pharm 2
A patient with high-risk factors for tuberculosis will begin therapy for latent TB with isoniazid and rifampin. The nurse learns that this patient takes oral contraceptives. The nurse will counsel this patient to discuss ____ with her provider.
another birth control method
A woman has been taking a progestin-only oral contraceptive and will begin using a vaginal ring. The nurse will teach the patient to insert the ring:
the day the last pill is taken and use backup contraception for 7 days.
The nurse is providing patient education about the application of transdermal estrogen spray. Which statement made by the patient best demonstrates understanding of the application of this medication? "I should apply this medication to my:
thighs and calves."
To prevent yellow or brown discoloration of teeth in children, tetracyclines should not be given:
to pregnant patients after the fourth month of gestation.
A 50-year-old postmenopausal patient who has had a hysterectomy has moderate to severe vasomotor symptoms and is discussing estrogen therapy (ET) with the nurse. The patient is concerned about adverse effects of ET. The nurse will tell her that:
transdermal preparations have fewer side effects.
A nurse is providing patient education about colesevelam [Welchol], a bile acid sequestrant. Which statement made by the patient demonstrates a need for further teaching?
"I will need to take supplements of fat-soluble vitamins."
A patient at increased risk for thromboembolic disorders will begin taking a progestin-only oral contraceptive. Which statement by the patient indicates understanding of how this oral contraceptive works?
"I will need to use backup contraception if I miss a pill."
A nurse provides teaching for a patient with cytomegalovirus (CMV) retinitis who will receive the ganciclovir ocular implant [Vitrasert]. Which statement by the patient indicates a need for further teaching?
"The implant will remain in place permanently."
A nurse is discussing various ways to obtain a medical abortion with a patient. Which statement by the patient best demonstrates understanding of mifepristone (RU 486) [Mifeprex]? "This drug is most effective if I use it:
within 7 weeks of conception."
A patient has been experiencing side effects with a combination oral contraceptive, and her provider has ordered a different combination product. The nurse will instruct the patient to do what?
Change products at the beginning of her next cycle.
The nurse is caring for a patient on a medical-surgical unit who has a fever of unknown origin. The prescriber has ordered a broad-spectrum antibiotic. Which intervention is the priority?
Obtaining all cultures before the antibiotic is administered
Insulin glargine is prescribed for a hospitalized patient who has diabetes. When will the nurse expect to administer this drug?
Once daily at bedtime
Which statement is accurate about the long-term complications of diabetes?
Optimal control of both types of diabetes reduces the risk of eye, kidney, and nerve damage.
A nurse is caring for a patient who takes an ACE inhibitor and an ARB medication who will begin taking TMP/SMZ to treat a urinary tract infection. Which serum electrolyte will the nurse expect to monitor closely?
Potassium
A patient is taking a combination oral contraceptive (OC) and tells the nurse that she is planning to undergo knee replacement surgery in 2 months. What will the nurse recommend for this patient?
The patient should discuss an alternate method of birth control prior to surgery.
A nursing student asks a nurse to clarify the differences between the mechanisms of spontaneous mutation and conjugation in acquired resistance of microbes. What will the nurse say?
Spontaneous mutation leads to resistance to only one antimicrobial agent.
A patient with type 2 diabetes mellitus takes glipizide. The patient develops a urinary tract infection, and the prescriber orders TMP/SMZ. What will the nurse tell the patient?
The patient should check the blood glucose level more often while taking TMP/SMZ.
A child with an ear infection is not responding to treatment with amoxicillin [Amoxil]. The nurse will expect the provider to order:
amoxicillin-clavulanic acid [Augmentin].
A patient who recently started therapy with an HMG-COA reductase inhibitor asks the nurse, "How long will it take until I see an effect on my LDL cholesterol?" The nurse gives which correct answer?
"A reduction usually is seen within 2 weeks."
A patient has a Pseudomonas aeruginosa infection that is sensitive to aminoglycosides, and the prescriber orders gentamicin. The patient tells the nurse that a friend received amikacin [Amikin] for a similar infection and wonders why amikacin was not ordered. What will the nurse tell the patient?
"Amikacin is given when infectious agents are resistant to other aminoglycosides."
A nursing student asks a nurse to explain the differences between amphotericin B [Abelcet] and the azoles group of antifungal agents. Which statement by the nurse is correct?
"Azoles have lower toxicity than amphotericin B."
A nurse is explaining to nursing students why a cephalosporin is used in conjunction with an aminoglycoside for a patient with an infection. Which statement by a student indicates understanding of the teaching?
"Cephalosporins enhance the actions of aminoglycosides by weakening bacterial cell walls."
A nurse is teaching a nursing student what is meant by "generations" of cephalosporins. Which statement by the student indicates understanding of the teaching?
"Cephalosporins have increased activity against gram-negative bacteria with each generation."
A patient has lamivudine-resistant hepatitis B and has been taking entecavir [Baraclude] for 2 years. The patient asks the nurse why the provider has recommended taking the drug for another year. What will the nurse tell the patient?
"Entecavir can reverse fibrosis and cirrhosis of the liver when taken long term."
A child with an upper respiratory infection caused by B. pertussis is receiving erythromycin ethylsuccinate. After 2 days of treatment, the parent asks the nurse why the child's symptoms have not improved. Which response by the nurse is correct?
"Erythromycin eliminates the bacteria that causes the infection, but not the toxin that causes the symptoms."
A patient has a viral sinus infection, and the provider tells the patient that antibiotics will not be prescribed. The patient wants to take an antibiotic and asks the nurse what possible harm could occur by taking an antibiotic. Which response by the nurse is correct?
"Even normal flora can develop resistance and transfer this to pathogens."
A patient is receiving gentamicin once daily. A nursing student asks the nurse how the drug can be effective if given only once a day. The nurse explains drug dosing schedules for aminoglycosides. Which statement by the student indicates a need for further teaching?
"Gentamicin has a longer half-life than other aminoglycosides."
A nurse is providing discharge teaching instructions for a patient taking cholestyramine [Questran]. Which statement made by the patient demonstrates a need for further teaching?
"I can take cholestyramine with my hydrochlorothiazide."
A patient who has type 2 diabetes will begin taking glipizide [Glucotrol]. Which statement by the patient is concerning to the nurse?
"I may continue to have a glass of wine with dinner."
A nurse is providing teaching for a patient who will begin taking clarithromycin ER [Biaxin XL] to treat an Helicobacter pylori infection. Which statement by the patient indicates understanding of the teaching?
"I may experience distorted taste when taking this medication."
A patient is being treated for a systemic fungal infection with amphotericin B [Abelcet] and will be discharged home from the hospital to complete every other day infusions of the medication for 6 to 8 weeks. The nurse provides discharge teaching before dismissal. Which statement by the patient indicates a need for further teaching?
"I may experience headaches and pain in my lower back, legs, and abdomen."
The nurse is caring for a patient who is human immunodeficiency virus (HIV) positive and is taking high doses of zidovudine [Retrovir]. The nurse is providing patient education about the adverse effects of the medication. Which statement by the patient demonstrates a need for further teaching?
"I may have a deficiency of vitamin B6."
A nurse is providing education about tetracycline [Sumycin]. Which statement by the patient best demonstrates understanding of the administration of this medication?
"I should not take this medication with milk or other dairy products."
A nurse is teaching a patient who will begin taking methimazole [Tapazole] for Graves' disease about the medication. Which statement by the patient indicates understanding of the teaching?
"I should report a sore throat or fever to my provider if either occurs."
A nurse teaches a patient about sulfonamides. Which statement by the patient indicates a need for further teaching?
"I should stop taking this drug when my symptoms are gone."
A nurse provides teaching to a patient who has had a hysterectomy and is about to begin hormone therapy to manage menopausal symptoms. Which statement by the patient indicates understanding of the teaching?
"I should take the lowest effective dose for the shortest time needed."
A patient is to begin taking doxycycline to treat a rickettsial infection. Which statement by the patient indicates a need for teaching about this drug?
