begun, vital signs must be monitored frequently to assess for adverse reactions such as cardiac dysrhythmias, visual disturbances, paresthesias (numbness or tingling of the hands or feet), respiratory difficulty, pain, fever, chills, and nausea. If these adverse effects or a severe reaction occur, the infusion must be discontinued (while the patient is closely monitored) and the prescriber contacted. The other options are incorrect.
2. A patient has an infestation with flukes. The nurse anticipates the use of which drug to treat this infestation? a. Praziquantel (Biltricide) b. Pyrantel (Pin-X) c. Metronidazole (Flagyl) d. Ivermectin (Stromectol)
ANS: A Praziquantel is an anthelmintic that is used to kill flukes. Metronidazole is used to treat protozoal infections. The other drugs listed are used for other helminthic infestations.
During therapy with amphotericin B, the nurse will monitor the patient for known adverse effects that would be reflected by which laboratory result? a. Serum potassium level of 2.7 mEq/L b. Serum potassium level of 5.8 mEq/L c. White blood cell count of 7000 cells/mm3 d. Platelet count of 300,000/ microliter
ANS: A The nurse needs to monitor for hypokalemia, a possible adverse effect of amphotericin B. The other options are incorrect.
Hydroxychloroquine (Plaquenil) is prescribed as part of malaria prophylaxis for a patient who will be traveling. The nurse will discuss which potential adverse effects with the patient? (Select all that apply.) a. Diarrhea b. Constipation c. Insomnia d. Dizziness e. Rash f. Headache
ANS: A, D, E, F Diarrhea, anorexia, nausea, vomiting, dizziness, rash, and headache are potential adverse effects of hydroxychloroquine. See Table 43-1 for other common adverse effects. The other options are not adverse effects of this drug.
A patient is being evaluated for a possible helminthic infection. The nurse knows that which statement about anthelmintic therapy is true? A. The drugs may cause severe drowsiness. B. Anthelmintics are very specific in their actions. C. Anthelmintics are effective against broad classes of infestations. D. The drugs are used to treat protozoal infections such as intestinal amebiasis.
ANS: B Anthelmintics are very specific in their actions, and it is important to identify the cause of the infestation before beginning treatment. They are not used to treat protozoal infections, and they do not cause severe drowsiness.
If a patient is taking fluconazole (Diflucan) with an oral anticoagulant, the nurse will monitor for which possible interaction? a. Reduced action of oral anticoagulants b. Increased effects of oral anticoagulants c. Hypokalemia d. Decreased effectiveness of the antifungal drug
ANS: B Azole antifungal drugs increase the effects of oral anticoagulants. As a result, increased bleeding may occur. The other options are incorrect.
A patient is taking nystatin (Mycostatin) oral lozenges to treat an oral candidiasis infection resulting from inhaled corticosteroid therapy for asthma. Which instruction by the nurse is appropriate? a. "Chew the lozenges until they are completely dissolved." b. "Let the lozenge dissolve slowly and completely in your mouth without chewing it. " c. "Rinse your mouth with water before taking the inhaler." d. "Rinse your mouth with mouthwash after taking the inhaler."
ANS: B Nystatin may be given orally in the form of lozenges, or troches, which need to be slowly and completely dissolved in the mouth for optimal effects; tablets are not to be chewed or swallowed whole. The other options are incorrect. Patients taking an inhaled corticosteroid must rinse their mouths with water thoroughly after taking the inhaler.
treatment with which medication for this pneumonia? a. Ivermectin (Stromectol) b. Atovaquone (Mepron) c. Praziquantel (Biltricide) d. Metronidazole (Flagyl)
ANS: B Pentamidine and atovaquone are used for the treatment of pneumonia caused by P. jirovecii. The other options are not used for this pneumonia.
6. A patient with an intestinal infection that is positive for the Giardia lamblia organism will be taking an antiprotozoal drug. The nurse will include which information in the teaching plan for this patient? a. The urine may become dilute and pale during therapy. b. Taking the medications with food reduces gastrointestinal upset. c. The medications should be taken on an empty stomach. d. The drugs may be discontinued once the diarrhea subsides.
ANS: B Taking these drugs with food reduces gastrointestinal upset. Antiprotozoal drugs may cause the urine to turn dark. These drugs should be administered for the prescribed length of time to ensure complete eradication of the infection.
The nurse is preparing to administer morning medications to a patient who has been newly diagnosed with tuberculosis. The patient asks, "Why do I have to take so many different drugs?" Which response by the nurse is correct? e. "Your prescriber hopes that at least one of these drugs will work to fight the tuberculosis.' f. "Taking multiple drugs reduces the chance that the tuberculosis will become drug resistant. " g. "Using more than one drug can help to reduce side effects." h. "Using multiple drugs enhances the effect of each drug."
ANS: B The use of multiple medications reduces the possibility that the organism will become drug resistant. The other options are incorrect.
6. A patient with a severe fungal infection has orders for voriconazole (Vfend). The nurse is reviewing the patient's medical record and would be concerned if which assessment finding is noted? a. Decreased breath sounds in the lower lobes b. History of cardiac dysrhythmias c. History of type 2 diabetes d. Potassium level of 4.0 mEq/L
ANS: B Voriconazole is contraindicated when co-administered with certain other drugs metabolized by the cytochrome P-450 enzyme 3A4 (e.g., quinidine) because of the risk for inducing serious cardiac dysrhythmias.
The nurse is administering an amphotericin B infusion. Which actions by the nurse are appropriate? (Select all that apply.) a. Administering the medication by rapid IV infusion b. Discontinuing the drug immediately if the patient develops tingling and numbness in the extremities c. If adverse effects occur, reducing the IV rate gradually until they subside d. Using an infusion pump for IV therapy e. Monitoring the IV site for signs of phlebitis and infiltration f. Administering premedication for fever and nausea g. Knowing that the intravenous solution for amphotericin B will be cloudy h. Knowing that muscle twitching may indicate hypokalemia
ANS: B, D, E, F If the patient develops tingling and numbness in the extremities (paresthesias), discontinue the drug immediately. An infusion pump is necessary for the infusion, and the nurse will monitor the IV site for signs of phlebitis and infiltration. Premedication to reduce the adverse effects of fever, malaise, and nausea may be ordered. The IV solution must be clear and without precipitates; and muscle weakness, not twitching, may indicate hypokalemia. The medication must be administered at the rate recommended and stopped, not slowed, if adverse reactions occurs.
The nurse is providing patient teaching for a patient who is starting antitubercular drug therapy. Which of these statements should be included? (Select all that apply.) a. 'Take the medications until the symptoms disappear." b. 'Take the medications at the same time every day." c. "You will be considered contagious during most of the illness and must take precautions to avoid spreading the disease." d. "Stop taking the medications if you have severe adverse effects." e. "Avoid alcoholic beverages while on this therapy." "If you notice reddish-brown or reddish-orange urine, stop taking the drug and contact your doctor right away." g. "If you experience a burning or tingling in your fingers or toes, report it to your prescriber immediately." h. "Oral contraceptives may not work while you are taking these drugs, so you will have to use another form of birth control."
ANS: B, E, G, H Medications for tuberculosis must be taken on a consistent schedule to maintain blood levels. Medication therapy for tuberculosis may last up to 24 months, long after symptoms disappear, and patients are infectious during the early part of the treatment. Compliance with antitubercular drug therapy is key, so if symptoms become severe, the prescriber should be contacted for an adjustment of the drug therapy. The medication must not be stopped. Because of potential liver toxicity, patients on this drug therapy must not drink alcohol. Discoloration of the urine is an expected adverse effect, and patients need to be warned about it beforehand. Burning or tingling in the fingers or toes may indicate that peripheral neuropathy is developing, and the prescriber needs to be notified immediately. A second form of birth control must be used because antitubercular drug therapy makes oral contraceptives ineffective.
A patient has received a prescription for a 2-week course of antifungal suppositories for a vaginal yeast infection. She asks the nurse if there is an alternative to this medication, saying, 'I don't want to do this for 2 weeks!" Which is a possibility in this situation? A. A single dose of a vaginal antifungal cream. B. A one-time infusion of amphotericin B. C. A single dose of a fluconazole (Diflucan) oral tablet. D. There is no better alternative to the suppositories.
ANS: C A single oral dose of fluconazole may be used to treat vaginal candidiasis. The other options are incorrect.
A patient is infected by invasive aspergillosis, and the medical history reveals that the patient has not been able to tolerate several antifungal drugs. The nurse anticipates an order for which medication to treat this infection? A. Fluconazole (Diflucan) B. Micafungin (Mycamine) C. Caspofungin (Cancidas) D. Nystatin (Mycostatin)
ANS: C Caspofungin is used for treating severe infection by Aspergillus species (invasive aspergillosis) in patients who are intolerant of or refractory to other drugs.
