Pharm AQ

The nurse is teaching the patient why hypertension must be treated. What information should be included in the teaching plan? Select all that apply. 1 "Hypertension is a risk factor for stroke." 2 "Hypertension is a risk factor for diabetes." 3 "Hypertension is a risk factor for emphysema." 4 "Hypertension is a risk factor for heart failure." 5 "Hypertension is a risk factor for cardiovascular disease."

1 "Hypertension is a risk factor for stroke." 4 "Hypertension is a risk factor for heart failure." 5 "Hypertension is a risk factor for cardiovascular disease." Hypertension is a risk factor for stroke, heart failure, and cardiovascular disease. It is not a risk factor for diabetes or emphysema.

A nurse is counseling a patient who is taking neomycin to prevent drug-induced superinfections. What advice should the nurse provide? 1. "Eat yogurt." 2 "Drink milk." 3 "Eat eggs daily." 4 "Eat green leafy vegetables."

1. "Eat yogurt." Antibiotic-induced superinfections are antibiotic-associated adverse effects. Neomycin may cause a superinfection; therefore, the patient should be instructed to consume buttermilk or yogurt to prevent this complication. Drinking milk or eating eggs and green leafy vegetables does not help prevent antibiotic-associated superinfections induced by neomycin. These foods do not affect the action of neomycin; neither do they prevent its adverse effects.

A patient with hypertension is prescribed a diuretic as first-line drug therapy after lifestyle changes have been ineffective. Which type of diuretics should the nurse anticipate will be used? 1 A loop diuretic 2 A thiazide diuretic 3 An osmotic diuretic 4 A potassium-sparing diuretic

2 A thiazide diuretic The thiazide diuretics such as hydrochlorothiazide are the most commonly used diuretics for the treatment of hypertension.

A 22-year-old female patient is prescribed amoxicillin. Which is the most important intervention for this patient? 1. Obtain a baseline complete blood count. 2. Assess if the patient is on oral contraceptives. 3. Inform the patient about possible superinfections. 4. Instruct the patient to not take the medication before meals.

2. Assess if the patient is on oral contraceptives. This medication may decrease the effectiveness of oral contraceptives. The nurse needs to assess whether or not the patient is on oral contraceptives and whether or not the patient is sexually active. Long-term use of antibiotics can cause blood dyscrasias, but a baseline complete blood count is not indicated. Informing the patient about possible superinfections and not to take the medication before meals are not priorities.

What is the most common adverse effect of the drug vancomycin when it is infused too rapidly? 1 Hearing loss 2 Kidney damage 3 Red man syndrome 4 Acute respiratory failure

3 Red man syndrome Red man syndrome is characterized by flushing and/or itching of the head, face, neck, and upper trunk area. It is the most common adverse effect of vancomycin when the drug is infused too rapidly. Hearing loss and kidney damage are adverse effects that occur if the blood levels of the drug are too high. Colistimethate is a polypeptide antibiotic that may cause respiratory failure when administered by inhalation.

A patient has a serious intraabdominal infection. Which antibiotic will the nurse expect to administer to this patient as empiric therapy? 1. Ampicillin 2. Penicillin V potassium 3. Ticarcillin-clavulanic acid 4. Amoxicillin-clavulanic acid

3. Ticarcillin-clavulanic acid Ticarcillin with clavulanic acid has one of the broadest antimicrobial spectra of all penicillins. This antibiotic is indicated as empiric therapy for this patient until the results of the culture and sensitivity are available. Ticarcillin-clavulanic acid is an extended-spectrum penicillin and a generation beyond the aminopenicillins. Ampicillin and amoxicillin-clavulanic acid are aminopenicillins. Penicillin V potassium is one of the natural penicillins.

The nursing instructor determines that the student nurse understands the rationale for administration of an angiotensin-converting enzyme (ACE) inhibitor for treatment of hypertension when the student makes which statement(s)? Select all that apply. 1 "They reduce afterload." 2 "Angiotensin II is a potent vasodilator." 3 "They promote sodium and water retention." 4 "Systemic vascular resistance (SVR) is decreased." 5 "ACE inhibitors modify the function of the sympathetic nervous system (SNS)."

1 "They reduce afterload." 4 "Systemic vascular resistance (SVR) is decreased." ACE inhibitors reduce afterload, or the resistance against which the left ventricle has to pump to eject its volume of blood during contraction. SVR is the resistance to blood flow that is determined by the diameter of the blood vessel and the vascular musculature. Because effects of vasoconstrictors are blocked, the vessels remain dilated, and so SVR is decreased. Angiotensin II is a potent vasoconstrictor. Angiotensin II also stimulates secretion of aldosterone, which enhances sodium and water reabsorption. Therefore, by preventing the conversion of angiotensin I to angiotensin II, these actions are blocked. Centrally acting alpha2-adrenergic receptor agonists, such as clonidine and methyldopa, not ACE inhibitors, act by modifying the function of the SNS.

A patient with type 2 diabetes mellitus is started on sulfamethoxazole/trimethoprim. Which nursing intervention is a priority for this patient? 1 Assess blood sugar. 2 Monitor platelet count. 3 Assess hemoglobin and hematocrit. 4 Take blood pressure every 4 hours.

1 Assess blood sugar. Sulfamethoxazole/trimethoprim increases the hypoglycemic response when taken with sulfonylureas (oral hypoglycemic agents). The nurse should assess blood sugar and determine what oral hypoglycemic the patient is taking. The remaining choices are not the priority.

Which assessment finding is a contraindication to a patient being prescribed a nonselective beta blocker? 1 Asthma 2 Weight loss 3 Elevated cholesterol 4 History of alcohol abuse

1 Asthma Beta blockers need to be used cautiously in patients who have a history of asthma, because these drugs induce bronchoconstriction and cause airway resistance, which may lead to dyspnea and wheezing. Weight loss and elevated cholesterol are not contraindications to using beta blockers. Beta blockers can interact with alcohol and cause adverse effects such as hypotension. However, a history of alcohol abuse is not a concern if the patient no longer engages in such behavior.

A patient is prescribed levofloxacin for the treatment of a bacterial infection. During the assessment, the nurse finds that the patient is taking calcium supplements. The nurse instructs the patient to take the calcium supplements at least 1 hour after taking levofloxacin. What could be the reason for this? 1 Calcium supplements interfere with levofloxacin absorption. 2 Calcium supplements increase the serum concentration of levofloxacin. 3 Calcium supplements antagonize the antibacterial activity of levofloxacin. 4 Calcium supplements and levofloxacin interact, affecting the intestinal flora.

1 Calcium supplements interfere with levofloxacin absorption. Levofloxacin is a quinolone antibiotic. Calcium supplements interfere with levofloxacin absorption and reduce oral absorption of levofloxacin. Therefore, the nurse instructs the patient to take calcium supplements at least 1 hour before or after taking levofloxacin to prevent this interaction. Calcium supplements do not increase the serum concentration of levofloxacin. Calcium supplements do not antagonize the antibacterial activity of levofloxacin. Nitrofurantoin interacts with levofloxacin and antagonizes its antibacterial activity. The interaction between calcium supplements and levofloxacin does not affect the intestinal flora. Oral anticoagulant and levofloxacin interaction affects the intestinal flora.