"I should take this drug with food to ensure more complete absorption."
While giving discharge instructions to a patient who will be taking cholestyramine [Questran], the nurse wants to assess the patient's understanding of the treatment. Which statement made by the patient best demonstrates a need for additional teaching?
"I will weigh myself weekly."
A nurse is teaching a patient who has been diagnosed with hypothyroidism about levothyroxine [Synthroid]. Which statement by the patient indicates a need for further teaching?
"If I take calcium supplements, I may need to decrease my dose of Synthroid."
A nurse is discussing intravenous amphotericin B treatment with a nursing student who is about to care for a patient with a systemic fungal infection. Which statement by the student indicates a need for further teaching?
"Infusions of amphotericin B should be administered over 1 to 2 hours."
A patient is diagnosed with periodontal disease, and the provider orders oral doxycycline [Periostat]. The patient asks the purpose of the drug. What is the nurse's response?
"It inhibits collagenase to protect connective tissue in the gums."
A nurse is discussing methicillin-resistant Staphylococcus aureus (MRSA) with a group of nursing students. Which statement by a student correctly identifies the basis for MRSA resistance?
"MRSA bacteria have developed PBPs with a low affinity for penicillins."
A nurse is teaching a nursing student about dalfopristin/quinupristin [Synercid]. Which statement by the student indicates an understanding of the teaching?
"Patients taking this drug should have blood tests performed frequently."
A nurse provides teaching to a group of nursing students about the risks and benefits of hormone therapy (HT), including estrogen therapy (ET) and combination estrogen/progestin therapy (EPT). Which statement by a student indicates understanding of the teaching?
"Principle benefits of ET are suppression of menopausal symptoms and prevention of bone loss."
A nursing student asks a nurse about flucytosine [Ancobon]. Which statement by the nurse is correct?
"Resistance is common with this medication."
A nurse is discussing microbial resistance among sulfonamides and trimethoprim with a nursing student. Which statement by the student indicates a need for further teaching?
"Resistance to sulfonamides is less than resistance to trimethoprim."
The nurse is teaching a nursing student about the mechanism by which antimicrobial agents achieve selective toxicity. Which statement by the student indicates a need for further teaching?
"Some agents cause phagocytosis of bacterial cells."
A patient who is taking immunosuppressant medications develops a urinary tract infection. The causative organism is sensitive to sulfonamides and to another, more expensive antibiotic. The prescriber orders the more expensive antibiotic. The nursing student assigned to this patient asks the nurse why the more expensive antibiotic is being used. Which response by the nurse is correct?
"Sulfonamides are bacteriostatic and depend on host immunity to work."
Lovastatin [Mevacor] is prescribed for a patient for the first time. The nurse should provide the patient with which instruction?
"Take lovastatin with your evening meal."
A patient will begin taking atorvastatin [Lipitor] to treat elevated LDL levels. The patient asks the nurse what to do to minimize the risk of myositis associated with taking this drug. What will the nurse counsel this patient?
"Take vitamin D and coenzyme Q supplements."
A pregnant adolescent patient asks the nurse whether she should continue to take her prescription for tetracycline [Sumycin] to clear up her acne. Which response by the nurse is correct?
"Tetracycline can be harmful to the baby's teeth and should be avoided."
A child with otitis media has had three ear infections in the past year. The child has just completed a 10-day course of amoxicillin [Amoxil] with no improvement. The parent asks the nurse why this drug is not working, because it has worked in the past. What will the nurse tell the patient?
"The bacteria have synthesized penicillinase."
A pregnant patient with fever, flank pain, and chills has a history of two previous bladder infections before getting pregnant. She is allergic to several antibiotics. She reports having taken methenamine successfully in the past. What will the nurse tell her?
"This agent is not effective against infections of the upper urinary tract."
The nurse prepares a patient with Graves' disease for radioactive iodine (131I) therapy. Which statement made by the patient best demonstrates understanding of 131I therapy?
"This drug will be taken up by the thyroid gland and will destroy the cells to reduce my hyperthyroidism."
An adolescent patient recently attended a health fair and had a serum glucose test. The patient telephones the nurse and says, "My level was 125 mg/dL. Does that mean I have diabetes?" What is the nurse's most accurate response?
"Unless you were fasting for longer than 8 hours, this does not necessarily mean you have diabetes."
A nurse is teaching an adolescent female patient about 28-day monophasic combination oral contraceptives. The provider has instructed the patient to begin taking the pills on the first Sunday after the onset of her next period. What will the nurse tell the patient?
"Use another form of contraception for the next month."
A patient has come to the clinic with tinea corporis, and the prescriber has ordered clotrimazole. When educating the patient about this medication, the nurse will include which statement?
"Use the medication for at least 1 week after the symptoms have cleared."
A patient has a free T4 level of 0.6 ng/dL and a free T3 of 220 pg/dL. The patient asks the nurse what these laboratory values mean. How will the nurse respond?
"We will need to obtain a TSH level to better evaluate your diagnosis."
A patient with osteopenia asks a nurse about the benefits of hormone therapy in preventing osteoporosis. Which statement by the nurse is correct?
"When hormone therapy is discontinued, bone mass is quickly lost."
A patient is about to begin treatment for latent tuberculosis. The patient is an alcoholic, has difficulty complying with drug regimens, and has mild liver damage. What will the nurse tell this patient?
"You must take isoniazid with close monitoring of hepatic function."
A healthcare worker who is asymptomatic has a screening TST result of 10 mm of induration during a pre-employment physical. What will the nurse reading this test tell the patient?
"You need to have a chest radiograph and a sputum culture."
A patient has begun taking an HMG-COA reductase inhibitor. Which statement about this class of drugs made by the nurse during patient education would be inappropriate?
"You should come into the clinic for liver enzymes in 1 month."
A nurse is instructing a patient receiving a cholesterol-lowering agent. Which information should the nurse include in the patient education?
"You should continue your exercise program to increase your HDL serum levels."
A patient with a history of elevated triglycerides and LDL cholesterol begins taking nicotinic acid [Niacin]. The patient reports uncomfortable flushing of the face, neck, and ears when taking the drug. What will the nurse advise the patient?
"You should take 325 mg of aspirin a half hour before each dose of Niacin to prevent this effect."
A nurse provides dietary counseling for a patient newly diagnosed with type 1 diabetes. Which instruction should be included?
"You should use a carbohydrate counting approach to maintain glycemic control."
A parent asks a nurse if the provider will prescribe an antibiotic for a child who attends school with several children who have strep throat. The child is complaining of a sore throat and has a fever. What will be the nurse's response?
"Your child should come to the clinic to have a throat culture done today."
A child has ringworm of the scalp. A culture of the lesion reveals a dermatophytic infection. The nurse teaching the child's parents about how to treat this infection will include which statement?
"Your child will need to take this oral medication for 6 to 8 weeks."
A patient received 500 mg of azithromycin [Zithromax] at 0800 as a first dose. What are the usual amount and time of the second dose of azithromycin?
250 mg at 0800 the next day
A patient is admitted to the unit for treatment for an infection. The patient receives IV amikacin [Amikin] twice a day. When planning for obtaining a peak aminoglycoside level, when should the nurse see that the blood is drawn?
30 minutes after the IV infusion is complete
A patient is receiving tobramycin 3 times daily. The provider has ordered a trough level with the 8:00 AM dose. The nurse will ensure that the level is drawn at what time?
7:45 AM
A young, nonpregnant female patient with a history of a previous urinary tract infection is experiencing dysuria, urinary urgency and frequency, and suprapubic pain of 3 days' duration. She is afebrile. A urine culture is positive for more than 100,000/mL of urine. The nurse caring for this patient knows that which treatment is most effective?
A 3-day course of trimethoprim/sulfamethoxazole [Bactrim]
Which patient should begin treatment for tuberculosis?