1. A patient who has a helminthic infection has a prescription for pyrantel (Antiminth). Which is one of the common adverse effects that the patient may experience while on this therapy? a. Vertigo b. Seizures c. Diarrhea d. Insomnia
ANS: C Diarrhea and abdominal pain are some of the possible gastrointestinal effects of pyrantel. See Table 43-11 for other adverse effects. The other options are incorrect.
7. A patient who has started drug therapy for tuberculosis wants to know how long he will be on the medications. Which response by the nurse is correct? a. "Drug therapy will last until the symptoms have stopped.' b. "Drug therapy will continue until the tuberculosis develops resistance." c. "You should expect to take these drugs for as long as 24 months." d. "You will be on this drug therapy for the rest of your life."
ANS: C Drug therapy commonly lasts for 24 months if consistent drug therapy has been maintained. The other options are incorrect.
7. The nurse is reviewing antimalarial drug therapy with a patient and instructs the patient to watch for and report which potential adverse reactions? a. Drowsiness b. Insomnia c. Visual disturbances d. Constipation
ANS: C Encourage the patient to contact the prescriber if there is unresolved nausea, vomiting, profuse diarrhea, or abdominal pain and to report immediately any visual disturbances, dizziness, or respiratory difficulties.
9. A patient is receiving hydroxychloroquine therapy but tells the nurse that she has never traveled out of her city. The nurse knows that a possible reason for this drug therapy is which condition? a. Lyme disease b. Toxoplasmosis c. Systemic lupus erythematosus d. Intestinal tapeworms
ANS: C Hydroxychloroquine, which is used for malaria, also possesses anti-inflammatory actions and has been used to treat rheumatoid arthritis and systemic lupus erythematosus. The other options are incorrect.
The nurse is administering one of the lipid formulations of amphotericin B. When giving this drug, which concept is important to remember? a. The lipid formulations may be given in oral form. b. The doses are much lower than the doses of the older drugs. c. The lipid formulations are associated with fewer adverse effects than the older drugs. d. There is no difference in cost between the newer and older forms.
ANS: C Newer lipid formulations of amphotericin B have been developed in an attempt to decrease the incidence of its adverse effects and increase its efficacy. However, the lipid formulations are more costly.
A patient who has been taking isoniazid (INH) has a new prescription for pyridoxine. She is wondering why she needs this medication. The nurse explains that pyridoxine is often given concurrently with the isoniazid to prevent which condition? a. Hair loss b. Renal failure c. Peripheral neuropathy d. Heart failure
ANS: C Pyridoxine (vitamin B6) may be beneficial for isoniazid-induced peripheral neuropathy. The other options are incorrect.
6. The nurse is reviewing the medication administration record of a patient who is taking isoniazid (INH). Which drug or drug class has a significant drug interaction with isoniazid? a. Pyridoxine (vitamin B6) b. Penicillins c. Phenytoin (Dilantin) d. Benzodiazepines
ANS: C Taking INH with phenytoin will cause decreased metabolism of the phenytoin, leading to increased drug effects. Pyridoxine is often given with isoniazid to prevent peripheral neuropathy. The other options are incorrect.
The nurse is counseling a woman who will be starting rifampin (Rifadin) as part of antitubercular therapy. The patient is currently taking oral contraceptives. Which statement is true regarding rifampin therapy for this patient? e. Women have a high risk for thrombophlebitis while on this drug. f. A higher dose of rifampin will be necessary because of the contraceptive. g. Oral contraceptives are less effective while the patient is taking rifampin. h. The incidence of adverse effects is greater if the two drugs are taken together.
ANS: C Women taking oral contraceptives and rifampin need to be counseled about other forms of birth control because of the impaired effectiveness of the oral contraceptives during concurrent use of rifampin.
The nurse is teaching a patient who is starting antitubercular therapy with rifampin. Which adverse effects would the nurse expect to see? a. Headache and neck pain b. Gynecomastia c. Reddish brown urine d. Numbness or tingling of extremities
Answer: C
5. A patient has been taking antitubercular therapy for 3 months. The nurse will assess for what findings that indicate a therapeutic response to the drug therapy? a. The chronic cough is gone. b. There are two consecutive negative purified protein derivative (PPD) results over 2 months. c. There is increased tolerance to the medication therapy, and there are fewer reports of adverse effects. d. There is a decrease in symptoms of tuberculosis along with improved chest x-rays and sputum cultures.
ANS: D A therapeutic response to antitubercular therapy is manifested by a decrease in the symptoms of tuberculosis, such as cough and fever, and by weight gain. The results of laboratory studies (culture and sensitivity tests) and the chest radiographic findings will be used to confirm the clinical findings of resolution of the infection.
The nurse is preparing an infusion of amphotericin B for a patient who has a severe fungal infection. Which intervention is appropriate regarding the potential adverse effects of amphotericin B? A. Discontinuing the infusion immediately if fever, chills, or nausea occur B. Gradually increasing the infusion rate until the expected adverse effects occur C. If fever, chills, or nausea occur during the infusion, administering medications to treat the symptoms D. Before beginning the infusion, administering an antipyretic and an antiemetic drug
ANS: D Almost all patients given the drug intravenously experience fever, chills, hypotension, tachycardia, malaise, muscle and joint pain, anorexia, nausea and vomiting, and headache. For this reason, pretreatment with an antipyretic (acetaminophen), antihistamines, and antiemetics may be conducted to decrease the severity of the infusion-related reaction. The other options are incorrect.
5. The nurse is reviewing instructions for vaginal antifungal drugs with a patient. Which statement by the nurse is an appropriate instruction regarding these drugs? a. "The medication can be stopped when your symptoms are relieved. " b. "Discontinue this medication if menstruation begins." c. "Daily douching is part of the treatment for vaginal fungal infections." d. "Abstain from sexual intercourse until the treatment has been completed and the infection has resolved.'
ANS: D Female patients taking antifungal medications for the treatment of vaginal infections need to abstain from sexual intercourse until the treatment has been completed and the infection has resolved. The medication needs to be taken for as long as prescribed. Instruct patients to continue to take the medication even if they are actively menstruating. Douching is not an appropriate intervention.
1. The nurse is discussing adverse effects of antitubercular drugs with a patient who has active tuberculosis. Which potential adverse effect of antitubercular drug therapy should the patient report to the prescriber? a. Gastrointestinal upset b. Headache and nervousness c. Reddish-orange urine and stool d. Numbness and tingling of extremities
ANS: D Patients on antitubercular therapy should report experiencing numbness and tingling of extremities, which may indicate peripheral neuropathy. Some drugs may color the urine, stool, and other body secretions reddish-orange, but this is not an effect that needs to be reported. Patients need to be informed of this expected effect. The other options are incorrect.
8. A patient is experiencing the exoerythrocytic phase of malaria. The nurse expects which drug to be used for this patient? a. Quinine b. Chloroquine (Aralen) c. Mefloquine (Lariam) d. Primaquine
ANS: D Primaquine is one of the few antimalarial drugs that can destroy the malarial parasites while they are in their exoerythrocytic phase. The other drugs are effective during the erythrocytic, or blood, phase.
A woman is traveling to a country where she will be at high risk for malarial infection. What will the nurse teach her regarding prophylactic therapy with hydroxychloroquine (Plaquenil)? a. Hydroxychloroquine is better absorbed and has fewer adverse effects if taken on an empty stomach. b. The drug is started 3 weeks before exposure but can be discontinued once she leaves the area. c. The medication is taken only when she observes mosquito bites because it can have toxic effects if taken unnecessarily. d. The drug is usually started 1 to 2 weeks before traveling to endemic areas and is continued for 4 weeks after leaving the area
ANS: D Prophylaxis of malaria with hydroxychloroquine is usually started I to 2 weeks before exposure and continued for 4 weeks after the person has left the area. The medication should be taken with food to decrease gastrointestinal upset.
2. The nurse will assess the patient for which potential contraindication to antitubercular therapy? a. Glaucoma b. Anemia c. Heart failure d. Hepatic impairment
ANS: D Results of liver function studies (e.g., bilirubin level, liver enzyme levels) need to be assessed because isoniazid and rifampin may cause hepatic impairment; severe liver dysfunction is a contraindication to these drugs. In addition, the patient's history of alcohol use needs to be assessed.
A patient newly diagnosed with tuberculosis (TB) has been taking antitubercular drugs for 1 week calls the clinic and is very upset. He says, "My urine is dark orange! What's wrong with me?" Which response by the nurse is correct? a. "You will need to stop the medication, and it will go away." b. "It's possible that the TB is worse. Please come in to the clinic to be checked." c. "This is not what we usually see with these drugs. Please come in to the clinic to be checked.' d. "This is an expected side effect of the medicine. Let's review what to expect."