A nurse is caring for a patient who is taking an angiotensin-converting enzyme inhibitor and develops a dry, uncomfortable, nonproductive cough that has persisted for several weeks. What is the nurse's priority action? 1 Call the health care provider to switch the medication. 2 Tell the patient that the cough will subside in a few days. 3 Assess the patient for other symptoms of upper respiratory infection. 4 Instruct the patient to take antitussive medication until the symptoms subside.

1 Call the health care provider to switch the medication. Angiotensin-converting enzyme inhibitors prevent the breakdown of bradykinins, frequently causing a nonproductive cough. Angiotensin receptor blocking agents do not block this breakdown, thus minimizing this annoying side effect. The patient should be switched to a different medication if the side effect cannot be tolerated.

Which is an appropriate nursing intervention for a patient who is taking hydrochlorothiazide? 1 Encourage intake of foods rich in potassium. 2 Schedule the dose to be taken in the evening. 3 Monitor serum calcium and sodium levels daily. 4 Take the radial pulse for 1 full minute before administering the drug.

1 Encourage intake of foods rich in potassium. Hydrochlorothiazide is a potassium-wasting diuretic that can lead to hypokalemia if potassium is not replaced sufficiently to meet losses. For this reason, the nurse should encourage increased intake of foods high in potassium. The remaining options are not relevant.

A nurse is preparing to administer a beta blocker to a patient. The nurse recognizes that beta blockers are used to treat which conditions? Select all that apply. 1 Hypertension 2 Angina pectoris 3 Heart failure (HF) 4 Sinus bradycardia 5 Cardiogenic shock 6 Chronic obstructive pulmonary disease (COPD)

1 Hypertension 2 Angina pectoris 3 Heart failure (HF) Beta blockers are effective in treating hypertension (secondary to negative inotropic effects) and angina pectoris (decreases cardiac workload when decreasing heart rate and contractility). Beta blockers have also been shown to reduce mortality in patients with HF. Beta blockers are not used to treat cardiogenic shock, sinus bradycardia, or COPD.

The nurse is performing a follow-up assessment of a patient who was prescribed a week's worth of antibiotics for gastroenteritis. Which signs and symptoms in the patient may indicate the need for referral to the primary health care provider? Select all that apply. 1 Jaundice 2 Mild nausea 3 Excessive fatigue 4 Elevated temperature 5 Occasional loose stools

1 Jaundice 3 Excessive fatigue 4 Elevated temperature Antibiotics are prescribed for a certain period. The nurse should monitor the patient for effectiveness of the therapy. The presence of jaundice indicates that the antibiotic is affecting liver function, and this needs to be reported to the primary health care provider. Excessive fatigue and an elevated body temperature indicate the persistence of infection, and the treatment needs to be revised. Mild nausea and occasional loose stools are the minor side effects of antibiotics and do not need to be reported to the primary health care provider.

A patient with a staphylococcal infection is prescribed tobramycin. About which assessment findings in the follow-up visit will the nurse immediately notify the primary health care provider? Select all that apply. 1 Nausea 2 Vertigo 3 Headache 4 Skin turgor 5 Visual acuity

1 Nausea 2 Vertigo 3 Headache During the follow-up visit, the nurse should monitor the patient for symptoms of persistent vertigo, nausea, and headache, because these are severe adverse effects of tobramycin. Therefore, the nurse should immediately report these symptoms to the primary health care provider to prevent complications. Tobramycin does not affect skin integrity or visual acuity. Therefore, changes in these are not related to tobramycin treatment.

A patient is prescribed a nonselective beta blocker. What nursing intervention is a priority for this patient? 1 Respiratory assessment 2 Assessment of blood glucose levels 3 Teaching about potential tachycardia 4 Orthostatic blood pressure assessment

1 Respiratory assessment Nonselective beta blockers can cause bronchospasms, and a respiratory assessment is indicated to check for potential respiratory side effects. Assessment of blood glucose and orthostatic blood pressure and teaching about tachycardia will not be priorities

The nurse is preparing to administer a first dose of an ACE inhibitor medication to a patient who is also being treated with lithium. What result should the nurse anticipate that from the interaction of the two drugs? 1 Toxic level of lithium 2 Decreased level of lithium 3 Toxic level of the ACE inhibitor 4 Decreased level of the ACE inhibitor

1 Toxic level of lithium The interaction of an ACE inhibitor and lithium will result in lithium toxicity.

A patient on antibiotic therapy needs drug trough levels drawn. Which is the most appropriate time for the nurse to draw the trough level? 1. 10 minutes before administration of the intravenous antibiotic 2. 60 minutes after completion of the intravenous antibiotic infusion 3. 30 minutes after beginning administration of the intravenous antibiotic 4. 90 minutes after the intravenous antibiotic is scheduled to be administered

1. 10 minutes before administration of the intravenous antibiotic Trough levels are drawn just before infusion. Peak serum drug levels should be drawn 30 to 60 minutes after the medication is infused. The nurse should document the time drug administration is started and completed and the exact time a peak and/or trough level is drawn.

The nurse should question the prescription of tetracycline for which patient? 1. A 6-year old patient with Haemophilus influenza 2. A 40-year-old patient diagnosed with rickettsia 3. A 60-year-old patient with a history of hypertension 4. A 45-year-old patient with a history of diabetes mellitus

1. A 6-year old patient with Haemophilus influenza Tetracycline is contraindicated in children younger than 8 years old because it can cause permanent discoloration of the teeth. Additionally, increasing tetracycline resistance to Haemophilus influenza is a concern. Tetracycline is used to treat rickettsia. Tetracycline is not contraindicated for patients diagnosed with diabetes mellitus or hypertension.

The nurse is caring for a postoperative patient. Which antibiotic is used for prophylaxis against infection in surgical patients? 1. Cefazolin 2. Cefoxitin 3. Cefepime 4. Ceftriaxone

1. Cefazolin First-generation cephalosporins, such as cefazolin, are used as prophylaxis against infection in surgical patients. First-generation agents are preferred to second- and third-generation cephalosporins for surgical prophylaxis because they are as effective as the newer drugs, are less expensive, and have a narrower antimicrobial spectrum. Cefoxitin is a second-generation cephalosporin, ceftriaxone is a third-generation cephalosporin, and cefepime is a fourth-generation cephalosporin.

A patient with pain and urinary tract infection develops fever, chills, and sores on the tongue. In the chart, the nurse finds an allergy to sulfonamides. Which drug does the nurse suspect is responsible for the patient's reaction? 1. Celecoxib 2. Glimepiride 3. Furosemide 4. Hydrochlorothiazide

1. Celecoxib Celecoxib is a COX-2 selective nonsteroidal antiinflammatory drug that helps in the treatment of acute pain. This drug contains sulfonamide moiety and, hence, should be avoided in patients with sulfonamide allergy. Glimepiride helps control elevated blood sugar levels in patients with diabetes, and it is safe for patients with sulfonamide allergy. Diuretics such as furosemide and hydrochlorothiazide are safe for patients with sulfonamide allergy.