A recent immigrant from a country with a high prevalence of TB with a 10-mm region of induration
Which fluoroquinolone antibiotics may be administered to children? (Select all that apply.) a.Ciprofloxacin [Cipro] b.Levofloxacin [Levaquin] c.Moxifloxacin [Avelox] d.Norfloxacin [Noroxin] e.Ofloxacin
A, B Ciprofloxacin [Cipro] Levofloxacin [Levaquin]
A nursing student wants to know the differences between hospital-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) and community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). Which statements about CA-MRSA are true? (Select all that apply.) a.20% to 30% of the general population are colonized with CA-MRSA. b.Boils caused by CA-MRSA can be treated without antibiotics. c.CA-MRSA is less dangerous than HA-MRSA. d.CA-MRSA does not cause necrotizing fasciitis. e.CA-MRSA is transmitted by airborne droplets.
A, B, C 20% to 30% of the general population are colonized with CA-MRSA. Boils caused by CA-MRSA can be treated without antibiotics. CA-MRSA is less dangerous than HA-MRSA.
The nurse is discussing upper and lower UTIs. Which of these conditions can be treated at home? (Select all that apply.) a.Acute cystitis b.Acute urethritis c.Recurrent UTI d.Severe pyelonephritis e.Acute bacterial prostatitis
A, B, C Acute cystitis Acute urethritis Recurrent UTI
Nitrofurantoin [Macrodantin] is prescribed for an adolescent female patient with acute cystitis. What should the nurse include in the teaching for this patient? (Select all that apply.) a."Make sure you tell your prescriber if you might be pregnant." b."If you experience any tingling or numbness, stop taking the drug and call the clinic immediately." c."Headaches and drowsiness can occur and are mild side effects." d."You should not take sulfonamides while taking this medication." e."Your urine may have a brown tinge while you are taking this drug."
A, B, C, E "Make sure you tell your prescriber if you might be pregnant." "If you experience any tingling or numbness, stop taking the drug and call the clinic immediately." "Headaches and drowsiness can occur and are mild side effects." "Your urine may have a brown tinge while you are taking this drug."
Which patients may receive gentamicin safely? (Select all that apply.) a.A 6-day-old newborn b.A 5-year-old child c.A pregnant woman d.A woman breast-feeding an infant e.An elderly patient with renal disease
A, B, D A 6-day-old newborn A 5-year-old child A woman breast-feeding an infant
A nursing student asks a nurse why tuberculosis resistance is so high. Which reasons are correct? (Select all that apply.) a.Adherence to drug regimens is erratic. b.Drug doses are often too low. c.Many hosts are immunocompromised. d.Many regimens contain too few drugs. e.Some TB drugs are bacteriostatic.
A, B, D Adherence to drug regimens is erratic. Drug doses are often too low. Many regimens contain too few drugs.
Besides the cost of administering a given drug, which are considerations when a provider selects a cephalosporin to treat an infection? (Select all that apply.) a.Adverse effects b.Antimicrobial spectrum c.Brand name d.Manufacturer e.Pharmacokinetics
A, B, E Adverse effects Antimicrobial spectrum Pharmacokinetics
Which infection(s) may be treated with linezolid [Zyvox])? (Select all that apply.) a.Community-acquired pneumonia (CAP) that is penicillin sensitive b.Nosocomial pneumonia caused by methicillin-sensitive Staphylococcus aureus (MSSA) c.Pneumonias caused by Mycoplasma avium d.Superficial methicillin-resistant Staphylococcus aureus skin infections (MRSA) e.Vancomycin-resistant infections
A, B, E Community-acquired pneumonia (CAP) that is penicillin sensitive Nosocomial pneumonia caused by methicillin-sensitive Staphylococcus aureus (MSSA) Vancomycin-resistant infections
The nurse is teaching a pharmacology refresher course to a group of nurses. A student asks what host factors affect the choice of agents in antimicrobial therapy. The nurse will tell the students that such host factors include what? (Select all that apply.) a.Age b.Gender c.Immune system status d.Infection site e.Weight
A, C, D Age Immune system status Infection site
A patient asks about the effectiveness of various birth control methods. The nurse should inform her that the most effective methods are what? (Select all that apply.) a.Intrauterine devices (IUDs) b.Spermicides c.Intramuscular medroxyprogesterone acetate d.Etonogestrel subdermal implants e.Male or female sterilization
A, C, D, E Intrauterine devices (IUDs) Intramuscular medroxyprogesterone acetate Etonogestrel subdermal implants Male or female sterilization
Tetracyclines are considered first-line drugs for which disorder(s)? (Select all that apply.) a.Chlamydia trachomatis cervicitis b.Clostridium difficile diarrhea c.Lyme disease d.Methicillin-resistant Staphylococus aureus skin infections e.Typhus fever
A, C, E Chlamydia trachomatis cervicitis Lyme disease Typhus fever
A patient is being started on nicotinic acid [Niaspan] to reduce triglyceride levels. The nurse is providing patient education and should include teaching about which adverse effects? (Select all that apply.) a.Facial flushing b.Constipation c.Hypoglycemia d.Gastric upset e.Itching
A, D, E Facial flushing Gastric upset Itching
A patient will be discharged from the hospital with a prescription for TMP/SMZ [Bactrim]. When providing teaching for this patient, the nurse will tell the patient that it will be important to:
drink 8 to 10 glasses of water each day.
A provider has ordered ceftriaxone 4 gm once daily for a patient with renal impairment. What will the nurse do?
Administer the medication as prescribed.
A patient will be discharged home to complete treatment with intravenous cefotetan with the assistance of a home nurse. The home care nurse will include which instruction when teaching the patient about this drug treatment?
Abstain from alcohol consumption during therapy.
A patient who is taking gentamicin and a cephalosporin for a postoperative infection requests medication for mild postsurgical pain. The nurse will expect to administer which of the following medications?
Acetaminophen
A patient is diagnosed with an infection caused by Staphylococcus aureus, and the prescriber orders intravenous gentamicin and penicillin (PCN). Both drugs will be given twice daily. What will the nurse do?
Administer gentamicin, flush the line, and then give the penicillin.
A prescriber has ordered cefoxitin for a patient who has an infection caused by a gram-negative bacteria. The nurse taking the medication history learns that the patient experienced a maculopapular rash when taking amoxicillin [Amoxil] several years earlier. What will the nurse do?
Administer the cefoxitin and observe for any side effects.
A patient is taking oral ketoconazole [Nizoral] for a systemic fungal infection. The nurse reviews the medication administration record and notes that the patient is also taking omeprazole [Prilosec] for reflux disease. What action should the nurse take?
Administer the omeprazole at least 2 hours after the ketoconazole.
A patient is diagnosed with a lung infection caused by P. aeruginosa. The culture and sensitivity report shows sensitivity to all aminoglycosides. The nurse knows that the rate of resistance to gentamicin is common in this hospital. The nurse will expect the provider to order which medication?
Amikacin [Amikin]
The parent of an infant with otitis media asks the nurse why the prescriber has ordered amoxicillin [Amoxil] and not ampicillin [Unasyn]. What will the nurse tell the parent?
Ampicillin is not as acid stable as amoxicillin.
A nurse working in a family planning clinic is teaching a class on intrauterine devices (IUDs). Which patient should be advised against using an IUD for contraception?
An 18-year-old woman with multiple sexual partners
A patient has been taking levothyroxine for several years and reports that "for the past 2 weeks, the drug doesn't seem to work as well as before." What will the nurse do?
Ask the patient when the prescription was last refilled.