ANS: D Rifampin, one of the first-line drugs for TB, causes a red-orange-brown discoloration of urine, tears, sweat, and sputum. Patients need to be warned about this side effect. The other options are incorrect.
3. A patient who is being treated for malaria has started therapy with quinine and tetracycline. He asks the nurse why he is on an antibiotic when malaria is caused by a parasite. Which response by the nurse is correct? a. "The tetracycline prevents reinfection by the malarial parasite." b. "The antibiotic is combined with quinine to reduce the side effects of the quinine." c. "An antibacterial drug prevents the occurrence of superinfection during antimalarial therapy." d. "The two drugs are more effective against malaria when given together."
ANS: D The combination of quinine and tetracycline takes advantage of their synergistic protozoacidal effects. The other responses are incorrect.
While monitoring a patient who is receiving intravenous amphotericin B, the nurse expects to see which adverse effect(s)? a. Hypertension b. Bradycardia c. Fever and chills d. Diarrhea and stomach cramps
Answer: C
When administering antifungal drug therapy, the nurse knows that an issue that contributes to many of the drug interactions with antifungals is the patient's: a. history of cardiac disease. b. history of gallbladder surgery. c. ethnic background. d. cytochrome P-450 enzyme system.
Answer: D
What is the priority assessment data for a client prescribed antibiotic therapy? -Immunizations -Cardiac dysrhythmias -Allergies -History of seizures
Allergies Antibiotic allergy is one of the most common drug allergies. An allergic reaction that occurs after administration of an antibiotic has the potential to cause severe anaphylaxis and possible death.
The nurse is obtaining a medication history from a client diagnosed with genital herpes. Which drug would the nurse expect this client to be prescribed? -Acyclovir (Zovirax) -Ribavirin (Virazole) -Amantadine (Symmetrel) -Zidovudine (Retrovir)
Acyclovir (Zovirax) Acyclovir is the drug of choice to treat herpes simplex infections, which includes the virus type 2 that causes genital herpes. Ribavirin is effective against respiratory syncytial virus, zidovudine against human immunodeficiency virus (HIV), and amantadine against Haemophilus influenzae type A.
The nurse will question the use of a fluoroquinolone antibiotic in a client already prescribed which medication? -Furosemide (Lasix) -Omeprazole (Prilosec) -Amiodarone (Cordarone) -Metoprolol (Lopressor)
Amiodarone (Cordarone) Dangerous cardiac dysrhythmias are more likely to occur when quinolones are taken by clients receiving class Ia and class III antidysrhythmic drugs such as disopyramide and amiodarone. For this reason, such drug combinations should be avoided.
The nurse needs to know that major adverse effects are MOST common by which drug? Griseofulvin (Fulvicin P/G) Ketoconazole (Nizoral) Amphotericin B (Amphocin) Fluconazole (Diflucan)
Amphotericin B (Amphocin) The major adverse effects caused by antifungal drugs are encountered most commonly in conjunction with amphotericin B treatment. Drug interactions and hepatotoxicity are the primary concerns in clients receiving other antifungal drugs, but the IV administration of amphotericin B is associated with a multitude of adverse effects.
When teaching a patient who is taking nystatin lozenges for oral candidiasis, which instruction by the nurse is correct? a. "Chew the lozenge carefully before swallowing." b. "Dissolve the lozenge slowly and completely in your mouth." c. "Dissolve the lozenge until it is half the original size, and then swallow it." d. "These lozenges need to be swallowed whole with a glass of water."
Answer: B
The nurse is reviewing the medication history of a patient who is taking hydroxychloroquine. However, the patient's chart does not reveal a history of malaria or travel out of the country. The patient is most likely taking this medication for: a. Plasmodium. b. thyroid disorders. c. roundworms. d. rheumatoid arthritis.
Answer: D
The nurse notes in a patient's medication history that the patient is taking terbinafine (Lamisil). Based on this finding, the nurse interprets that the patient has which disorder? a. Vaginal candidiasis b. Cryptococcal meningitis c. Invasive aspergillosis d. Onychomycosis
Answer: D
. Praziquantel (Biltricide) is prescribed for a patient with a tapeworm infection. The nurse prepares to administer the medication via which route? a. Rectal b. Oral c. Intravenous d. Inhalation
Answer: B
Which teaching point would be appropriate to include when the nurse is informing a patient about the adverse effects of antimalarials? a. The skin may turn blotchy while these medications are taken. b. These medications may cause anorexia and abdominal distress. c. These medications may cause increased urinary output. d. The patient may experience periods of diaphoresis and chills.
Answer: B
During an infusion of amphotericin B, the nurse knows that which administration technique may be used to minimize infusion-related adverse effects? a. Forcing of fluids during the infusion b. Infusing the medication quickly c. Infusing the medication over a longer period of time d. Stopping the infusion for 2 hours after half of the bag has infused, and then resuming 1 hour later
Answer: C
During antitubercular therapy with isoniazid, a patient received another prescription for pyridoxine. Which statement by the nurse best explains the rationale for this second medication? a. "This vitamin will help to improve your energy levels." b. "This vitamin helps to prevent neurologic adverse effects." c. "This vitamin works to protect your heart from toxic effects." d. "This vitamin helps to reduce gastrointestinal adverse effects."
Answer: B
A client, who weighs 45.4 kg, is prescribed pyrantel (Pin-X) for a roundworm infection. The dosage is 11 mg/kg in one single dose to a maximum of 1 g. What is the appropriate dosage for this client?
Answer: 499 mg (45.4 kg × 11 mg/kg = 499.4 mg, which rounds to 499 mg)
The order reads, "Give nystatin (Mycostatin) suspension, 500,000 units by mouth (swish and swallow) 4 times a day for 1 week." The medication is available in a suspension of 100,000 units per mL. How many milliliters will the nurse give per dose?
Answer: 5 mL
A patient with Pneumocystis jirovecii pneumonia will be receiving pentamidine (Pentam 300) as an intravenous piggyback (IVPB) dose. The medication has been added to a 100-mL bag of D5W for the infusion, and it needs to infuse over 120 minutes. The nurse will set the infusion pump to infuse at what rate for this IVPB medication?
Answer: 50 mL/hr. First, convert 120 minutes to hours because the pump will infuse at milliliters per hour rate. 120 minutes x (1 hour/60minutes) = 2 hours. 100 mL / 2 hours = 50 mL/hr.
A 5-year-old patient has been diagnosed with malaria after returning from an overseas trip. The patient is to receive one dose of mefloquine (Lariam), 25 mg/kg PO. The child weighs 44 lb. How much mefloquine will this child receive?
Answer: 500 mg
The order for isoniazid (INH) reads: "Give 5 mg/kg PO daily." The patient weighs 275 pounds. What is the amount per dose? Is this a safe dose?
Answer: 625 mg/dose; no, maximum dose is 300 mg
The nurse is teaching a client who is preparing to travel to a malarious country about the prophylactic medication chloroquine (Aralen). The nurse would instruct the client to take this drug for how long after leaving the affected area? 12 weeks 8 weeks 4 weeks 2 weeks
Answer: 8 weeks Treatment for malaria prophylaxis is usually started 2 weeks before travel and continues for 8 weeks after travel is completed.
Bedaquiline (Sirturo) is prescribed for a patient, and the nurse is providing instructions to the patient about the medication. Which statement by the patient indicates a correct understanding of the instructions? a. "I will take this with food." b. "I need to take this 1 hour before breakfast." c. "I can stop this drug if the side effects bother me." d. "It's okay to have a glass of wine while taking this drug."
Answer: A
Before administering antiprotozoal drugs, the nurse will review which baseline assessment? a. Complete blood count b. Serum magnesium level c. Creatinine clearance d. Arterial blood gas concentrations
Answer: A
The nurse is counseling a woman who is beginning antitubercular therapy with rifampin. The patient also takes an oral contraceptive. Which statement by the nurse is most accurate regarding potential drug interactions? a. "You will need to switch to another form of birth control while you are taking the rifampin." b. "Your birth control pills will remain effective while you are taking the rifampin." c. "You will need to take a stronger dose of birth control pills while you are on the rifampin." d. "You will need to abstain from sexual intercourse while on the rifampin to avoid pregnancy."
Answer: A
The nurse knows that antimalarial drugs are used to treat patients with infections caused by which microorganism? a. Plasmodium spp. b. Candida albicans c. Pneumocystis jirovecii d. Mycobacterium
Answer: A
What information should the nurse provide to a client prescribed rifampin (Rifadin)? Peripheral neuropathy is an expected side effect, and the patient should report any numbness or tingling of the extremities. Oral contraception is the preferred method of birth control when using rifampin. A nonharmful adverse effect of this medication is red-orange discoloration of urine, sweat, tears, skin, salvia, and feces. The patient will only need to take this medication for the prescribed 14-day period.