The nurse is caring for a patient who has a urinary tract infection and is being treated with sulfamethoxazole/trimethoprim (SMZ-TMP). Which findings does the nurse report to the primary health care provider to prevent complications? Select all that apply. 1. Diarrhea 2. Yellowish eyes 3. Blood in the urine 4. Shortness of breath 5. Change in the color of the sputum

1. Diarrhea 3. Blood in the urine 4. Shortness of breath Sulfamethoxazole/trimethoprim (SMZ-TMP) is a sulfonamide antibiotic. The nurse should monitor the patient for diarrhea, blood in the urine, and shortness of breath. These symptoms indicate an adverse reaction to the drug. Therefore the nurse should immediately notify the primary health care provider to prevent complications. Sulfonamide antibiotics do not affect oral secretions or the eyes. Changes in the color of the sputum and yellowish eyes are not symptoms associated with an adverse reaction to sulfonamide antibiotics. Changes in the color of the sputum indicate infection. Yellowish eyes are a sign of jaundice. Hepatotoxicity is a possibility with sulfonamides.

When planning care for a patient receiving a sulfonamide antibiotic, which is a primary intervention? 1. Force fluids to at least 2000 mL/day. 2. Encourage liquids that produce acidic urine. 3. Encourage a diet that causes an alkaline ash. 4. Insert a Foley catheter for accurate input and output measurement.

1. Force fluids to at least 2000 mL/day. Forcing fluids will help prevent crystallization in the urine and kidney stone formation associated with sulfonamide antibiotics, regardless of the type of fluid consumed. Consuming a specific type of diet will not decrease the risk of crystallization. It is outside the nurse's scope of practice to decide to insert a Foley catheter.

A patient has been prescribed sulfamethoxazole/trimethoprim (Bactrim). What is the nurse's primary intervention for this patient? 1. Instruct the patient to increase fluid intake. 2. Instruct the patient to take the medication for 14 days. 3. Assess the patient's urine before and after treatment. 4. Ensure the patient does not eat anything when taking the medication.

1. Instruct the patient to increase fluid intake. Increased fluid intake is highly recommended to avoid complications such as crystallization in the urine. The course of therapy is not always 14 days; the drug is not prescribed only for urinary tract infections; and the patient does not have to take the drug on an empty stomach.

How does penicillin work to destroy bacteria? 1 It interferes with cell wall synthesis. 2 It binds irreversibly to the cell wall. 3 It interrupts bacterial DNA processes. 4 It interrupts bacterial RNA processes.

1. It interferes with cell wall synthesis. Penicillin inhibits transpeptidases and activates autolysins. This disrupts the synthesis of the cell wall and promotes active destruction of the cell wall. These combined actions result in cell lysis and death. Penicillin irreversibly inactivates a key enzyme in bacterial cell wall synthesis, but it does not bind irreversibly to the cell wall. Penicillin does not interrupt bacterial DNA or RNA processes to destroy bacteria.

How does penicillin work to destroy bacteria? 1. It interferes with cell wall synthesis. 2. It binds irreversibly to the cell wall. 3. It interrupts bacterial DNA processes. 4. It interrupts bacterial RNA processes.

1. It interferes with cell wall synthesis. Penicillin inhibits transpeptidases and activates autolysins. This disrupts the synthesis of the cell wall and promotes active destruction of the cell wall. These combined actions result in cell lysis and death. Penicillin irreversibly inactivates a key enzyme in bacterial cell wall synthesis, but it does not bind irreversibly to the cell wall. Penicillin does not interrupt bacterial DNA or RNA processes to destroy bacteria.

Which antibiotics are safest for the nurse to administer to children? 1 Macrolides 2 Quinolones 3 Tetracyclines 4 Sulfonamides

1. Macrolides Macrolide antibiotics are safe for children because they do not produce severe side effects. Quinolone, tetracycline, and sulfonamide antibiotics are not safe for children. Quinolone antibiotics have adverse effects on bone or cartilage development in children. Tetracycline antibiotics adversely affect the development of teeth or bones in children. Sulfonamide antibiotics displace bilirubin from albumin and precipitate kernicterus (hyperbilirubinemia) in children.

Which of the following drugs is contraindicated for a patient who is receiving erythromycin therapy? 1. Warfarin 2. Digoxin 3. Tetracyclines 4. Estrogen-containing contraceptives

1. Warfarin Taking warfarin with erythromycin therapy may result in decreased warfarin metabolism and excretion, thereby leading to an increased risk of bleeding or hemorrhage. Digoxin, tetracyclines, and estrogen-containing contraceptives do not interact with erythromycin.

A patient is receiving transdermal clonidine. What information does the nurse need to include in the teaching plan? 1 "Take the medication on an empty stomach." 2 "Remove the old patch before applying the new patch." 3 "Stay in bed for at least an hour after receiving a new patch." 4 "Keep the new patch on for 30 minutes before removing the old patch."

2 "Remove the old patch before applying the new patch." The patient needs to remove the old patch before applying a new one.

The nurse is assessing a patient who has been prescribed hydrochlorothiazide. What does the nurse inform the patient about the medication regimen? 1 "Take iron supplements every day." 2 "Take the dose only in the morning." 3 "You should limit your intake of oats." 4 "You should not eat melons or grapes."

2 "Take the dose only in the morning." Hydrochlorothiazide is a thiazide diuretic that is used in the treatment of various types of edema. Diuretics are to be taken in the morning because they cause urination at night (nocturia) and subsequent loss of sleep when taken late in the afternoon or night. Therefore, the nurse should instruct the patient to take the medication only in the morning to avoid the side effects of the drug. This medication does not cause anemia; therefore, the patient need not take iron supplements. The nurse can suggest that the patient eat fiber-rich food such as oats to help prevent constipation, but not because a diuretic is prescribed. Due to loss of fluids, the patient may have dehydration. Hence the nurse can suggest that the patient eat fruits high in fluid content such as melons and grapes.

Which effect indicates that a patient is experiencing an adverse effect of enalapril? 1 Persistent dry mouth 2 A dry, hacking cough 3 Serum potassium of 4.2 mEq/L 4 Serum sodium of 147 mEq/L

2 A dry, hacking cough One of the major side effects of angiotensin-converting enzyme (ACE) inhibitors such as enalapril is a dry, irritating, nonproductive cough. This cough is a major reason for the discontinuation of ACE inhibitors. The cough is a result of increased bradykinin in the lungs, which induces increased prostaglandin and nitric oxide production and causes the cough. Persistent dry mouth is an adverse effect of adrenergic medications. A potassium level of 4.2 mEq/L is normal; ACE inhibitors are more likely to increase the serum potassium level. A sodium level of 147 mEq/L is above normal; ACE inhibitors are more likely to decrease the serum sodium level.

Which patient should not receive amlodipine as prescribed at 8:00 AM? 1 A patient with tachycardia 2 A patient with hypotension 3 A patient with angina pectoris 4 A patient with a subarachnoid hemorrhage

2 A patient with hypotension A patient who is scheduled to receive a calcium channel blocker should have blood pressure assessed before administration. Hypotension would be a contraindication to administering this medication. Tachycardia is not a contraindication, and some calcium channel blockers decrease the heart rate. Patients with angina may receive calcium channel blockers for their vasodilating effects. The medication will not do anything to worsen the condition of a patient who has suffered a subarachnoid hemorrhage.