A nurse counsels a patient with diabetes who is starting therapy with an alpha-glucosidase inhibitor. The patient should be educated about the potential for which adverse reactions? (Select all that apply.) a.Hypoglycemia b.Flatulence c.Elevated iron levels in the blood d.Fluid retention e.Diarrhea
B, E Flatulence Diarrhea
According to studies of estrogen/progestin therapy (EPT), what are its known benefits? (Select all that apply.) a.Cardiovascular protection in older patients b.Decreased osteoporosis risk c.Glycemic control d.Improved wound healing e.Prevention of colorectal cancer
B, C, D Decreased osteoporosis risk Glycemic control Improved wound healing
The nurse is providing patient education for a postmenopausal patient who is considering EPT. Which risks associated with EPT should the nurse discuss with the patient? (Select all that apply.) a.Increased colon cancer b.Stroke c.Deep vein thrombosis d.Ovarian cancer e.Decreased bone density
B, C, D Stroke Deep vein thrombosis Ovarian cancer
Which organisms can be treated with penicillin G (Benzylpenicillin)? (Select all that apply.) a.Methicillin-resistant Staphylococcus aureus b.Neisseria meningitidis c.Pseudomonas aeruginosa d.Streptococcus pyogenes e.Treponema pallidum
B, D, E Neisseria meningitidis Streptococcus pyogenes Treponema pallidum
A patient newly diagnosed with diabetes expresses concern about losing her vision. Which interventions should be included in the plan of care to reduce this risk? (Select all that apply.) a.Initiation of reliable contraception to prevent pregnancy b.Ways to reduce hyperglycemic episodes c.Use of a prokinetic drug (eg, metoclopramide) d.Smoking cessation e.Emphasis on the importance of taking antihypertensive drugs consistently
B, D, E Ways to reduce hyperglycemic episodes Smoking cessation Emphasis on the importance of taking antihypertensive drugs consistently
An elderly patient who has type 2 diabetes has a history of severe hypoglycemia. The patient's spouse asks the nurse what the optimum A1c level is for the patient. Which is correct?
Below 8.0
A nurse is educating the staff nurses about ketoacidosis. To evaluate the group's understanding, the nurse asks, "Which sign or symptom would not be consistent with ketoacidosis?" The group gives which correct answer?
Blood glucose level of 60 mg/dL
Which cephalosporin may be used to treat meningitis?
Cefotaxime
A patient has a skin infection and the culture reveals methicillin-resistant Staphylococcus aureus (MRSA). What is an appropriate treatment for this patient?
Ceftaroline
Which patients should be given antibiotics prophylactically? (Select all that apply.) a.Children who attend day care with other children who have strep throat b.Children undergoing chemotherapy who have mild neutropenia c.Patients with certain congenital heart defects at risk for bacterial endocarditis d.Patients with compound fractures undergoing surgical repair e.Postoperative patients who have undergone emergency cesarean sections
C, D Patients with certain congenital heart defects at risk for bacterial endocarditis Patients with compound fractures undergoing surgical repair
Which are benefits of using a combination of two or more antibiotics? (Select all that apply.) a.Reduced cost b.Reduced risk of superinfection c.Reduced toxicity d.Reduced resistance e.Reduced risk in severe infection
C, D, E Reduced toxicity Reduced resistance Reduced risk in severe infection
A patient is receiving an intraperitoneal aminoglycoside during surgery. To reverse a serious side effect of this drug, the nurse may expect to administer which agent?
Calcium gluconate
A patient with no known drug allergies is receiving amoxicillin [Amoxil] PO twice daily. Twenty minutes after being given a dose, the patient complains of shortness of breath. The patient's blood pressure is 100/58 mm Hg. What will the nurse do?
Contact the provider and prepare to administer epinephrine.
A nurse is preparing to administer intramuscular penicillin to a patient who is infected with T. pallidum and notes that the order is for sodium penicillin G. Which action is correct?
Contact the provider to discuss changing the drug to benzathine penicillin G.
A patient is taking erythromycin ethylsuccinate for a chlamydial infection and develops vaginal candidiasis. The prescriber orders ketoconazole to treat the superinfection. What will the nurse do?
Contact the provider to discuss changing to a different antifungal medication.
A patient with a urinary tract infection is given a prescription for TMP/SMZ. When reviewing the drug with the patient, the nurse learns that the patient has type 1 diabetes mellitus and consumes alcohol heavily. What will the nurse do?
Contact the provider to request a different antibiotic for this patient.
An adolescent female patient with multiple sexual partners asks a nurse about birth control methods. The patient tells the nurse she tried oral contraceptives once but often forgot to take her pills. The nurse will recommend discussing which contraception with the provider?
DMPA (Depo-Provera) and condoms
A nurse is caring for a patient who is receiving amphotericin B [Abelcet] for a systemic fungal infection. In spite of receiving diphenhydramine and acetaminophen before initiation of treatment, the patient has fever and chills with rigors. The nurse will contact the provider to discuss the addition of which drug?
Dantrolene
A nurse is preparing to administer an antibiotic to a patient with methicillin-resistant Staphylococcus aureus (MRSA). The nurse would expect the healthcare provider to order which antibiotic?
Daptomycin [Cubicin]
Which side effect of clindamycin [Cleocin] causes the most concern and may warrant discontinuation of the drug?
Diarrhea
A patient receiving a cephalosporin develops a secondary intestinal infection caused by Clostridium difficile. What is an appropriate treatment for this patient?
Discontinuing the cephalosporin and beginning metronidazole [Flagyl]
A patient who is taking a combination oral contraceptive begins taking carbamazepine. After several weeks, the patient tells the nurse she has begun experiencing spotting during her cycle. What will the nurse tell her to do?
Discuss an oral contraceptive with increased estrogen.
A child has received amoxicillin [Amoxil] for three previous ear infections, but a current otitis media episode is not responding to treatment. The nurse caring for this child suspects that resistance to the bacterial agent has occurred by which microbial mechanism?
Drug inactivation
Which plasma lipoprotein level is most concerning when considering the risk of coronary atherosclerosis?
Elevated low-density lipoprotein
A 6-week-old infant who has not yet received immunizations develops a severe cough. While awaiting nasopharyngeal culture results, the nurse will expect to administer which antibiotic?
Erythromycin ethylsuccinate
The nurse assesses a newly diagnosed patient for short-term complications of diabetes. What does this assessment include?
Evaluation for hyperglycemia, hypoglycemia, and ketoacidosis
A patient is to undergo orthopedic surgery, and the prescriber will order a cephalosporin to be given preoperatively as prophylaxis against infection. The nurse expects the provider to order which cephalosporin?
First-generation cephalosporin
A patient with a history of congestive heart failure and renal impairment has esophageal candidiasis. Which antifungal agent would the nurse anticipate giving to this patient?
Fluconazole [Diflucan]
A patient is receiving tobramycin three times daily. A tobramycin peak level is 4.5 and the trough is 1.2. What will the nurse do?
Give the next dose as ordered.
A nurse transcribes a new prescription for potassium penicillin G given intravenously (IV) every 8 hours and gentamicin given IV every 12 hours. Which is the best schedule for administering these drugs?
Give the penicillin at 0800, 1600, and 2400; give the gentamicin [Garamycin] at 1800 and 0600.
What is the most reliable measure for assessing diabetes control over the preceding 3-month period?
Glycosylated hemoglobin level
A nurse caring for a patient notes that the patient has a temperature of 104°F and a heart rate of 110 beats per minute. The patient's skin is warm and moist, and the patient complains that the room is too warm. The patient appears nervous and has protuberant eyes. The nurse will contact the provider to discuss:
Graves' disease.
A nurse obtaining an admission history on an adult patient notes that the patient has a heart rate of 62 beats per minute, a blood pressure of 105/62 mm Hg, and a temperature of 96.2°F. The patient appears pale and complains of always feeling cold and tired. The nurse will contact the provider to discuss tests for which condition?
Hypothyroidism
A recent campaign, initiated by the Centers for Disease Control (CDC), to delay the emergence of antibiotic resistance in hospitals, has what as one of its objectives?
Increased adherence to prescribed antibiotics
A nurse is reviewing a patient's medications and realizes that gemfibrozil [Lopid] and warfarin [Coumadin] are to be administered concomitantly. Which effect will the nurse anticipate in this patient?
Increased anticoagulant effects
A patient with hypothyroidism begins taking PO levothyroxine [Synthroid]. The nurse assesses the patient at the beginning of the shift and notes a heart rate of 62 beats per minute and a temperature of 97.2°F. The patient is lethargic and difficult to arouse. The nurse will contact the provider to request an order for which drug?