Answer: A nonharmful adverse effect of this medication is red-orange discoloration of urine, sweat, tears, skin, salvia, and feces. Red-orange-brown discoloration of the skin, sweat, tears, urine, feces, sputum, saliva, and tongue as an adverse effect of the drug, but it is not harmful. Rifampin does not cause peripheral neuropathies (isoniazid does), but it does interfere with the effectiveness of oral contraceptives. All antitubercular drugs need to be taken long term to eradicate the slow-growing mycobacterium lying deep within the tissues
When giving metronidazole, the nurse implements appropriate administration techniques, including which of these? (Select all that apply.) a. Giving oral forms with food b. Giving oral forms on an empty stomach with a full glass of water c. Infusing intravenous doses over 30 to 60 minutes d. Administering intravenous doses by bolus over 5 minutes e. Obtaining ordered specimens before starting the medication
Answer: A, C, E
When counseling a patient who has been newly diagnosed with TB, the nurse will make sure that the patient realizes that he or she is contagious? a. during all phases of the illness. b. any time up to 18 months after therapy begins. c. during the postictal phase of TB. d. during the initial period of the illness and its diagnosis.
Answer: D
While monitoring a patient, the nurse knows that a therapeutic response to antitubercular drugs would be: a. The patient states that he or she is feeling much better. b. The patient's laboratory test results show a lower white blood cell count. c. The patient reports a decrease in cough and night sweats. d. There is a decrease in symptoms, along with improved chest x-ray and sputum culture results.
Answer: D
When monitoring a patient who is receiving caspofungin, the nurse will look for which serious adverse effects? (Select all that apply.) a. Blood dyscrasias b. Hypotension c. Pulmonary infiltrates d. Tinnitus e. Hepatotoxicity
Answer: a, b, e,
. The nurse is monitoring for liver toxicity in a patient who has been receiving long-term isoniazid therapy. Manifestations of liver toxicity include: (Select all that apply.) a. Orange discoloration of sweat and tears b. Darkened urine c. Dizziness d. Fatigue e. Visual disturbances f. Jaundice
Answer: b, d, f,
The acetic acid derivative indomethacin (Indocin) has which properties? (Select all that apply.) Antinausea Antipyretic Anticonvulsant Antirheumatic Antiinflammatory
Antipyretic Antirheumatic Antiinflammatory NSAIDs are known for their antiinflammatory effects. Indomethacin, in addition, is also used for its antirheumatic and antipyretic properties. NSAIDs are often known to have nausea as a common adverse effect. Indomethacin is not used as an anticonvulsant.
Medications used to treat HIV infections are more specifically classified as what type of drugs? -Antiparasitic -Antiviral -Antifungal -Antiretroviral
Antiretroviral HIV is a member of the retrovirus family; therefore, drugs used to treat this virus are classified as antiretroviral drugs. Although antiretroviral drugs also fall under the broader category of antiviral drugs in general, their mechanisms of action are unique to the acquired immune deficiency syndrome virus. So, they are more commonly referred to by their subclassification as antiretroviral drugs.
When teaching a patient receiving paclitaxel (Taxol), the nurse needs to prepare the patient for which adverse effect?
Arthralgias
When performing discharge teaching for a client prescribed oral linezolid (Zyvox) to treat methicillin-resistant Staphylococcus aureus (MRSA), the nurse should emphasize which important information? -Stop the drug as soon as you feel better. -Take the drug with an antacid to avoid gastrointestinal (GI) upset. -Report any occurrence of constipation or facial flushing. -Avoid ingestion of foods containing tyramine.
Avoid ingestion of foods containing tyramine. Hypertension may occur in clients consuming tyramine-containing foods such as aged cheese or wine, soy sauce, smoked meats or fish, and sauerkraut while taking linezolid. Linezolid causes diarrhea, not constipation, and should be taken with food to decrease GI distress. An antacid would interfere with absorption.
A client is making an appointment for allergy testing. The nurse instructs the client not take what class of medications at least 4 days before allergy testing? A. Antitussives B. Antihistamines C. Decongestants D. Bronchodilators
B
A patient complains of worsening nasal congestion despite the use of oxymetazoline (Afrin) nasal spray every 2 to 4 hours for the past 5 days. The nurse's response is based on knowledge that: A. oxymetazoline is not an effective nasal decongestant. B. sustained use of nasal decongestants over several days may result in rebound congestion. C. oxymetazoline should be administered in an hourly regimen for severe congestion. D. the patient is probably displaying an idiosyncratic reaction to oxymetazoline
B
The nurse is discussing use of antitussive medications with a client. What common adverse effect does the nurse include in the client teaching? A. Tremors and palpitations B. Drowsiness and dizziness C. Diarrhea and abdominal cramping D. Flushing and decreased heart rate
B
The nurse is providing care to a client prescribed a nonselective adrenergic agonist bronchodilator. Which condition documented in the client's medical history would alert the nurse to question this prescription? A. Thrombocytopenia B. Coronary artery disease C. Mycobacterium tuberculosis D. Chronic obstructive pulmonary disease
B
The nurse receives laboratory values for a client with a theophylline level of 14 mcg/mL. How does the nurse interpret this theophylline level? A. Toxic B. Therapeutic C. Subtherapeutic D. Life threatening
B
Which statement by the nurse should be included when teaching a client about the proper use of metered-dose inhalers? A. "After you inhale the medication once, repeat until you obtain relief." B. "Wait 1 to 2 minutes before you take a second puff of the same drug." C. "Make sure that you puff out air several times after you inhale the medication." D. "Hold the inhaler in your mouth, take a deep breath, and then compress the inhaler."
B
Before administration of an immunosuppressant drug, the nurse should perform which actions? (Select all that apply.) A. Measure abdominal girth. B. Check liver enzyme tests. C. Assess level of consciousness. D. Assess blood pressure and heart rate. E. Check blood urea nitrogen and creatinine levels.
B, C, D, E Serious adverse effects to immunosuppressant drugs include neurotoxicity, nephrotoxicity, hepatotoxicity, and hypertension.
Before administering an LTRA medication, the nurse would assess the client for allergies to which substance? (Select all that apply.) A. Latex B. Lactose C. Cellulose D. Povidone E. Chlorhexidine
B,C,D
The nurse is discussing with the client the management of symptoms of an upper respiratory tract infection. Which classes of medications are often used in treating the symptoms of upper respiratory tract infections? (Select all that apply.) A. Antibiotics B. Antitussives C. Expectorants D. Antihistamines E. Nasal decongestants
B,C,D,E
The nurse is discussing use of antihistamines for allergic rhinitis. Which medications would be included in the list of H1 antagonists used in the treatment of allergic rhinitis? (Select all that apply.) A. Nizatidine (Axid) B. Cetirizine (Zyrtec) C. Ranitidine (Zantac) D. Loratadine (Claritin) E. Fexofenadine (Allegra)
B,D,E
The current immunization for tetanus and diphtheria toxoids and pertussis, Tdap, is administered to people in which age range? A. Younger than 6 years of age B. 11 years of age and older C. Any age range D. In the first 2 years of life
B. 11 years of age and older Currently, DTaP is the preferred preparation for primary and booster immunization against these diseases in children from 6 weeks to 6 years of age unless use of the pertussis component is contraindicated. Tdap is the recommended vaccine for adolescents and adults, those over the age of 11 years.
Upon which patient finding would the nurse hold the ordered dose of filgrastim (Neupogen) and notify the provider? A. Fever of 99.5° F B. Absolute neutrophil count (ANC) count of 12,000 cells/mm3 C. White blood cell (WBC) count of 4.5/mm3 D. Blood pressure of 142/88 mm Hg
B. Absolute neutrophil count (ANC) count of 12,000 cells/mm3 Filgrastim (Neupogen) is usually discontinued when a patient's ANC rises above 10,000 cells/mm3. However, some prescribers will stop it when the ANC is between 1000 and 2000 cells/mm3.
What is the priority nursing assessment to monitor when administering vaccinations? A. Myalgias B. Anaphylaxis C. Symptoms of infection D. Pain at the injection site
B. Anaphylaxis Anaphylaxis is a potential life-threatening adverse reaction to vaccines. Pain and myalgias can occur but are not life threatening.