What should the nurse use to help prevent ototoxicity in a patient receiving gentamicin? Select all that apply. 1 A peak level 2 A trough level 3. 0.9% NaCl solution 4 Baseline renal function 5 Baseline hearing acuity 6 Super infection prevention

2 A trough level 4 Baseline renal function 5 Baseline hearing acuity The risk of ototoxicity associated with gentamicin increases when the trough level (the lowest circulating level of the medication during its administration) of the drug exceeds the range of normal values. Peak levels are not used to monitor toxicity, because elevations in peak levels are short-lived; assessment of peak levels helps to guide decisions about therapeutic dose ranges. Poorly functioning kidneys eliminate gentamicin more slowly, thus allowing excessively high serum levels of gentamicin to circulate for a longer time. Baseline hearing assessment data is important to establish for use in the early detection of hearing impairment. A peak trough level, 0.9% NaCl as diluents, and super infections are not related to the prevention of ototoxicity in patients receiving gentamicin.

The nurse is caring for a patient who is taking antibiotics. The patient reports flushing, itching, hives, anxiety, and throat and tongue swelling. The nurse finds that the patient has a rapid, irregular pulse. Which condition may the patient have as a result of taking the antibiotic? 1 Tolerance to the antibiotic drugs 2 An allergic anaphylactic reaction 3 Clostridium difficile bacterial infection 4 Glucose-6-phosphate dehydrogenase deficiency

2 An allergic anaphylactic reaction The patient has developed an allergic anaphylactic reaction to the penicillin antibiotics. Flushing, itching, hives, anxiety, and throat and tongue swelling are symptoms associated with an allergic anaphylactic reaction. In this condition, the patient's pulse rate may become rapid and irregular. Watery diarrhea, abdominal pain, and fever are the symptoms of a Clostridium difficile infection. The administration of antibiotics to patients with glucose-6-phosphate dehydrogenase deficiency leads to hemolysis. The patient has no symptoms associated with hemolysis and therefore does not have glucose-6-phosphate dehydrogenase deficiency.

The primary health care provider instructs a nurse to administer intravenous vancomycin. During infusion, the patient has excessive sweating, flushes on the neck and head, and reports itching on the head, face, and upper trunk. What is the best nursing intervention in this situation? 1 Increase the rate of infusion of vancomycin. 2 Decrease the rate of infusion of vancomycin. 3 Stop the administration of the vancomycin infusion. 4 Advise the patient to get the blood pressure checked.

2 Decrease the rate of infusion of vancomycin. Rapid infusion of vancomycin results in red man syndrome. This syndrome is characterized by flushing and itching of the head, face, neck, and upper trunk. It is most commonly seen when the drug is infused too rapidly. The symptoms of red man syndrome can usually be alleviated by slowing the rate of infusion of the dose to at least 1 hour. Rapid infusions of vancomycin may cause hypotension; hence the patient sweats excessively. Rapid administration of the vancomycin infusion worsens the itching and hypotension. Stopping the administration of the vancomycin infusion may worsen the methicillin-resistant Staphylococcus aureus infection. Checking the blood pressure is a secondary intervention and is done once the patient is stabilized.

The nurse administers ampicillin to a patient who also receives tobramycin. Which condition may occur with this concomitant pharmacotherapy? 1 Red man syndrome 2 Impaired renal function 3 Drug-resistant organism 4 Infusion site inflammation

2 Impaired renal function Ampicillin and tobramycin have a tendency to cause renal dysfunction. Administering both medications at the same time can lead to renal impairment through enterococcal infection. Vancomycin is responsible for causing red man syndrome. Properly administered combination therapy with penicillin and an aminoglycoside is not associated with the development of drug-resistant organisms; however, prevention of the development of drug-resistant organisms is always a nursing goal. The nurse ensures that the infusion site remains protected to help prevent interruptions in therapy.

A patient with a methicillin-resistant Staphylococcus aureus (MRSA) infection is prescribed vancomycin. The nurse collects a blood sample from the patient before administering the second dose of the drug and finds the serum drug concentration is 8 mcg/mL. What change will the nurse expect in the primary health care provider's prescription? 1 Rapidly infuse the vancomycin 2 Increase the dose of vancomycin 3 Stop the administration of vancomycin 4 Replace vancomycin with another antibiotic

2 Increase the dose of vancomycin The blood concentration of vancomycin is 8 mcg/mL. This indicates that the dose of the drug is less than that required to achieve therapeutic effects. Optimal blood concentrations of vancomycin are 18 to 50 mcg/mL (peak concentration) and 10 to 20 mcg/mL (trough concentration). Hence, the primary health care provider should increase the dose of vancomycin to reach a therapeutic concentration and obtain the desired effects. The nurse should not rapidly infuse vancomycin, because it may result in red man syndrome and hypotension. The nurse should not stop administrating vancomycin, because it may worsen the MRSA infection. The nurse does not observe any side effects associated with vancomycin in the patient. Therefore, replacing vancomycin with another medicine is not required.

Which laboratory reports should the nurse evaluate if the patient is administered vancomycin and tobramycin? 1 Serum glucose 2 Serum creatinine 3 Prothrombin time 4 Serum electrolytes

2 Serum creatinine There is a risk of a drug interaction resulting in ototoxicity and nephrotoxicity when vancomycin is given concurrently with aminoglycosides. For this reason, the nurse should evaluate serum creatinine reports to assess kidney function. Concomitant administration of vancomycin and tobramycin does not necessitate monitoring of serum glucose, prothrombin time, or serum electrolytes.

A patient has a new prescription for an angiotensin-converting enzyme (ACE) inhibitor. During a review of the patient's list of current medications, which medication(s) should alert the nurse for a possible interaction with this new prescription? Select all that apply. 1 Warfarin, 5 mg by mouth daily 2 Spironolactone, 25 mg by mouth daily 3 Ibuprofen, 400 mg by mouth twice daily 4 Alprazolam, 0.25 mg by mouth twice daily 5 Potassium chloride, 20 mEq by mouth daily

2 Spironolactone, 25 mg by mouth daily 3 Ibuprofen, 400 mg by mouth twice daily 5 Potassium chloride, 20 mEq by mouth daily Hyperkalemia may occur with any ACE inhibitor. Potassium supplementation and potassium-sparing diuretics, such as spironolactone, need to be used with caution. The use of nonsteroidal antiinflammatory drugs (NSAIDs) along with ACE inhibitors may also predispose patients to the development of acute renal failure. There is no interaction between ACE inhibitors and anticoagulants, such as warfarin, or benzodiazepines, such as alprazolam.

A patient who is receiving 50 mg of losartan daily for hypertension reports taking ibuprofen four times daily for relief of pain from osteoarthritis. The nurse should be concerned about which potential interaction? 1 Ibuprofen can potentiate the effect of losartan. 2 When combined with losartan, ibuprofen can lead to potential renal failure. 3 When combined with losartan, ibuprofen increases the risk for hypokalemia. 4 When ibuprofen and losartan are taken concurrently, the risk for the side effect of cough is increased.

2 When combined with losartan, ibuprofen can lead to potential renal failure. When nonsteroidal antiinflammatory drugs (NSAIDs), such as ibuprofen, are taken concurrently with angiotensin II receptor blockers (ARBS), such as losartan, there is potential for the development of renal failure. When NSAIDs are taken concurrently with ARBs, the effects of the ARB are decreased. Therefore, the intended effect of lowering the blood pressure with losartan may not be met. ARBs increase the risk for hyperkalemia, not hypokalemia, and cough is associated with administration of angiotensin-converting enzyme (ACE) inhibitors, not ARBs.