Intravenous levothyroxine
A patient who is being treated for HIV infection has a 5-mm area of induration after a routine TST. The patient's chest radiograph is normal, and there are no other physical findings. The nurse will expect this patient to begin treatment with which drugs?
Isoniazid and rifabutin
A patient with HIV who takes protease inhibitors develops tuberculosis and will begin treatment. Which drug regimen will be used for this patient?
Isoniazid, pyrazinamide, ethambutol + rifabutin
A patient is beginning treatment for active tuberculosis (TB) in a region with little drug-resistant TB. Which treatment regimen will be used initially?
Isoniazid, rifampin, pyrazinamide, and ethambutol
A patient with second-degree burns is treated with silver sulfadiazine [Silvadene]. A nursing student asks the nurse about the differences between silver sulfadiazine and mafenide [Sulfamylon], because the two are similar products, and both contain sulfonamides. What does the nurse tell the student about silver sulfadiazine?
It has antibacterial effects related to release of free silver.
A patient with type 1 diabetes is eating breakfast at 7:30 AM. Blood sugars are on a sliding scale and are ordered before a meal and at bedtime. The patient's blood sugar level is 317 mg/dL. Which formulation of insulin should the nurse prepare to administer?
Lispro [Humalog]
A patient has an infection caused by Pseudomonas aeruginosa. The prescriber has ordered piperacillin and amikacin, both to be given intravenously. What will the nurse do?
Make sure to administer the drugs at different times using different IV tubing.
Which statement is correct about the contrast between acarbose and miglitol?
Miglitol has not been associated with hepatic dysfunction.
A patient with severe community-acquired pneumonia has been prescribed telithromycin [Ketek]. Which aspect of the patient's medical history is of concern to the nurse?
Myasthenia gravis
A patient shows signs and symptoms of conjunctivitis. Which aminoglycoside would the nurse expect to be ordered?
Neomycin [Neomycin]
The nurse is caring for a pregnant patient recently diagnosed with hypothyroidism. The patient tells the nurse she does not want to take medications while she is pregnant. What will the nurse explain to this patient?
Neuropsychologic deficits in the fetus can occur if the condition is not treated.
A postmenopausal patient who has had a hysterectomy and who has a family history of coronary heart disease reports experiencing vaginal dryness and pain with intercourse but tells the nurse that she doesn't want to take hormones because she is afraid of adverse effects. The nurse will suggest that the woman ask her provider about:
Premarin vaginal.
A hospitalized patient who is taking demeclocycline [Declomycin] reports increased urination, fatigue, and thirst. What will the nurse do?
Provide extra fluids and reassure the patient that these are expected side effects.
A patient has an infection caused by Streptococcus pyogenes. The prescriber has ordered dicloxacillin PO. What will the nurse do?
Question the need for a penicillinase-resistant penicillin.
A patient is receiving intravenous voriconazole [Vfend]. Shortly after the infusion starts, the patient tells the nurse, "Colors look different, and the light hurts my eyes." What will the nurse do?
Reassure the patient that these effects will subside in about 30 minutes.
A nurse is performing a physical assessment on a patient with tuberculosis who takes rifampin [Rifadin]. What would be an expected finding?
Red-orange-tinged urine
Which is a possible benefit of taking fish-oil supplements?
Reduced risk of dysrhythmia in patients after myocardial infarction
A nurse is caring for a patient who has a superficial fungal infection and notes that the provider has ordered 200 mg of ketoconazole [Nizoral] 200 mg PO once daily. Which action by the nurse is correct?
Request an order for a different antifungal medication.
A nurse is reviewing the culture results of a patient receiving an aminoglycoside. The report reveals an anaerobic organism as the cause of infection. What will the nurse do?
Request an order for a different class of antibiotic.
A patient is about to receive penicillin G for an infection that is highly sensitive to this drug. While obtaining the patient's medication history, the nurse learns that the patient experienced a rash when given amoxicillin [Amoxil] as a child 20 years earlier. What will the nurse do?
Request an order for a skin test to assess the current risk.
A patient is receiving intravenous potassium penicillin G, 2 million units to be administered over 1 hour. At 1900, the nurse notes that the dose hung at 1830 has infused completely. What will the nurse do?
Request an order for serum electrolytes and cardiac monitoring.
A nurse working in a family planning clinic is preparing to administer a first dose of intramuscular DMPA [Depo-Provera] to a young adult patient. The woman tells the nurse she has just finished her period. What will the nurse do?
Schedule an appointment for her to receive the injection in 3 weeks.
A patient who is receiving a final dose of intravenous (IV) cephalosporin begins to complain of pain and irritation at the infusion site. The nurse observes signs of redness at the IV insertion site and along the vein. What is the nurse's priority action?
Select an alternate intravenous site and administer the infusion more slowly.
An Asian patient will begin taking rosuvastatin [Crestor] to treat hypercholesterolemia. What will the nurse include when teaching this patient about this medication?
Serum drug levels must be monitored more frequently than with other patients.
A patient has just purchased a 1-year supply of 28-day-cycle oral contraceptives. She tells the nurse she wishes she had planned things better, because she has calculated that her period will begin during her upcoming honeymoon. What will the nurse suggest?
She should discard the inert pills and start a new pack during the honeymoon.
A patient with type 1 diabetes recently became pregnant. The nurse plans a blood glucose testing schedule for her. What is the recommended monitoring schedule?
Six or seven times a day
A child has been receiving chloramphenicol for a Neisseria meningitidis central nervous system (CNS) infection. The nurse administers the dose and subsequently notes that the child has vomited and appears dusky and gray in color. The child's abdomen is distended. What will the nurse do?
Stop the infusion immediately and notify the provider.
An older adult patient is diagnosed with hypothyroidism. The initial free T4 level is 0.5 mg/dL, and the TSH level is 8 microunits/mL. The prescriber orders levothyroxine [Levothroid] 100 mcg/day PO. What will the nurse do?
Suggest that the provider lower the dose.
The nurse is caring for a patient who will begin receiving intravenous ciprofloxacin [Cipro] to treat pyelonephritis. The nurse learns that the patient has a history of myasthenia gravis. Which action by the nurse is correct?
Suggest that the provider order a different antibiotic for this patient.
The nurse has been caring for a patient who has been taking antibiotics for 3 weeks. Upon assessing the patient, the nurse notices the individual has developed oral thrush. What describes the etiology of the thrush?
Superinfection
A patient who has been taking gentamicin for 5 days reports a headache and dizziness. What will the nurse do?
Suspect ototoxicity and notify the prescriber.
A patient who has been taking linezolid [Zyvox] for 6 months develops vision problems. What will the nurse do?
Tell the patient that this symptom is reversible when the drug is discontinued.
The nurse working on a high-acuity medical-surgical unit is prioritizing care for four patients who were just admitted. Which patient should the nurse assess first?
The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units of 70/30 Novolin insulin
A patient with type 1 diabetes who takes insulin reports taking propranolol for hypertension. Why is the nurse concerned?
The beta blocker can mask the symptoms of hypoglycemia.
A postmenopausal woman will begin taking atorvastatin [Lipitor] to treat hypercholesterolemia. The woman reports a history of osteopenia with a family risk of osteoporosis. What will the nurse include when teaching this patient?
The need to discuss taking a bisphosphonate medication with her provider
A nurse is reviewing the medications of a patient with diabetes before discharge. The nurse realizes that the patient will be going home on colesevelam, a bile acid sequestrant, and insulin. What patient education should the nurse provide in the discharge teaching for this patient?
The patient needs to monitor the blood sugar carefully, because colesevelam can cause hypoglycemia.
A patient in her twenties with Graves' disease who takes methimazole [Tapazole] tells a nurse that she is trying to conceive and asks about disease management during pregnancy. What will the nurse tell her?
The patient should discuss changing to propylthiouracil from now until her second trimester with her provider.
A patient is taking a combination oral contraceptive (OC) and reports breast tenderness, edema, and occasional nausea. What will the nurse recommend?