Which are mechanisms of action of biologic response-modifying drugs? (Select all that apply.) A. Interruption of the cell lifecycle at the genetic level to interfere with growth of the cancer cell B. Direct toxic effect on tumor cells, causing them to rupture C. Adverse modification of a tumor's biology, making it harder for the tumor cells to survive and reproduce D. Enhancement or restoration of the host's immune system defenses against a tumor
B. Direct toxic effect on tumor cells, causing them to rupture C. Adverse modification of a tumor's biology, making it harder for the tumor cells to survive and reproduce D. Enhancement or restoration of the host's immune system defenses against a tumor In terms of their activity against cancer cells, biologic response-modifying drugs work by one of three mechanisms: (1) enhancement or restoration of the host's immune system defenses against the tumor; (2) direct toxic effect on the tumor cells, which causes them to lyse, or rupture; or (3) adverse modification of the tumor's biology, which makes it harder for the tumor cells to survive and reproduce. This class does not interrupt any genetic level of cell replication.
Which vaccination is marketed and recommended in the prevention of a virus that is known to cause cervical cancer? A. Herpes zoster vaccine (Zostavax) B. Papillomavirus vaccine (Gardasil) C. Pneumococcal vaccine (Prevnar 13) D. Hepatitis B virus vaccine (Recombivax HB)
B. Papillomavirus Vaccine Human papillomavirus virus (HPV) is a common cause of genital warts and cervical cancer. The HPV vaccine (Gardasil, Cervarix) is the first and only vaccine known to prevent cancer.
What teaching would the nurse provide to a client receiving tetanus toxoid? A. "You will have lifetime immunity from this injection." B. "Soreness at the injection site is a common reaction." C. "This medication must be repeated weekly for 4 weeks." D. "Increase fluid and fiber in your diet to prevent constipation."
B. Soreness at the injection site is a common reaction Soreness at the injection site is a common adverse effect of tetanus toxoid.
An allergy to which substance is a contraindication to the administration of an immunizing drug? A. Soy B. Egg C. Corn D. Wheat
B.Egg Contraindications to the administration of immunizing drugs include allergy to the immunization itself or allergy to any of its components, such as eggs or yeast.
Explain use of BCG.
BCG, or bacille Calmette-Guerin, is a vaccine for tuberculosis (TB) disease. BCG is used in many countries with a high prevalence of TB to prevent childhood tuberculous meningitis and miliary disease. It will not prevent Tb but will help with the severity of the case. It will also cause a false positive with PPD, will need a chest x-ray.
When teaching a client about potential adverse effects of NSAID therapy, the nurse will teach the client to immediately notify the health care provider of which effect? Diarrhea Mild indigestion Black tarry stools Nonproductive cough
Black tarry stools A major adverse effect of NSAID therapy is gastrointestinal (GI) distress with potential GI bleeding. Black or tarry stools are indicative of a GI bleed.
What are important for the nurse to monitor in a client receiving an antifungal medication? (Select all that apply.) • Blood urea nitrogen • Daily weights • Creatinine • Mental status • Intake and output
Blood urea nitrogen Daily weights Creatinine Intake and output Nursing interventions appropriate to clients receiving antifungal drugs vary depending on the particular drug. However, it is important for the nurse to monitor all clients for indications of possible medication-induced renal damage so that prompt interventions can occur to prevent further dysfunction. Monitoring intake and output amounts, daily weights, and renal function tests will help prevent such damage.
For a client receiving an intravenous (IV) infusion of gentamicin (Garamycin), the nurse would monitor which laboratory values? -Serum glutamic-oxaloacetic transaminase and alanine transaminase -Prothrombin time and partial thromboplastin time -Hematocrit and hemoglobin -Blood urea nitrogen (BUN) and creatinine
Blood urea nitrogen (BUN) and creatinine Gentamicin has a high potential for nephrotoxicity. Nephrotoxicity typically occurs in 5% to 25% of clients. Thus, the client's renal function test results for BUN and creatinine must be monitored closely throughout therapy.
Explain how to evaluate effectiveness of treatment regime.
By the decrease of symptoms, negative blood smears, and negative x-rays.
Client teaching regarding the use of leukotriene receptor antagonists (LTRAs) drugs such as zafirlukast (Accolate) would include which statement by the nurse? A. "It will take about 3 or 4 weeks before you notice a therapeutic effect." B. "Take the medication when you are short of breath and begin wheezing." C. "This medication works by preventing the inflammation that causes your asthma attack." D. "Increase fiber and fluid in your diet to prevent the common adverse effect of constipation."
C
The nurse performs discharge teaching with a client who is prescribed the anticholinergic inhaler ipratropium bromide (Atrovent). Which statement by the client indicates to the nurse that teaching has been successful? A. "I will not drink grapefruit juice while taking this drug." B. "I may gain weight as a result of taking this medication." C. "This inhaler is not to be used alone to treat an acute asthma attack." D. "Nausea and vomiting are common adverse effects of this medication."
C
The nurse would question a prescription for pseudoephedrine (Sudafed) in a client with a history of which condition? A. Pneumonia B. Osteoporosis C. Hypertension D. Peptic ulcer disease
C
What body system will the nurse assess for known common adverse effects of traditional antihistamines? A. Respiratory B. Cardiovascular C. Central nervous D. Gastrointestinal
C
What is the PRIORITY intervention for the nurse to complete before administration of intravenous (IV) amphotericin B? a. Assess for nausea and vomiting. b. Monitor for cardiac dysrhythmias. c. Check for premedication prescriptions. d. Monitor IV site for signs of phlebitis.
C
Which instruction should the nurse include when teaching a client who is prescribed an expectorant? A. Take the medication once a day at bedtime. B. Restrict fluids to decrease mucus production. C. Increase fluid intake to decrease viscosity of secretions. D. Take a drug with oral codeine when cough worsens.
C
Which statement by the client demonstrates an understanding about beclomethasone diproprionate (Beconase) mechanism of action? A. "I only need to take this medication when my symptoms get bad." B. "I will need to taper off the medication to prevent acute adrenal crisis." C. "This medication will help prevent the inflammatory response of my allergies." D. "I will monitor my blood sugar because I may develop drug-induced diabetes."
C
3. When monitoring patients on antitubercular drug therapy, the nurse knows that which drug may cause a decrease in visual acuity? a. Rifampin (Rifadin) b. Isoniazid (INH) c. Ethambutol (Myambutol) d. Streptomycin
C Ethambutol may cause a decrease in visual acuity or even blindness resulting from retrobulbar neuritis. The other options are incorrect.
To assess for the dose-limiting toxicity of ganciclovir (Cytovene), the nurse will monitor which laboratory test result? -Creatine phosphokinase -Liver function tests -Blood urea nitrogen -Complete blood count (CBC)
Complete blood count (CBC) Bone marrow suppression is a dose-limiting toxicity of ganciclovir; therefore, the CBC should be monitored.
The nurse would teach a client prescribed cyclosporine (Sandimmune) to avoid which substance? A. Sunscreen B. Chocolate milk C. Grapefruit juice D. Acetaminophen
C. Clients should avoid consuming grapefruit or grapefruit juice because they will increase the blood concentrations of cyclosporine. Sunscreen should be used to avoid photosensitivity, and the medication should be taken with food or chocolate milk to prevent gastrointestinal upset.
Which client statement indicates to the nurse that the client understands the discharge teaching for ethambutol (Myambutol)? A. "Constipation will be a problem, so I will increase the fiber in my diet." B. "Dizziness and drowsiness are common adverse effects with this drug." C. "I will need to have my vision checked periodically while I am taking this drug." D. "This medication may cause my bodily secretions to turn red-orange-brown."
C. "I will need to have my vision checked periodically while I am taking this drug."
What information should the nurse provide to a client prescribed rifampin (Rifadin)? A. Oral contraception is the preferred method of birth control when using rifampin. B. The patient will only need to take this medication for the prescribed 14-day period. C. A nonharmful adverse effect of this medication is red-orange discoloration of urine, sweat, tears, skin, salvia, and feces. D. Peripheral neuropathy is an expected side effect, and the patient should report any numbness or tingling of the extremities.
C. A nonharmful adverse effect of this medication is red-orange discoloration of urine, sweat, tears, skin, salvia, and feces.
Patients receiving filgrastim (Neupogen) should be taught to expect which side effect? A. Hypotension B. Constipation C. Bone pain D. Insomnia
C. Bone Pain Filgrastim increases the production of white blood cells in the bone marrow, triggering the common side effect of bone pain.
A client who is allergic to penicillin is at increased risk for an allergy to which drug? -Erythromycin (E-mycin) -Gentamicin (Garamycin) -Cefazolin sodium (Ancef) -Demeclocycline (Declomycin)
Cefazolin sodium (Ancef) Clients who are allergic to penicillins have an increased risk of allergy to other beta-lactam antibiotics. The incidence of cross-reactivity between cephalosporins and penicillins is reported to be between 1% and 4%.