Which instruction will the nurse include in the discharge teaching for a patient receiving tetracycline? 1. "Take the medication until you feel better." 2. "Use sunscreen and protective clothing when outdoors." 3. "Keep the remainder of the medication in case of recurrence." 4. "Take the medication with food or milk to minimize gastrointestinal upset."

2. "Use sunscreen and protective clothing when outdoors." Photosensitivity is a common side effect of tetracycline. Exposure to the sun can cause severe burns. The medication should not be taken with milk and should be completely finished.

The nurse works in a medical-surgical unit. Which patients should the nurse monitor for atypical signs of infection? Select all that apply. 1. A 30-year-old patient with fractured tibia 2. A 78-year-old patient with urinary incontinence 3. A 40-year-old patient with coronary artery disease 4. A 35-year-old patient who underwent a renal transplant 5. A 55-year-old patient who received radiation therapy for lung cancer

2. A 78-year-old patient with urinary incontinence 4. A 35-year-old patient who underwent a renal transplant 5. A 55-year-old patient who received radiation therapy for lung cancer Infections usually manifest as fever, chills, sweat, pain, weakness, redness, and swelling. These manifestations indicate that the immune system is actively responding against invading microorganisms. People with dysfunctional immune systems may not be able to mount an immune response and may lack the typical signs and symptoms of infection. The 78-year-old patient with urinary incontinence may have lowered immune function due to age and may not manifest the typical signs and symptoms of infection. The 35-year-old patient who underwent a renal transplant will be receiving immunosuppressant drugs and will have compromised immune function. The 55-year-old patient who received radiation therapy for lung cancer may have reduced immune function and may not manifest the usual signs of infection.

While instructing a patient about antibiotic therapy, the nurse explains to the patient that bacterial resistance to antibiotics can occur when what happens? Select all that apply. 1. Antibiotics are taken with water or juice. 2. Antibiotics are prescribed to treat a viral infection. 3. Antibiotics are taken with ascorbic acid (vitamin C). 4. Patients stop taking an antibiotic after they feel better. 5. Antibiotics are prescribed according to culture and sensitivity reports.

2. Antibiotics are prescribed to treat a viral infection. 4. Patients stop taking an antibiotic after 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. The same thing can occur when bacteria are exposed to antibiotics in the environment or when antibiotics are erroneously used to treat a viral infection. Antibiotics taken with water or vitamin C does not contribute to bacterial resistance. Acidic fluids, like juices, may nullify the antibacterial action of oral penicillin, but do not cause bacterial resistance.

A patient has been on sulfonamides for urinary tract infections. The nurse assesses the patient and finds bruises on the legs and arms. What is the nurse's best action? 1. Tell the patient to be more careful. 2. Assess the patient's platelet counts. 3. Administer vitamin K to the patient. 4. Ask the patient if someone is abusing her

2. Assess the patient's platelet counts. Blood disorders such as hemolytic anemia, aplastic anemia, and low white blood cell and platelet counts could result from prolonged use and high dosages. The nurse should assess the patient before assuming frequent falls, vitamin K deficiency, or potential abuse.

A patient receiving antibiotics for chronic tonsillitis has been experiencing abdominal pain and cramps associated with frequent watery stools. Which infection does the nurse suspect? 1. Klebsiella infection 2. Clostridium infection 3. Acinetobacter infection 4. Enterococcus infection

2. Clostridium infection C. difficile infection is associated with watery diarrhea, abdominal pain, and fever. Klebsiella, Acinetobacter, and Enterococcus are common pathogens that lead to health care-associated infections such as pneumonia and urinary tract infections.

A patient who enjoys drinking socially has been prescribed cefotetan. The nurse explains to the patient that alcohol should be avoided for how long? 1. No avoidance of alcohol is warranted 2. During drug therapy and for 3 days afterward 3. During drug therapy and for 7 days afterward 4. During drug therapy and for 14 days afterward

2. During drug therapy and for 3 days afterward Alcohol is not recommended with cefamandole, cefoperazone, or cefotetan. An increase in acetaldehyde in the blood may result, producing a disulfiram-type reaction (e.g., stomach pain, nausea, vomiting, headaches, low blood pressure, tachycardia, respiratory difficulties, increased sweating, or flushing of the face). Patients should avoid alcoholic beverages, medications containing alcohol, or intravenous alcohol solutions during the administration of these drugs and for 3 days afterward. Seven and 14 days after therapy is not warranted.

A patient is prescribed sulfamethoxazole/trimethoprim (co-trimoxazole) for the treatment of a urinary tract infection. Which biochemical parameter does the nurse assess before administering the drug? 1. Liver enzymes 2. Red blood cell count 3. Creatinine clearance 4. Uric acid baseline level

2. Red blood cell count Sulfamethoxazole/trimethoprim (co-trimoxazole) is a sulfonamide antibiotic. Sulfonamide antibiotics may cause anemia in the patient. Therefore the patient's red blood cell count should be assessed before beginning sulfonamide therapy to check the possibility of drug-related anemia. Sulfamethoxazole/trimethoprim (co-trimoxazole) does not affect liver enzymes, creatinine levels, or uric acid levels. Therefore these need not be checked before the administration of sulfamethoxazole/trimethoprim (co-trimoxazole).

Which medication may result in ineffectiveness of penicillin V potassium? 1. Ibuprofen 2. Rifampin 3. Probenecid 4. Methotrexate

2. Rifampin Rifampin and penicillin V potassium cause a drug-drug interaction. Rifampin inhibits the efficacy of penicillin and results in poor action of penicillin. Due to this drug-drug interaction, symptoms are persistent after the administration of penicillin V potassium. Ibuprofen interacts with penicillin V potassium, which results in increased levels of active penicillin for therapeutic action. Methotrexate interacts with penicillin V potassium and increases the methotrexate level in the body due to decreased renal elimination of methotrexate. Probenecid and penicillin V potassium interact and prolong the effects of penicillin V potassium.

The nurse advises a patient to use sunscreen and wear a hat to avoid the sun between 10:00 AM and 4.00 PM. Which group of antibiotics is the patient most likely using? 1. Penicillins 2. Sulfonamide 3. First-generation cephalosporins 4. Second-generation cephalosporins

2. Sulfonamide Sulfonamides, including cotrimoxazole and tetracyclines (especially demeclocycline), are more likely than other antibiotics to cause photosensitivity during their use. Photosensitivity is induced by exposure to sunlight during sulfonamide drug therapy. So the nurse advises the patient to use sunscreen and wear a hat. Allergic reactions to penicillins occur in 0.7% to 4% of treatment courses. The most common reactions are urticaria, pruritus, and angioedema. The safety profiles, contraindications, and pregnancy ratings of cephalosporins are similar to those of penicillins. The most commonly reported adverse effects are mild diarrhea, abdominal cramps, rash, pruritus, redness, and edema. No photosensitivity is seen here.

When instructing a patient about antibiotic therapy, the nurse explains that which condition occurs when the normal flora are disturbed during antibiotic therapy? 1. Organ toxicity 2. Superinfection 3. Hypersensitivity 4. Rebound toxicity

2. Superinfection Antibiotic therapy can destroy the normal flora of the body, which typically inhibit the overgrowth of fungi and yeast. When the normal flora are decreased, these organisms can overgrow and cause infections. Organ toxicity, hypersensitivity, and rebound toxicity are not a disturbance in the normal flora associated with antibiotic therapy.