The patient should request an OC containing less estrogen.
A patient recently began receiving clindamycin [Cleocin] to treat an infection. After 8 days of treatment, the patient reports having 10 to 15 watery stools per day. What will the nurse tell this patient?
The patient should stop taking the clindamycin now and contact the provider immediately.
A patient taking gemfibrozil [Lopid] and rosuvastatin [Crestor] concurrently begins to complain of muscle aches, fatigue, and weakness. What should the nurse monitor?
The patient's creatinine kinase levels
A patient with type 1 diabetes reports mixing NPH and regular insulin to allow for one injection. What should the nurse tell the patient?
This is an acceptable practice.
A patient who is taking ketoconazole tells the nurse that her periods have become irregular. What will the nurse tell her?
This is caused by a reversible effect on estradiol synthesis.
Which superficial mycosis is generally treated with oral antifungal agents?
Tinea capitis
A patient who is taking nitrofurantoin calls the nurse to report several side effects. Which side effect of this drug causes the most concern and would require discontinuation of the medication?
Tingling of the fingers
A 20-year-old female patient has suprapubic discomfort, pyuria, dysuria, and bacteriuria greater than 100,000/mL of urine. Which are the most likely diagnosis and treatment?
Uncomplicated lower urinary tract infection treatable with short-course therapy
A patient who has cystic fibrosis has a Pseudomonas aeruginosa infection and the provider has ordered aztreonam [Cayston]. What will the nurse teach this patient about administration of this drug?
Use the nebulizer to administer the drug three times daily.
A provider has ordered oral voriconazole [Vfend] for a patient who has a systemic fungal infection. The nurse obtains a medication history and learns that the patient takes phenobarbital for seizures. The nurse will contact the provider to discuss which possibility?
Using a different antifungal agent
A patient develops CDAD. Which antibiotic is recommended for treating this infection?
Vancomycin
A patient who is at risk for osteoporosis will begin taking the selective estrogen receptor modulator raloxifene [Evista]. Which statement will the nurse include when teaching this patient about the medication?
Vasomotor symptoms are a common side effect of this drug.
A patient has an invasive aspergillosis infection. Which antifungal agent is the drug of choice for this infection?
Voriconazole [Vfend]
A patient with bronchitis is taking TMP/SMZ, 160/800 mg orally, twice daily. Before administering the third dose, the nurse notes that the patient has a widespread rash, a temperature of 103°F, and a heart rate of 100 beats per minute. The patient looks ill and reports not feeling well. What will the nurse do?
Withhold the dose and notify the provider of the symptoms.
A patient who is taking drugs to treat HIV has tuberculosis and has been on a four-drug regimen for 3 months without improvement in symptoms. Which drug will the nurse anticipate that the provider will add to this patient's regimen?
bedaquiline [Sirturo]
A patient has a positive urine culture 1 week after completion of a 3-day course of antibiotics. The nurse anticipates that the prescriber will:
begin a 2-week course of antibiotics.
A patient with a history of renal calculi has fever, flank pain, and bacteriuria. The nurse caring for this patient understands that it is important for the provider to:
begin antibiotic therapy after urine culture and sensitivity results are available.
A 1-year-old child with cretinism has been receiving 8 mcg/kg/day of levothyroxine [Synthroid]. The child comes to the clinic for a well-child checkup. The nurse will expect the provider to:
change the dose of levothyroxine to 6 mcg/kg/day.
A patient calls a family planning clinic and tells the nurse that her vaginal ring, which has been in place for 2 weeks, came out sometime during the night while she was sleeping. The nurse will instruct her to:
clean the ring with warm water, reinsert it, and use condoms for 7 days.
A patient newly diagnosed with tuberculosis asks the nurse why oral medications must be given in the clinic. The nurse will tell the patient that medications are given in the clinic so that:
clinic staff can observe adherence to drug regimens.
A patient comes to a clinic for tuberculosis medications 2 weeks after beginning treatment with a four-drug induction phase. The patient's sputum culture remains positive, and no drug resistance is noted. At this point, the nurse will expect the provider to:
continue the four-drug regimen and recheck the sputum in 2 weeks.
A patient who will begin combination estrogen/progestin therapy (EPT) for menopause asks the nurse why she can't take an estrogen-only preparation. The patient has not had a hysterectomy, has a slightly increased risk of cardiovascular disease, and has mild osteopenia. The nurse will tell her that the progestin is necessary to:
decrease her risk of endometrial cancer.
A patient who has been receiving intravenous gentamicin for several days reports having had a headache for 2 days. The nurse will request an order to:
discontinue the gentamicin.
A nurse assisting a nursing student with medications asks the student to describe how penicillins (PCNs) work to treat bacterial infections. The student is correct in responding that penicillins:
disrupt bacterial cell wall synthesis.
A woman complains of burning on urination and increased frequency. The patient has a history of frequent urinary tract infections (UTIs) and is going out of town in 2 days. To treat the infection quickly, the nurse would expect the healthcare provider to order:
fosfomycin [Monurol].
A patient with HIV contracts herpes simplex virus (HSV), and the prescriber orders acyclovir [Zovirax] 400 mg PO twice daily for 10 days. After 7 days of therapy, the patient reports having an increased number of lesions. The nurse will expect the provider to:
give intravenous foscarnet every 8 hours for 2 to 3 weeks.
A patient who takes the loop diuretic ethacrynic acid is given intravenous gentamicin for an infection. After several days of treatment with gentamicin, the nurse reviews the patient's most recent laboratory results and notes a gentamicin trough of 2.1 mcg/mL and normal blood urea nitrogen (BUN) and serum creatinine levels. The nurse will question the patient about:
headache, dizziness, or vertigo.
A nurse is caring for an African American patient who has been admitted to the unit for long-term antibiotic therapy with sulfonamides. The patient develops fever, pallor, and jaundice. The nurse would be correct to suspect that the patient has developed:
hemolytic anemia.
The nurse is caring for a patient receiving intravenous acyclovir [Zovirax]. To prevent nephrotoxicity associated with intravenous acyclovir, the nurse will:
hydrate the patient during the infusion and for 2 hours after the infusion.
A nurse is teaching a community education class on contraceptives. The nurse tells the class that if spermicides containing nonoxynol-9 are used, the patient should take special precautions, because these spermicides have been linked to:
increased transmission of the human immunodeficiency virus (HIV).
A pregnant female patient with bacteriuria, suprapubic pain, urinary urgency and frequency, and a low-grade fever is allergic to sulfa, ciprofloxacin, and amoxicillin. The nurse knows that the best alternative for treating this urinary tract infection is with:
methenamine [Hiprex].
The nurse is caring for a patient who is taking a protease inhibitor (PI). Upon review of the laboratory test results, the nurse notes that the patient has newly elevated plasma triglycerides and cholesterol. The nurse expects that the prescriber will manage these levels with:
modified diet and exercise.
A nurse is preparing to administer oral ofloxacin to a patient. While taking the patient's medication history, the nurse learns that the patient takes warfarin and theophylline. The correct action by the nurse is to request an order to:
monitor coagulation levels.
A nurse is obtaining a drug history from a patient about to receive sulfadiazine. The nurse learns that the patient takes warfarin, glipizide, and a thiazide diuretic. Based on this assessment, the nurse will expect the provider to:
monitor the patient's coagulation levels.
A patient is about to begin treatment with isoniazid. The nurse learns that the patient also takes phenytoin [Dilantin] for seizures. The nurse will contact the provider to discuss:
monitoring phenytoin levels.
A patient who is taking simvastatin [Zocor] develops an infection and the provider orders azithromycin [Zithromax] to treat the infection. The nurse should be concerned if the patient complains of:
muscle pain.
A patient has a localized skin infection, which is most likely caused by a gram-positive cocci. Until the culture and sensitivity results are available, the nurse will expect the provider to order a ____-spectrum ____ agent.
narrow; systemic
A patient has a positive test for hepatitis C and is admitted to the hospital. The admission laboratory tests reveal a normal ALT, and a liver biopsy is negative for hepatic fibrosis and inflammation. The nurse will prepare this patient for:
no medication therapy at this time.