What is the MOST important action for the nurse to complete before administration of intravenous (IV) amphotericin B? Monitor for cardiac dysrhythmias. Assess for nausea and vomiting. Monitor IV site for signs of phlebitis. Check for premedication prescriptions.
Check for premedication prescriptions. Almost all clients given IV amphotericin B experience fever, chills, hypotension, tachycardia, malaise, muscle and joint pain, anorexia, nausea and vomiting, and headache. Pretreatment with an antipyretic, antihistamine, and antiemetic can minimize or prevent these adverse reactions. The other choices are appropriate nursing actions after the IV infusion has begun.
A nurse is caring for a client diagnosed with malaria. What drug would the nurse expect to be prescribed? Pentamidine (Pentam) Penicillin Chloroquine (Aralen) Metronidazole (Flagyl)
Chloroquine (Aralen) Chloroquine is a standard drug used for the treatment of malaria in an acute stage.
In an effort to prevent superinfections of the GI tract such as Clostridium difficile, the nurse will instruct clients to eat which foods? -Cultured dairy products such as yogurt -Low-fat meats such as chicken and pork -Multigrain wheat bread -Raw fruits and vegetables
Cultured dairy products such as yogurt The natural flora in the GI tract may be killed off by antibiotics, leaving other bacteria such as C. difficile to overgrow. This process may be prevented through consumption of probiotics (e.g., yogurt, buttermilk, kefir).
A nurse is providing education to a client taking two different bronchodilator medications. The nurse identifies which characteristic as the advantage of salmeterol (Serevent) over other beta2 agonists such as albuterol (Proventil)? A. Quicker peak action B. Shorter onset of action C. Extended time of action D. Longer duration of action
D
The nurse is providing education to a client with a history of chronic nasal congestion secondary to allergic rhinitis. Which class of medications should the nurse anticipate the provider would recommend for the client to use on a long-term basis? A. Antitussives B. Expectorants C. Antihistamines D. Intranasal steroids
D
The nurse providing care to patient with a fungal infection is aware that which drugs is known for the most number of possible adverse effects? a. Ketoconazole b. Griseofulvin c. Fluconazole d. Amphotericin B
D
When providing general education on use of over-the-counter (OTC) medications for allergies, which instruction should the nurse to include? A. Discontinue use 4 days before allergy testing. B. It may cause dry mouth and difficulty urinating. C. The medication treats the signs and symptoms but is not a cure. D. Do not use in children younger than 2 years of age unless prescribed
D
Which antifungal drug can be given intravenously to treat severe yeast infections as well can be prescribed as a one-time oral dose to treat vaginal yeast infections? a. Voriconazole b. Caspofungin c. Nystatin d. Fluconazole
D
Which herbal product, when taken with theophylline, can decrease theophylline's serum drug levels? A. Garlic B. Echinacea C. Peppermint oil D. St. John's wort
D
Before administering an intravenous (IV) injection of basiliximab (Simulect), the nurse should anticipate giving which medication? A. Meperidine (Demerol) B. Acetaminophen (Tylenol) C. Diphenhydramine (Benadryl) D. Methylprednisolone (Solu-Medrol)
D. IV methylprednisolone is administered before basiliximab injection to prevent or minimize acute allergic-type reactions associated with this medication.
The drug mycophenolate (CellCept) has a black box warning because of which potential adverse effect? A. Hypertension B. Suicidal ideations C. Abnormal heart rhythms D. Congenital malformations
D. Mycophenolate (CellCept) is an antimetabolite and suppresses T cell proliferation. It is indicated for the prevention of organ rejection as well as the treatment of organ rejection. Mycophenolate has a black box warning from the U.S. Food and Drug Administration stating that it is associated with an increased risk of congenital malformations and spontaneous abortions when used during pregnancy.
The nurse would anticipate administering which medication to a client demonstrating acute organ rejection? A. Azathioprine (Imuran) B. Basiliximab (Simulect) C. Sirolimus (Rapamune) D. Muromonab-CD3 (Orthoclone OKT3)
D. Only muromonab-CD3 (Orthoclone OKT3) is used to treat acute organ rejection. The other immunosuppressants are used to prevent organ rejection.
Before discharge, the nurse is reviewing a client's prescribed medication regimen for tuberculosis (TB). The client asks the nurse why pyridoxine (vitamin B6) has been prescribed while continuing to take isoniazid (Nydrazid) to treat TB. What is the nurse's best response? A. "Multidrug therapy is necessary to prevent the occurrence of resistant bacteria." B. "You really should not be on that drug. I will check with the health care provider." C. "Pyridoxine is another antitubercular drug that will work synergistically with the isoniazid." D. "Pyridoxine will help prevent numbness, and tingling that can occur secondary to the isoniazid."
D. "Pyridoxine will help prevent numbness, and tingling that can occur secondary to the isoniazid."
What instruction should the nurse include for a client prescribed rifampin (Rifadin) and isoniazid (Nydrazid) prophylactically secondary to TB exposure? A. Advise that these drugs will only need to be taken for 7 to 10 days. B. Remind that sunscreen is not needed during outdoor activities. C. Explain that isoniazid may decrease blood serum glucose in susceptible people. D. Emphasize that oral contraceptives become ineffective when given with rifampin.
D. Emphasize that oral contraceptives become ineffective when given with rifampin.
Which vaccination was developed to prevent bacterial meningitis caused by Haemophilus influenzae? A. Preener B. Gardasil C. Hepatitis B vaccine D. Hib conjugate vaccine
D. Hib conjugate vaccine H. influenzae type b (Hib) (HibTITER, ActHIB, Liquid PedvaxHIB) vaccine is a noninfectious, bacteria-derived vaccine. Before this vaccine was developed, infections caused by Hib were the leading cause of bacterial meningitis in children 3 months to 5 years of age.
Administration of which substance provides passive immunity? A. Vaccines B. Toxoids C. Antitoxins D. Immunoglobulins
D. Immunoglobulins Vaccines, antitoxins, and toxoids provide active immunity by stimulating the humoral immune system. Immunoglobulins provide passive immunity by giving the patient substances to fight specific antigens.
When assessing for adverse effects to Rifamate (combination isoniazid and rifampin), the nurse would monitor which laboratory values? (Select all that apply.) A. Cholesterol B. Uric acid levels C. Sputum cultures D. Liver function tests E. Complete blood cell count
D. Liver function tests E. Complete blood cell count
The nurse anticipates a prescription for vitamin supplementation for a client who is receiving isoniazid (Nydrazid) therapy. What vitamin supplement is usually prescribed with isoniazid? A. Folate B. Calcium C. Vitamin E D. Vitamin B6
D. Vitamin B6
The nurse knows colchicine (Colcrys) exerts its therapeutic effect by what action? Increases uric acid metabolism Decreases mobility of leukocytes Increases process of phagocytosis Increases production of lactic acid
Decreases mobility of leukocytes Colchicine works by inhibiting the metabolism and migration of leukocytes into joints affected by gout, thus resulting in decreased inflammation.
When a client is receiving an IV infusion of metronidazole (Flagyl), what adverse effect would the nurse immediately report to the health care provider? Elevated blood pressure Dark colored urine Diminished breath sounds Dizziness or confusion
Dizziness or confusion During use of this drug, metronidazole administered intravenously, report to the health care provider any changes in neurologic status (e.g., dizziness, confusion).
What instruction should the nurse include for a client prescribed rifampin (Rifadin) and isoniazid (Nydrazid) prophylactically secondary to TB exposure? Remind that sunscreen is not needed during outdoor activities. Explain that isoniazid may decrease blood serum glucose in susceptible people. Emphasize that oral contraceptives become ineffective when given with rifampin. Advise that these drugs will only need to be taken for 7 to 10 days.
Emphasize that oral contraceptives become ineffective when given with rifampin.
What instruction should the nurse include for a client prescribed rifampin (Rifadin) and isoniazid (Nydrazid) prophylactically secondary to TB exposure? Remind that sunscreen is not needed during outdoor activities. Explain that isoniazid may decrease blood serum glucose in susceptible people. Emphasize that oral contraceptives become ineffective when given with rifampin Advise that these drugs will only need to be taken for 7 to 10 days.
Emphasize that oral contraceptives become ineffective when given with rifampin. Women taking oral contraceptives who are prescribed rifampin must be switched to another form of birth control because oral contraceptives become ineffective when given with rifampin. These medications must be taken long term because mycobacterium is slow growing. They can cause photosensitivity, necessitating the use of sunscreen. Finally, isoniazid may increase, not decrease, serum glucose levels.
When planning care for a client receiving a sulfonamide antibiotic, it is important for the nurse to perform which intervention? -Take the medication with dairy products such as milk or yogurt. -Advise the client to report any tinnitus to the health care provider. -Avoid direct sun exposure and tanning beds. -Encourage fluid intake of 2000 to 3000 mL/day.