The nurse is assessing a patient who is prescribed sulfamethoxazole/trimethoprim (SMZ-TMP) for the treatment of shigellosis enteritis. The nurse instructs the patient to increase fluid intake up to 3000 mL per day. What is the reason behind this? 1. To prevent hypotension in the patient 2. To prevent drug-related crystalluria in the patient 3. To prevent mucosal irritation and dryness of the mouth 4. To maintain the fluid and electrolyte balance in the body

2. To prevent drug-related crystalluria in the patient Sulfamethoxazole/trimethoprim (SMZ-TMP) is a sulfonamide antibiotic, which may cause crystalluria in the patient. Therefore the nurse instructs the patient to increase fluid intake up to 3000 mL per day to prevent drug-related crystalluria.

What are the adverse effects of sulfonamide antibiotics? Select all that apply. 1. Polyuria 2. Urticaria 3. Pancreatitis 4. Constipation 5. Hepatotoxicity

2. Urticaria 3. Pancreatitis 5. Hepatotoxicity Urticaria, pancreatitis, and hepatotoxicity are the side effects of sulfonamide antibiotics. Sulfonamide antibiotics do not cause polyuria. They cause crystalluria. Sulfonamide antibiotics do not cause constipation; they may cause diarrhea.

The nurse is caring for a patient with hypertension who is prescribed a clonidine transdermal patch. What should the nurse teach this patient? 1 "Change the patch daily at the same time." 2 "Remove the patch before taking a shower or bath." 3 "Get up slowly from a sitting to a standing position." 4 "Do not take other antihypertensive medications while using this patch."

3 "Get up slowly from a sitting to a standing position." Clonidine can cause dizziness. Patient safety is a priority. The patch is left on for 7 days and can be left on while bathing. This medication is often prescribed with other drugs.

What statement indicates to the nurse that the patient needs additional instruction about antihypertensive treatment? 1 "I will change my position slowly to prevent feeling dizzy." 2 "I will not mow my lawn until I see how this medication makes me feel." 3 "I will check my blood pressure daily and take my medication when it is over 140/90 mm Hg." 4 "I will include rest periods during the day to help me tolerate the fatigue my medicine may cause."

3 "I will check my blood pressure daily and take my medication when it is over 140/90 mm Hg." Antihypertensive medications need to be taken routinely to maintain a normotensive state and prevent complications. Many patients do not adhere to this regimen because hypertension itself does not cause symptoms, whereas the medication can cause some untoward effects. Patient teaching is essential. If the patient indicates an intention to take rest periods and change positions slowly to prevent orthostatic hypotension, this demonstrates compliance with the treatment regimen.

The nurse is instructing a patient about potential adverse effects of a prescribed angiotensin-converting enzyme (ACE) inhibitor. The nurse should instruct the patient to immediately seek medical attention if which adverse effect occurs? 1 Fatigue 2 Diarrhea 3 Angioedema 4 Dry, nonproductive cough

3 Angioedema Angioedema is a strong vascular reaction involving inflammation of submucosal tissue (e.g., laryngeal edema) and can result in anaphylaxis. Fatigue and a dry, nonproductive cough are possible adverse reactions but are not life-threatening. Diarrhea is not an adverse effect of ACE inhibitors.

A patient is taking hydrochlorothiazide. On assessment, the nurse notices the patient has muscle weakness and hypotension. What is the nurse's first intervention? 1 Reduce salt in the patient's food 2 Administer calcium supplements 3 Assess the serum potassium level 4 Give a lower dose of the medication

3 Assess the serum potassium level Hydrochlorothiazide overdose leads to hypokalemic symptoms, which are characterized by muscle weakness and hypotension. The nurse should immediately assess the patient's serum potassium level to determine the course of action. Decreasing the salt intake would further reduce the patient's blood pressure and cause sodium deficiency. Giving calcium supplements alone does not reduce the symptoms caused by potassium deficiency. Reducing the dose of the medication will not help restore the electrolyte balance.

The nurse is assessing a patient who has developed watery diarrhea. After checking the patient's history, the nurse finds that the patient was recently treated with antibiotics. Which further testing might be needed in this patient? 1 Sputum test 2 Acinetobacter test 3 Clostridium difficile test 4 Culture and sensitivity test

3 Clostridium difficile test If the patient was previously treated with antibiotics and developed watery diarrhea, then the patient needs to be tested for Clostridium difficile infection. If the result of this test is positive, then the patient needs to be treated for a serious superinfection. Infections with C. difficile are increasingly becoming resistant to standard therapy. Watery diarrhea is a common symptom of C. difficile infection. C. difficile bacteria are not present in sputum; therefore a sputum test is not indicated. A test for Acinetobacter is not helpful in this situation because the symptoms are not suggestive of an infection caused by this bacterium. Culture and sensitivity testing is helpful to optimize drug selection in individual cases, but not in this situation.

A patient who is prescribed intravenous (IV) vancomycin reports frequent ringing in the ears. Which condition should the nurse suspect? 1 Red man syndrome 2 Probable convulsion 3 Early vestibular damage 4 Ineffective antibiotic therapy

3 Early vestibular damage Frequent ringing in the ears, or tinnitus, is an adverse effect of vancomycin. Red man syndrome is more likely to occur when the drug is infused too rapidly. Convulsion is an adverse effect of quinolones. Secondary infection can be caused by ineffective antibiotic therapy, not vestibular damage.

A community health nurse is providing education on clonidine to an elderly patient during a home visit. Which adverse effect should be emphasized as most concerning to this patient? 1 Dry mouth 2 Restlessness 3 Hypotension 4 Constipation

3 Hypotension Clonidine falls under the class of adrenergic medications. Adverse effects include bradycardia with reflex tachycardia, dry mouth, drowsiness, dizziness, depression, edema, constipation, and male impotence. Because of the high incidence of postural hypotension with this medication and decreased mobility and reaction time in the elderly, this adverse effect places the patient at increased risk for falls and is thus the most concerning.

A patient receiving the adrenergic medication clonidine reports experiencing constipation. What should be included in the plan of care for this patient? Select all that apply. 1 Restrict dietary fiber intake. 2 Limit fluids to 1000 mL/day. 3 Increase the amount of fruits and vegetables in the diet. 4 Inform the patient that this is a common adverse effect of the medication. 5 Discuss incorporation of psyllium-based products in the plan of care with the health care provider.

3 Increase the amount of fruits and vegetables in the diet. 4 Inform the patient that this is a common adverse effect of the medication. 5 Discuss incorporation of psyllium-based products in the plan of care with the health care provider. Constipation is one of the most common adverse effects of adrenergic medications such as clonidine, and the patient should be made aware of this. Increasing (not restricting) dietary fiber through increased intake of fruits and vegetables, increasing fluid intake (if not contraindicated), and taking psyllium-based products should assist with preventing constipation.

The nurse is caring for a patient who is scheduled to begin treatment with carvedilol. While the nurse is updating the history, the patient reports experiencing frequent attacks of asthma. What is the nurse's priority action? 1 Expect a decreased effect from the medication 2 Expect an increased effect from the medication 3 Notify the health care provider of this information 4 Monitor the patient for a toxic reaction to the drug

3 Notify the health care provider of this information A history of asthma is considered to be a contraindication for use of carvedilol. The priority action is to inform the health care provider of this information.