An older adult patient with chronic obstructive pulmonary disease (COPD) develops bronchitis. The patient has a temperature of 39.5°C. The nurse will expect the provider to:
order empiric antibiotics while waiting for sputum culture results.
A nurse is preparing to administer a dose of gentamicin to a patient who is receiving the drug 3 times daily. The nurse will monitor ____ levels.
peak and trough
A patient who is taking doxycycline for a serious infection contacts the nurse to report anal itching. The nurse will contact the provider to discuss:
prescribing an antifungal drug to treat a superinfection.
A patient arrives in the emergency department with a heart rate of 128 beats per minute and a temperature of 105°F. The patient's skin feels hot and moist. The free T4 level is 4 ng/dL, the free T3 level is 685 pg/dL, and the TSH level is 0.1 microunits/mL. The nurse caring for this patient will expect to administer:
propylthiouracil (PTU).
A patient presents to the emergency department with complaints of chills, severe flank pain, dysuria, and urinary frequency. The patient has a temperature of 102.9°F, a pulse of 92 beats per minute, respirations of 24 breaths per minute, and a blood pressure of 119/58 mm Hg. The nurse would be correct to suspect that the patient shows signs and symptoms of:
pyelonephritis.
A patient has been taking a progestin-only, or "minipill," OC for 3 months and reports spotting and irregular menstrual cycles. The nurse will:
reassure the patient that this is normal with this form of contraception.
A nurse reads a tuberculin skin test on a patient and notes a 6- to 7-mm area of induration. The patient is a young adult who has recently immigrated from a country with a high prevalence of tuberculosis. The patient has no other risk factors. The nurse will expect the provider to:
reassure the patient that this is not considered a positive test result.
A provider orders intravenous moxifloxacin [Avelox] for a patient who has sinusitis. Before administering the drug, the nurse will review this patient's chart for:
recent serum electrolyte levels.
The nurse is caring for a patient who is receiving vancomycin [Vancocin]. The nurse notes that the patient is experiencing flushing, rash, pruritus, and urticaria. The patient's heart rate is 120 beats per minute, and the blood pressure is 92/57 mm Hg. The nurse understands that these findings are consistent with:
red man syndrome.
A patient with an infection caused by Pseudomonas aeruginosa is being treated with piperacillin. The nurse providing care reviews the patient's laboratory reports and notes that the patient's blood urea nitrogen and serum creatinine levels are elevated. The nurse will contact the provider to discuss:
reducing the dose of piperacillin.
A patient is admitted to the hospital and will begin taking levothyroxine [Synthroid]. The nurse learns that the patient also takes warfarin [Coumadin]. The nurse will notify the provider to discuss ____ the ____ dose.
reducing; warfarin
A nurse preparing to administer intravenous gentamicin to a patient notes that the dose is half the usual dose for an adult. The nurse suspects that this is because this patient has a history of:
renal disease.
A patient calls the nurse to report that she forgot to take a combination OC pill during the third week of her cycle. She tells the nurse that she missed another pill earlier that week. The nurse will tell her to:
take a pill now, continue the pack, skip the placebo pills, and start a new pack on week 4.
A patient who has drug-sensitive tuberculosis has completed 2 months of the standard four-drug therapy and asks the nurse how long he will have to take medication. Which response by the nurse is correct?
"You will need to take only two drugs for the next 4 months."
A nurse is teaching a group of nursing students about influenza prevention. Which statement by a student indicates understanding of the teaching?
"I should receive the vaccine every year in October or November."
A patient will receive oral ciprofloxacin [Cipro] to treat a urinary tract infection. The nurse provides teaching for this patient. Which statement by the patient indicates a need for further teaching?
"I should take this medication with food or milk to improve absorption."
A patient who is taking didanosine [Videx] reports nausea, vomiting, and abdominal pain. What will the nurse recommend to this patient?
"You will need laboratory tests to determine if these are serious effects of the drug."
A 30-year-old male patient reports having two to four urinary tract infections a year. What will the nurse expect to teach this patient?
"You will need to take a low dose of medication for 6 months to prevent infections."
The parent of a 5-year-old child who has had four urinary tract infections in the past year asks the nurse why the provider doesn't just order an antibiotic for the child's current symptoms of low-grade fever, flank pain, and dysuria since these are similar symptoms as before. Which is the most important reason given by the nurse?
"Your child may need tests to assess for urinary tract abnormalities."
The nurse is providing education to a group of patients who are HIV positive. The nurse is discussing the various medications used to treat HIV infection. A patient asks about nevirapine [Viramune]. Which statements by the nurse most accurately reflect the facts about nevirapine? (Select all that apply.) a."Some herbal preparations can reduce the levels of this drug." b."This agent can damage the liver; therefore, liver function tests are needed periodically." c."Usually no adverse effects occur when this medication is used alone." d."The drug must be dosed five times per day at evenly spaced intervals." e."You should call your healthcare provider immediately if you develop a rash."
A, B, E "Some herbal preparations can reduce the levels of this drug." "This agent can damage the liver; therefore, liver function tests are needed periodically." "You should call your healthcare provider immediately if you develop a rash."
A nurse is caring for a patient with HIV/acquired immunodeficiency syndrome (AIDS) who has taken protease inhibitors for 18 months. The patient has been diagnosed with active tuberculosis. Which drug(s) would the nurse expect to be added to the treatment plan of a patient with HIV/AIDS? (Select all that apply.) a.Isoniazid b.Rifampin [Rifadin] c.Pyrazinamide [PZA] d.Ethambutol [Myambutol] e.Rifabutin [Mycobutin]
A, C, D, E Isoniazid Pyrazinamide [PZA] Ethambutol [Myambutol] Rifabutin [Mycobutin]
Which antibiotics may be administered topically? (Select all that apply.) a.Bacitracin b.Daptomycin c.Ofloxacin d.Polymyxin B e.Rifampin
A, D Bacitracin Polymyxin B
Ketoconazole is used as an alternative to amphotericin B for less severe systemic mycosis. Which are the primary reasons for choosing ketoconazole? (Select all that apply.) a.It can be given orally. b.It can be used safely in patients with hepatic dysfunction. c.It can be given once weekly rather than daily. d.It is effective for severe, acute infections. e.It is less toxic.
A, E It can be given orally. It is less toxic.
Which patient with a urinary tract infection will require hospitalization and intravenous antibiotics?
An older adult man with a low-grade fever, flank pain, and an indwelling catheter
A patient who is taking nelfinavir [Viracept] calls the nurse to report moderate to severe diarrhea. What will the nurse expect the provider to recommend?
An over-the-counter antidiarrheal drug
The nurse is preparing to administer amphotericin B intravenously. The nurse will expect to pretreat the patient with which medications?
Acetaminophen [Tylenol], diphenhydramine [Benadryl], and meperidine [Demerol]
A patient has a systemic candidal infection, and the provider has ordered oral fluconazole [Diflucan] 400 mg on day 1 and 200 mg once daily thereafter. What will the nurse do?
Administer the drug as ordered.
A nurse is preparing to administer medications to a patient recently started on delavirdine [Rescriptor]. Which concurrent prescription should the nurse question before administration?
Alprazolam [Xanax]
A nursing student is caring for a patient with community-acquired pneumonia (CAP) who also has a methicillin-resistant Staphylococcus aureus (MRSA) skin infection. The prescriber has ordered daptomycin [Cubicin]. The nurse encourages the student to approach the provider to request a different antibiotic because of which facts about daptomycin? (Select all that apply.) a.It causes significant renal impairment. b.It is approved only for bloodstream and skin infections. c.It increases the risk of serious cardiorespiratory events. d.It is more likely to produce resistant strains of bacteria. e.It is not effective against MRSA infections.
B, C It is approved only for bloodstream and skin infections. It increases the risk of serious cardiorespiratory events.