Encourage fluid intake of 2000 to 3000 mL/day. Clients should be encouraged to drink plenty of fluids (2000 to 3000 mL/24 hours) to prevent drug-related crystalluria associated with sulfonamide antibiotics.
Which antifungal drug can be given intravenously to treat severe yeast infections as well as a one-time oral dose to treat vaginal yeast infections? Nystatin (Mycostatin) Caspofungin (Cancidas) Fluconazole (Diflucan) Voriconazole (Vfend)
Fluconazole (Diflucan) Fluconazole is an antifungal drug that does not cause the major adverse effects of amphotericin when given intravenously. It is also very effective against vaginal yeast infections, and a single dose is often sufficient to treat vaginal infections.
The nurse should assess a client for nephrotoxicity and ototoxicity when administering which antimicrobial? -Erythromycin -Clindamycin (Cleocin) -Cefazolin (Ancef) -Gentamicin (Garamycin)
Gentamicin (Garamycin) Aminoglycoside antibiotics, including gentamicin, have a high risk for nephrotoxicity and ototoxicity.
A new vaccination, Zostavax (Zoster Vaccine Live), has been approved to prevent the development of what condition in adults older than the age of 60 years? -Herpes zoster -Influenza A -Herpes simplex -Avian influenza
Herpes zoster Zoster vaccine (Zostavax) is a vaccine for the prevention of herpes zoster. Herpes zoster, also known as shingles, is an extremely painful condition caused by the varicella-zoster virus that also causes chickenpox. The vaccine is approved for clients 60 years of age or older to prevent reactivation of the zoster virus that causes shingles, although clients as young as 50 years may receive it. Zostavax is a one-time vaccine.
Current research has lead to discovery of cancer-causing viruses. Which virus that is linked to cancer can be prevented by vaccination in humans?
Human papillomavirus
The nurse has provided education to a client about fungal skin infection. Further client teaching is necessary when the client includes which condition in the discussion of fungal skin infections? Impetigo Vaginal yeast infection Athlete's foot Thrush
Impetigo Impetigo is a bacterial skin infection and would not be classified as a fungal skin infection. If the client included this in the discussion, further teaching is needed. All other skin infections listed are fungal and would be treated with antifungal medications.
When administering a nonsteroidal antiinflammatory drug and a penicillin drug together, the displacement of the penicillin antibiotic from the protein-binding sites will result in which effect? -Absence of free drug in the blood -Increased free drug in blood -Decreased free drug in blood -No change in free drug in blood
Increased free drug in blood Drugs that are not bound to protein are free and thus active to exert their therapeutic (or toxic, if too much free) effect.
What is the mechanism of action of nonsteroidal antiinflammatory drugs (NSAIDs)? Enhancing pain perception Inhibiting prostaglandin production Increasing blood flow to painful areas Increasing the supply of natural endorphins
Inhibiting prostaglandin production Prostaglandins are produced in response to activation of the arachidonic pathway. NSAIDs work by blocking cyclooxygenase (COX-1 and COX-2), the enzyme responsible for conversion of arachidonic acid into prostaglandins. Decreasing the synthesis of prostaglandins results in decreased pain and inflammation.
The most significant drug interactions with use of antivirals occur when antivirals are administered via which route? -Optically -Rectally -Topically -Intravenously
Intravenously Significant drug interactions that occur with antiviral drugs arise most often when they are administered via systemic routes such as intravenously and orally. Many of these drugs are also applied topically to the eye or body, however, and the incidence of drug interactions associated with these routes of administration is much lower.
Which NSAID would the nurse anticipate administering parenterally for the treatment of acute postoperative pain? Ketorolac (Toradol) Diclofenac (Cataflam) Allopurinol (Zyloprim) Indomethacin (Indocin)
Ketorolac (Toradol) Ketorolac can be administered by injection (intramuscularly or intravenously) and is indicated for the short-term treatment of moderate to severe acute pain.
A client who is prescribed metronidazole (Flagyl) for a gynecologic infection provides the nurse with a list of medications that are routinely taken. Which medication would lead the nurse to question the prescription for Flagyl? -Multivitamin (Thera-Tabs) -Lithium (Eskalith) -Ibuprofen (Advil) -Levothyroxine (Synthroid)
Lithium (Eskalith) Concomitant use of lithium and metronidazole may result in lithium toxicity. Thus, a client who reports taking lithium should alert the nurse to notify the health care provider because of the potential significant interaction.
What is advantage of COX-2 inhibitors over other NSAIDs? Maintain GI mucosa Have a longer duration of action Have a more rapid onset of action Are less likely to cause hepatic toxicity
Maintain GI mucosa By not inhibiting the COX-1 enzyme to maintain an intact gastric mucosal barrier by increasing secretion of mucus, the risks of GI adverse effects are decreased.
Discuss drugs to treat multi drug resistant TB.
Multidrug-resistant TB (MDR TB) is caused by TB bacteria that is resistant to at least isoniazid and rifampin, the two most potent TB drugs. These drugs are used to treat all persons with TB disease. First line drugs: Rifampin, INH, Rifapentine, Ethambutol, Rifabutin, Pyrazinamide, and streptomycin.
What is the organism that causes tuberculosis?
Mycobacterium
What is the MOST common drug used to treat oral candidiasis? Oseltamivir (Tamiflu) Griseofulvin (Fulvicin P/G) Amantadine (Symmetrel) Nystatin (Mycostatin
Nystatin (Mycostatin) Nystatin is an antifungal drug that is used for a variety of candidal infections. It is applied topically as a cream, ointment, or powder. It is also available as a troche and an oral liquid or tablet
When providing health promotion teaching at a senior citizen center, the nurse would include information about which medication used to decrease the duration of influenza A and B? -Oseltamivir (Tamiflu) -Ganciclovir (Cytovene) -Enfuvirtide (Fuzeon) -Indinavir (Crixivan)
Oseltamivir (Tamiflu) Oseltamivir (Tamiflu) and zanamivir (Relenza) are active against influenza virus types A and B and have been shown to reduce the duration of influenza infection by several days.
What conditions are considered contradictions for use of antifungal medications? (Select all that apply.) • Heart failure • Respiratory failure • Pancreatic failure • Liver failure • Kidney failure
Pancreatic failure Liver failure Drug allergy, liver failure, kidney failure, and porphyria (for griseofulvin) are the most common contraindications for antifungal drugs.
Describe how the tubercle bacilli spread.
Passed to others via airborne through cough or breathing the same air.
The client's culture has grown gram-positive cocci, and the health care provider prescribes two different antibiotics, one of which is gentamicin (Garamycin). To treat this type of infection, which type of antibiotic is typically prescribed together with gentamicin (Garamycin)? -Aminoglycoside -Penicillin -Fluoroquinolone -Cephalosporin
Penicillin In gram-positive cocci, gentamicin is usually given in combination with a penicillin antibiotic. The other antibiotics are not typically prescribed with gentamicin for this culture result.
When admitting a client to a medical-surgical unit with a diagnosis of Pneumocystis jirovecii pneumonia, the nurse will anticipate administering which medication? Pentamidine (Pentam) Paromomycin (Humatin) Iodoquinol (Yodoxin) Albendazole (Albenza)
Pentamidine (Pentam) Iodoquinol and paromomycin are used to treat intestinal amebiasis, and albendazole is used to treat helminthic infections.
Which adverse effect can result if tetracycline is administered to children younger than 8 years of age? -Delayed growth development -Drug-induced neurotoxicity -Permanent discoloration of the teeth -Gastrointestinal (GI) and rectal bleeding
Permanent discoloration of the teeth Tetracycline is contraindicated in children younger than 8 years of age because it can cause permanent discoloration of the adult teeth and tooth enamel, which are still forming in the child.
The nurse would question a prescription to administer misoprostol (Cytotec) to a client with which condition? Pregnancy Peptic ulcer Gastroesophageal reflux disease Chronic obstructive pulmonary disease
Pregnancy Misoprostol is an abortifacient and thus is contraindicated in pregnancy
The nurse is administering probenecid (Benemid) to a client with recurrent strep throat. The nurse teaches the client that the MOST likely reason for taking this medication is for what drug effect? Increase uric acid excretion Prevent the occurrence of gout Inhibit bacterial growth and replication Prolong the effectiveness of penicillin therapy
Prolong the effectiveness of penicillin therapy Besides its use for the treatment of the hyperuricemia associated with gout and gouty arthritis, probenecid also has the ability to delay the renal excretion of penicillin, thus increasing serum levels of penicillin and prolonging its effect.