Which action should the nurse take if a patient receiving intravenous vancomycin complains of facial pruritus? 1 Give diphenhydramine with the infusion 2 Wrap the infusion in foil to protect it from light 3 Program the vancomycin to infuse at a slower rate 4 Document that the patient has a hypersensitivity reaction

3 Program the vancomycin to infuse at a slower rate The nurse infuses vancomycin over at least 1 hour, because rapid infusion can cause red man syndrome. It is indicated by flushing or itching of the face, neck, and trunk, as well as more serious problems like tachycardia and hypotension. Diphenhydramine is an anticholinergic drug used for treating histamine-mediated allergies and motion sickness and to promote sleep. Orally disintegrating medicines are wrapped in foils that, once administered, dissolve on the patient's tongue. Pruritus in a patient taking vancomycin is more an indication of red man syndrome than hypersensitivity.

Which parameter is most important to assess before administering vancomycin to a patient? 1 Platelet count 2 Liver function 3 Renal function 4 Hemoglobin level

3 Renal function Vancomycin should be used cautiously in patients with preexisting renal dysfunction. Platelet count is done before administering linezolid. Liver function should be assessed before administering nitrofurantoin. Hemoglobin levels should be assessed before administering antibiotics.

The nurse is caring for a patient who is being treated for acne. The nurse anticipates that the health care provider is most likely to treat the patient using which medication? 1 Polymyxin 2 Tobramycin 3 Tetracycline 4 Vancomycin

3 Tetracycline Tetracycline is considered a drug of choice for the treatment of acne rather than vancomycin, tobramycin, and polymyxin, which are not used in the treatment of acne.

The nurse has administered the morning dose of tobramycin to a patient according to the prescription. In the evening, the nurse collects a blood sample from the patient and observes that the serum drug concentration is greater than 2 mcg/mL. What does the nurse infer from this? 1 The patient is at risk for heartburn. 2 The patient is at risk for nasal congestion. 3 The patient is at risk for renal dysfunction. 4 The patient is at risk for red man syndrome.

3 The patient is at risk for renal dysfunction. The safe therapeutic serum concentration of tobramycin is less than or equal to 1 mcg/mL (which is undetectable in blood tests). Serum concentration of the drug greater than 2 mcg/mL is associated with greater risk for both ototoxicity and nephrotoxicity (renal dysfunction). Increased serum concentrations of this drug cause increased serum creatinine concentrations. This indicates declining renal function. Heartburn is an adverse effect of quinolones. The use of metronidazole is associated with nasal congestion and red man syndrome, which is characterized by flushing and/or itching of the head, face, neck, and upper trunk area and is an adverse effect of vancomycin.

What is the primary indication for the use of calcium channel blockers (CCBs)? 1 To prolong the QT interval 2 To reduce elevations in heart rate 3 To decrease the workload of the heart 4 To treat acute myocardial infarction (MI)

3 To decrease the workload of the heart CCBs decrease afterload and reduce the workload of the heart by decreasing muscle contraction and promoting muscle relaxation. CCBs do not prolong the QT interval. CCBs are contraindicated in patients with acute MI. Some calcium channel blockers decrease elevations in heart rate; however, this is not the primary indication for the use of calcium channel blockers.

A primary health care provider instructs a nurse to administer vancomycin to a patient. The nurse administers intravenous vancomycin to the patient over 1 hour. Why will the nurse do this? 1 To prevent edema 2 To prevent hemolysis 3 To prevent hypotension 4 To prevent abdominal flatulence

3 To prevent hypotension Rapid infusion of vancomycin may precipitate hypotension as well as cause red man syndrome. Therefore, intravenous vancomycin should be infused slowly. Vancomycin does not cause edema during administration. However, edema may be observed because of nephrotoxicity when the drug is given in excess. Hemolysis and abdominal flatulence are not major effects observed during infusion of vancomycin. Vancomycin does not affect the structural integrity of red blood cells. Abdominal flatulence is a common adverse effect associated with quinolones.

What should the nurse assess within an hour after administering a diuretic? Select all that apply. 1 Weight 2 Heart rate 3 Urinary output 4 Blood pressure 5 Neurologic status

3 Urinary output 4 Blood pressure The nurse should assess urinary output and blood pressure within an hour after administering a diuretic. Weight assessment is not the best way to monitor a diuretic given for hypertension. Heart rate is not a measure of diuretic effectiveness. Neurologic status should not change.

A patient is prescribed sulfamethoxazole/trimethoprim (co-trimoxazole) for a urinary tract infection. What instruction does the nurse give to the patient to prevent complications associated with sulfamethoxazole/trimethoprim (co-trimoxazole)? 1. "Limit your fluid intake." 2. "Avoid eating citrus fruits." 3. "Avoid exposure to sunlight." 4. "Limit your intake of milk products."

3. "Avoid exposure to sunlight." Sulfamethoxazole/trimethoprim (co-trimoxazole) is a sulfonamide antibiotic and may cause photosensitivity. The nurse should instruct the patient to avoid exposure to sunlight during sulfonamide therapy because it may cause a photosensitivity reaction or another type of skin reaction in the patient. The nurse instructs the patient to increase fluid intake to avoid the risk of crystalluria. Sulfonamide antibiotics do not have any interaction with milk products or citrus fruits, so these can be consumed.

The patient has been prescribed sulfamethoxazole/trimethoprim. The nurse notes that the patient has a history of kidney stones. What is the highest priority instruction for the nurse to give to the patient? 1. "Take the medication on a full stomach." 2. "Take the medication on an empty stomach." 3. "Take the medication with a full glass of fluid." 4. "Take the medication at regularly spaced intervals."

3. "Take the medication with a full glass of fluid." Of the instructions provided, the only one that would affect the prevention of kidney stones is to take the medication with a full glass of fluid. Sulfamethoxazole/trimethoprim may be taken with or without food. Although the medication should be taken at regularly spaced intervals, this will not have an impact on the development of kidney stones.

The patient has been started on a medication regimen that includes sulfamethoxazole/trimethoprim. The nurse notes that the source of the patient's infection has been determined to be viral in origin. What is the nurse's highest priority action? 1. Administer the medication as ordered by the provider. 2. Ensure that the information is documented in the chart. 3. Contact the health care provider to discuss the medication. 4. Ask the patient if he knows how he contracted the infection.

3. Contact the health care provider to discuss the medication. The health care provider should be contacted regarding the ordering of sulfamethoxazole/trimethoprim for this patient because it has not been shown to be effective in treating viral infections.

For which adverse effect should the nurse be alert in a patient who is taking tobramycin as an antibiotic therapy? 1 Nausea 2 Confusion 3. Hearing loss 4 Pain on injection

3. Hearing loss Tobramycin belongs to the class of aminoglycosides, whose adverse effects may cause hearing loss or ototoxicity. Pain on injection is an adverse effect of gonadotropin-releasing hormone (GnRH) agonists. Confusion is an adverse effect of interferons. Nausea is an adverse effect of antineoplastic drugs.

The nurse is observing a few patients. Which patient does the nurse suspect to be most prone to health care-associated infection? 1. Patient A 2. Patient B 3. Patient C 4. Patient D

3. Patient C Health care-associated infections (HAIs) are most common among patients in critical care, dialysis, oncology, transplant, and burn units because of the reliance on various devices such as mechanical ventilators, catheters, intravenous infusion lines, and dialysis equipment. Patient C, with fourth-stage chronic renal failure, is on dialysis and is therefore more prone to HAIs. The patients with osteonecrosis of the knee, hypertension, and who underwent joint replacement are less prone to HAIs.