The nurse asks a graduate nurse, "When a patient in the initial phase of HIV infection is assessed, which findings would you expect to see?" The graduate nurse would be correct to respond with which conditions? (Select all that apply.) a.Respiratory distress b.Fever c.Myalgia d.Lymphadenopathy e.Insomnia
B, C, D Fever Myalgia Lymphadenopathy
Which patient(s) should be tested for latent TB? (Select all that apply.) a.A day care employee b.A worker in a mycobacteriology laboratory c.A patient with cardiovascular disease d.A patient with diabetes mellitus e.An immigrant from a country where TB is prevalent
B, D, E A worker in a mycobacteriology laboratory A patient with diabetes mellitus An immigrant from a country where TB is prevalent
Amphotericin B is the drug of choice for which systemic mycosis? (Select all that apply.) a.Aspergillosis b.Candidiasis c.Dermatophytosis d.Histoplasmosis e.Mucormycosis
B, D, E Candidiasis Histoplasmosis Mucormycosis
A patient will begin treatment with posaconazole [Noxafil] to treat oropharyngeal candidiasis that has not responded to fluconazole. The provider has ordered 200 mg three times daily. Which action by the nurse is correct?
Discuss a 400-mg twice daily drug regimen with the provider.
A male patient with hepatitis C will begin triple drug therapy with pegylated interferon alfa 2a [Pegasys], ribavirin [Ribasphere], and boceprevir [Victrelis]. The patient tells the nurse that his wife is pregnant. What will the nurse tell him?
Boceprevir is contraindicated in males whose partners are pregnant.
A patient is about to begin therapy with ethambutol. The nurse knows that, before initiating treatment with this drug, it is important to obtain which test(s)?
Color vision and visual acuity
The nurse is caring for a patient who is HIV positive and is taking zidovudine [Retrovir]. Before administering the medication, the nurse should monitor which laboratory values?
Complete blood count (CBC)
A patient who is receiving intravenous ciprofloxacin for pneumonia develops diarrhea. A stool culture is positive for Clostridium difficile. The nurse will expect the provider to:
add metronidazole [Flagyl].
Before giving methenamine [Hiprex] to a patient, it is important for the nurse to review the patient's history for evidence of which problem?
Elevated blood urea nitrogen and creatinine
The nurse is performing a physical assessment on a patient who is receiving treatment with abacavir, zidovudine, and lamivudine [Trizivir]. The patient complains of fatigue. Upon further assessment, the nurse finds a rash and notes that the patient has a temperature of 101.1°F. What is the nurse's best course of action?
Have the patient hold the medications and arrange for an immediate evaluation by the prescriber.
The nurse is preparing to discharge a patient with HIV who will continue to take enfuvirtide [Fuzeon] at home. The nurse is providing patient education about the medication. What information about the administration of enfuvirtide is most appropriate for the patient?
How to reconstitute and self-administer a subcutaneous injection
The nurse is caring for a patient who is HIV positive and has a previous history of drug and alcohol abuse. The patient is being treated with combination therapies, including didanosine [Videx]. Which laboratory findings would most concern the nurse?
Increased serum amylase and triglycerides and decreased serum calcium
A patient is about to begin treatment for latent tuberculosis with a short course of daily rifampin. The patient asks why rifapentine [Priftin] cannot be used, because it can be given twice weekly. What will the nurse tell this patient about rifapentine?
It is not approved for treatment of latent TB.
A patient with histoplasmosis is being treated with itraconazole [Sporanox]. The nurse will teach this patient to report which symptoms?
Nausea, vomiting, and anorexia
A patient with HIV and mucocutaneous HSV is being treated with foscarnet after failing treatment with acyclovir. After 2 weeks, the patient's dose is increased to 90 mg/kg over 2 hours from 40 mg/kg over 1 hour. The patient reports numbness in the extremities and perioral tingling. What will the nurse do?
Notify the provider and request an order for a serum calcium level.
A patient will begin taking an immunosuppressant medication. The nurse learns that the patient has a history of frequent candidal infections. The nurse will expect the provider to order which drug as prophylaxis?
Posaconazole [Noxafil]
An immunocompromised child is exposed to chickenpox and the provider orders valacyclovir [Valtrex] to be given orally three times daily. The nurse will contact the provider to change this order for which reason?
The drug may cause serious adverse effects in immunocompromised patients.
A patient starting therapy with efavirenz [Sustiva] asks about the timing of the medication with regard to meals. What patient education about the administration of this medication should the nurse provide?
The drug should be taken once daily on an empty stomach.
A patient taking stavudine [Zerit] telephones the clinic and reports numbness and tingling in the hands and feet. What should the nurse tell the patient?
The medication will probably be stopped, and the patient should come into the clinic for further evaluation.
A 65-year-old patient who receives glucocorticoids for arthritis is admitted to the hospital for treatment of a urinary tract infection. The prescriber has ordered intravenous ciprofloxacin [Cipro]. Before administering the third dose of this drug, the nurse reviews the bacterial culture report and notes that the causative organism is Escherichia coli. The bacterial sensitivity report is pending. The patient complains of right ankle pain. What will the nurse do?
Withhold the dose of ciprofloxacin and notify the provider of the patient's symptoms.
A patient with hepatitis B begins treatment with adefovir [Hepsera] and asks the nurse how long the drug therapy will last. The nurse will tell the patient that the medication will need to be taken for:
an indefinite, prolonged period of time.
An older male patient comes to the clinic with complaints of chills, malaise, myalgia, localized pain, dysuria, nocturia, and urinary retention. The nurse would most likely suspect that the patient has:
prostatitis.
After starting an antiviral protease inhibitor, a patient with HIV telephones the nurse, complaining, "I'm so hungry and thirsty all the time! I'm urinating 10 or 12 times a day." The nurse recognizes these findings to be consistent with:
hyperglycemia.
A hospitalized patient is being treated for tuberculosis with a drug regimen that includes pyrazinamide. The patient complains of pain in the knee and shoulder joints. The nurse will contact the provider to request an order for:
ibuprofen.
A nursing student asks a nurse why pegylated interferon alfa is used instead of regular interferon for a patient with hepatitis C. The nurse will tell the student that pegylated interferon:
is administered less frequently than interferon.
A pregnant patient is treated with trimethoprim/sulfamethoxazole (TMP/SMZ) [Bactrim] for a urinary tract infection at 32 weeks' gestation. A week later, the woman delivers her infant prematurely. The nurse will expect to monitor the infant for:
kernicterus.
A patient is being treated with amphotericin B [Abelcet] for a systemic fungal infection. After several weeks of therapy, the provider orders flucytosine [Ancobon] in addition to the amphotericin. The nurse understands that the rationale for this combination is that it:
lowers the dose of amphotericin B and reduces toxicity.
A patient has a positive test for influenza type A and tells the nurse that symptoms began 5 days before being tested. The prescriber has ordered oseltamivir [Tamiflu]. The nurse will tell the patient that oseltamivir:
may not be effective because of the delay in starting treatment.
A patient who is pregnant has a history of recurrent genital herpesvirus (HSV). The patient asks the nurse what will be done to suppress an outbreak when she is near term. The nurse will tell the patient that:
oral acyclovir [Zovirax] may be used during pregnancy.
A patient has been taking isoniazid [Nydrazid] for 4 months for latent tuberculosis. The patient reports bilateral tingling and numbness of the hands and feet, as well as feeling clumsy. The nurse expects the provider to:
order pyridoxine 100 mg per day.
A female patient who has hepatitis C is being treated with pegylated interferon alfa and ribavirin [Ribasphere]. It will be important for the nurse to teach this patient that:
she will need a monthly pregnancy test during her treatment.
A patient who is taking calcium supplements receives a prescription for ciprofloxacin [Cipro] for a urinary tract infection. The nurse will teach this patient to:
take the calcium either 6 hours before or 2 hours after taking the ciprofloxacin.
A patient comes to the clinic and receives valacyclovir [Valtrex] for a herpes-zoster virus. The nurse instructs the patient to take the medication:
without regard to meals.