A client with a known heart condition is prescribed an antibiotic before a dental procedure. What type of antibiotic therapy is this considered? -Prophylactic -Supportive -Definitive -Empiric
Prophylactic Prophylactic antibiotic therapy is used to prevent infections in individuals who are at high risk of development of an infection during or after a procedure. The antibiotics are given before the procedure for prophylactic treatment.
The nurse would question a prescription for voriconazole (Vfend) if the client was taking which medication? Prednisone (Deltasone) Quinidine Clindamycin (Cleocin) Captopril (Capoten)
Quinidine The nurse would question a prescription for quinidine because both voriconazole and quinidine are metabolized by the cytochrome P-450 enzyme system. The drugs will compete for the limited number of enzymes, and one of the drugs will end up accumulating.
Explain how to read Mantoux test (PPD).
Read 48-72 hours after administered. Checked by induration of 10 mm or larger.
Which is a complication of vancomycin IV infusions? -Cardiomyopathy -Neurotoxicity -Red man syndrome -Angioedema
Red man syndrome When infused too rapidly, clients receiving vancomycin may develop hypotension accompanied by flushing or itching of the head, face, neck, and upper trunk area. This phenomenon is called red man syndrome.
Explain multi-drug resistant tuberculosis.
Resistant to a majority of drugs. Generally, this occurs because patients do not finish antibiotic treatment and later comes back two-fold w/ resistance factors. So, it may take two synergetic drugs or broad spectrum strong medications.
Which nursing diagnosis is appropriate for a client prescribed colchicine (Colcrys)? Constipation related to adverse effect of the medication Risk for infection related to medication-induced leukocytosis Risk for injury related to adverse effect of life threatening seizures Risk for fluid volume deficient related to nausea, vomiting, and diarrhea
Risk for fluid volume deficient related to nausea, vomiting, and diarrhea Colchicine is administered on an hourly basis until pain is relieved, the client develops severe nausea and diarrhea, or the maximum dose (6 mg) has been administered. Bleeding into the GI or urinary tracts is a potential serious adverse effect of colchicine.
During antibiotic therapy, the nurse will assess the client for a condition that may occur because of the disruption of normal flora. The nurse knows this as what condition? -Superinfection -Hypersensitivity -Allergic reaction -Organ toxicity
Superinfection Superinfections can occur when antibiotic therapy reduces or completely eliminates the normal bacterial flora of the body, which normally would inhibit the overgrowth of fungi and yeast. When the normal bacterial are flora and are reduced or completely eliminated, these organisms can overgrow and cause infections.
A client visits the health care provider for treatment of tinea pedis (athlete's foot). Which medication would the nurse MOST likely instruct the client to take to treat this condition? Voriconazole (Vfend) Caspofungin (Cancidas) Amphotericin B (Amphocin) Terbinafine (Lamisil)
Terbinafine (Lamisil) Terbinafine (Lamisil) is classified as an allylamine antifungal drug and is currently the only drug in its class. It is available in a topical cream, gel, and spray for treating superficial dermatologic infections, including tinea pedis (athlete's foot), tinea cruris (jock itch), and tinea corporis (ringworm).
How would the nurse define the term nadir to a patient?
The average number of days it takes for chemotherapy to have its peak effect on the bone marrow
Discuss the characteristics of the tubercle bacilli:
The bacilli are 2-4 um in length and have a very slow generation time of between 15 and 20 hours. The cell wall of the mycobacterium is unique in that it is composed mainly of acidic waxes, specifically mycolic acids. They are a nonmotile, acid-fast, obligate aerobe. "the active lung infection"
Which statement best describes health care-associated infections? -The infection develops in response to various antibiotics. -Clients are admitted to the hospital with an infectious disease. -The infection was not incubating at the time of admission. -They develop in more than 15% of hospitalized clients.
The infection was not incubating at the time of admission. A health care-associated infection is an infection that is acquired during the course of receiving treatment for another condition in a health care facility. The infection is not present or incubating at the time of admission; also known as a nosocomial infection.
Explain the concept of "slow acetylator".
The slow acetylator phenotype often experiences toxicity from drugs such as isoniazid, sulfonamides, procainamide, and hydralazine, whereas the fast acetylator phenotype may not respond to isoniazid and hydralazine in the management of tuberculosis and hypertension, respectively. Patients with the highest plasma isoniazid levels were generally slow acetylators and they suffered from peripheral nerve damage, while fast acetylators were not affected. Slow acetylators are also at risk for sulfonamide-induced toxicity and can suffer from idiopathic lupus erythematosus while taking procainamide. The slow acetylator phenotype is an autosomal recessive trait.
The nurse would question a prescription for chloroquine (Aralen) in a client also prescribed which medication? Doxycycline (Doryx) Valproic acid (Depakote) Diazepam (Valium) Clindamycin (Cleocin)
Valproic acid (Depakote) Concurrent use of chloroquine with valproic acid may reduce serum drug levels of valproic acid and thus increase the risk of seizure activity. Chloroquine may be given concurrently with clindamycin or doxycycline for synergistic actions.
How is the effectiveness of antiviral drugs administered to treat HIV infection assessed and evaluated? -Viral load -Red blood cell counts -Lymphocyte counts -Megakaryocytes
Viral load All antiretroviral drugs work to reduce the viral load, which is the number of viral RNA copies per milliliter of blood.
The nurse anticipates a prescription for vitamin supplementation for a client who is receiving isoniazid (Nydrazid) therapy. What vitamin supplement is usually prescribed with isoniazid? Vitamin E Calcium Vitamin B6 Folate
Vitamin B6 Pyridoxine (vitamin B6) is often given concurrently with isoniazid to prevent the adverse effect of isoniazid induced peripheral neuropathy associated with neurotoxicity.
When providing education to a client undergoing antineoplastic drug therapy, the nurse instructs the client to immediately notify the health care provider for which signs and symptoms? (Select all that apply.) a. Swollen tongue b. Blood in urine c. Difficulty sleeping d. Nausea on the day of treatment e. Bleeding gums f. New and persistent cough
a b e f
The nurse would teach a client prescribed metronidazole (Flagyl) to avoid ingestion of which drink? -Wine -Coffee -Milk -Orange Juice
Wine A disulfiram-like (Antabuse) reaction may occur with concurrent ingestion of metronidazole and alcohol, leading to facial flushing, tachycardia, palpitations, nausea, and vomiting.
When a client is receiving cisplatin (Platinol), the nurse will monitor the client for which possible severe adverse effects? (Select all that apply.) a. Nausea and vomiting b. Peripheral neuropathy c. Pulmonary toxicity d. Ototoxicity e. Nephrotoxicity
a b d e
Which are known severe adverse effects of alkylating agents? (Select all that apply.) a. Ototoxicity b. Bone marrow suppression c. Cardiotoxicity d. Nephrotoxicity e. Neurotoxicity
a b d e
When a client is receiving tamoxifen (Soltamox), the nurse will suspect which type of cancer? a. Colon b. Breast c. Lung d. Renal
b
What are the possible severe adverse effects specific to the cytotoxic antibiotics? Select all that apply. a. Neurotoxicity b. Nephrotoxicity c. Liver toxicity d. Pneumonitis e. Cardiovascular toxicity
b c d e
The nurse is discussing the use of alkylating drugs with a client. What is the best way for the nurse to describe the action of alkylating drugs on cancer cells? a. They stop the meiosis of cell division and reproduction. b. They interact within the cell through intercalation. c. They alter the chemical structure of the deoxyribonucleic acid (DNA). d. They specifically change the messenger ribonucleic acid sequence.
c
The nurse should question a prescription of hydroxyurea (Hydrea) for a client with which laboratory test result? a. Hemoglobin of 15 g/dL b. White blood cell (WBC) count of 8000/mm3 c. Platelet count of 8000/mm3 d. Serum creatinine of 1.0 mg/dL
c
What is considered a major dose-limiting adverse effect of doxorubicin (Adriamycin)? a. Hepatoxicity b. Nephrotoxicity c. Cardiomyopathy d. Hemorrhagic cystitis
c
When a client is receiving cyclophosphamide (Cytoxan), the nurse should advise the client to drink plenty of fluids to prevent which condition? a. Renal failure b. Neutropenia c. Hemorrhagic cystitis d. Liver dysfunction
c
Explain dormancy in mycobacterium tuberculosis.
latent tuberculosis infection, in which the bacteria exist in a non-replicative state, 2-5 years before presents symptoms.
The nurse would anticipate administering which medication to patients receiving high-dose methotrexate (Trexall)?
leucovorin
Nausea and vomiting are frequent adverse effects associated with antineoplastic therapy. Patients who are experiencing this unpleasant effect will be advised
to try to maintain hydration and nutrition, which are very important during treatment.