A patient is prescribed cefuroxime for a respiratory tract infection. Which drug allergy, if present in the patient's medical history, may indicate the need for change of prescription? 1. Aztreonam 2. Imipenem/cilastatin 3. Penicillin V potassium 4. Sulfamethoxazole/trimethoprim

3. Penicillin V potassium Cefuroxime is a cephalosporin antibiotic that has a cross-interaction with penicillin antibiotics. A patient who developed allergic reactions with penicillin may develop an allergic reaction to cephalosporin as well. Therefore the prescription needs to be changed. Aztreonam is a monobactam antibiotic and does not manifest a cross-reaction with cephalosporin. Imipenem/cilastatin is a semisynthetic carbapenem antibiotic and does not interact with cephalosporin. Sulfamethoxazole/trimethoprim is a sulfa drug and does not have cross-reaction with cephalosporin

A patient with a respiratory infection is treated with doxycycline. At the follow-up visit, the nurse finds that the signs and symptoms of infection have not subsided. Which patient action might have caused a reduction in the therapeutic effect of the drug? 1. The patient took the medication with salt crackers. 2. The patient refrained from going out in the sunlight. 3. The patient took the medication with a glass of milk. 4. The patient refrained from taking antacids along with the medication.

3. The patient took the medication with a glass of milk. Doxycycline is a tetracycline antibiotic. The absorption of the medication may be reduced if it binds with calcium, magnesium, or iron. Therefore the patient should stay away from dairy products, antacids, and iron supplements when taking this medication. Taking medications with salt crackers helps to reduce gastrointestinal irritation. Direct exposure to sunlight may cause photosensitivity reaction, but does not reduce the drug efficacy. Antacids should be avoided with the medication because they can reduce its efficacy.

The nurse demonstrates knowledge of use of calcium-channel blockers (CCBs) for management of hypertension by making which statement to the patient? 1 "CCBs promote excretion of water." 2 "CCBs block reabsorption of sodium." 3 "CCBs increase blood return to heart." 4 "CCBs relax vascular smooth muscle."

4 "CCBs relax vascular smooth muscle." By blocking calcium channels, CCBs inhibit muscle contraction in the coronary arteries and peripheral arteries, resulting in vasodilation, improved blood flow to the myocardium, and decreased blood pressure. CCBs have no direct role in sodium or water activity. Because CCBs decrease blood return to the heart, preload is reduced.

Which comment by the patient indicates understanding about the use of enalapril for treatment of hypertension? 1 "I cannot go out in the sun while on this therapy." 2 "I should stop the drug if I have ringing in my ears." 3 "If I feel tired, I should call the health care provider." 4 "If I develop a chronic cough, I need to notify my health care provider."

4 "If I develop a chronic cough, I need to notify my health care provider." The medication cannot be stopped abruptly, because this can cause rebound hypertension. The patient is typically tired at the beginning of therapy and should not stop the medication. The medication should not be taken with an antacid, because this may delay absorption. Using a hot tub or staying in hot temperatures for long periods is not recommended because of the resulting hypotension.

What should the nurse inform a patient about allergic reactions to an antibacterial drug? 1 "Allergic reactions always manifest as urticaria or pruritus." 2 "An allergic reaction will only occur after the first dose of medication." 3 "Any adverse effect of an antibacterial is considered an allergic reaction." 4 "Stop taking the medication immediately at the first sign of an allergic reaction."

4 "Stop taking the medication immediately at the first sign of an allergic reaction." If an allergic reaction occurs, the patient should stop taking the drug and report to the primary health care provider immediately. Possible reactions include anaphylaxis, skin rashes, urticaria, or bronchospasm. Allergic reactions are not limited to urticaria or pruritus and may also manifest as rashes or shortness of breath. These reactions are possible after either the first or the successive doses of a medication. An allergy is a side effect of a medication.

A primary health care provider prescribes an antacid to a patient who is taking ciprofloxacin. What information should the nurse mention while counseling the patient? 1 "Take both drugs simultaneously." 2 "Take the drug on an empty stomach." 3 "Take the antacid every alternate day." 4 "Take the antacid 2 hours before the drug."

4 "Take the antacid 2 hours before the drug." The nurse should instruct the patient to take the antacid 2 hours before taking ciprofloxacin to improve the drug's absorption. Ciprofloxacin causes gastric irritation when administered on an empty stomach. The antacids should not be taken on alternate days, because this may not help prevent gastrointestinal problems. Ciprofloxacin interacts with antacids, and this decreases the absorption of the ciprofloxacin.

The nurse is teaching a patient about the reason for the administration of calcium channel blockers. What statement should be included in the teaching plan? 1 "This medication will help your body to get rid of sodium." 2 "This medication will work to cause your body to get rid of fluid." 3 "This medication will help you to lose weight to lower your blood pressure." 4 "This medication will vasodilate your blood vessels to lower your blood pressure."

4 "This medication will vasodilate your blood vessels to lower your blood pressure." Calcium channel blockers cause vasodilation and are used for hypertension to lower blood pressure. They cause direct vasodilation by blocking calcium influx in smooth muscles in the blood vessels. This medication class does not help to rid the body of fluids, decrease sodium, or help the patient to lose weight.

The nurse is assessing a patient who is prescribed sulfamethoxazole/trimethoprim (co-trimoxazole). What instruction does the nurse give to the patient before the administration of sulfamethoxazole/trimethoprim (co-trimoxazole)? 1 "Eat more high-protein foods." 2 "Avoid eating high-calorie foods." 3 "Avoid consumption of dairy products." 4 "Use any method other than oral contraception for birth control."

4 "Use any method other than oral contraception for birth control." Sulfamethoxazole/trimethoprim (co-trimoxazole) is a sulfonamide antibiotic. Sulfonamide antibiotics reduce the efficacy of oral contraceptives, which may result in unintended pregnancy. Therefore the nurse should instruct the patient to switch over to another method of contraception to prevent unwanted pregnancy. Sulfamethoxazole/trimethoprim (co-trimoxazole) does not interact with high-protein foods. Dairy products and high-calorie foods do not interfere with metabolism of sulfamethoxazole/trimethoprim (co-trimoxazole).

Which patient with hypertension would benefit most from receiving an alpha1 blocker? 1 A pregnant patient 2 A patient with asthma 3 A patient with an increased heart rate 4 A patient with benign prostatic hyperplasia

4 A patient with benign prostatic hyperplasia An alpha1 blocker will increase urinary flow rates and decrease outflow obstruction by preventing smooth muscle contraction in the bladder neck and urethra. This can be beneficial to a patient with benign prostatic hyperplasia. A pregnant patient, a patient with asthma, or a patient with an increased heart rate would not benefit from this medication.

The nurse is administering amlodipine. What assessment finding requires immediate action? 1 Calcium level of 8 mEq/dL 2 Potassium level of 5 mEq/dL 3 Apical pulse of 100 beats/min 4 Blood pressure of 80/60 mm Hg

4 Blood pressure of 80/60 mm Hg Amlodipine is the most common calcium channel blocker used for hypertension. Blood pressure that goes below 100 mm Hg should be reported to the health care provider immediately, and the medication should be held. The patient's calcium and potassium levels and apical pulse are within normal limits and do not require immediate action.

Which laboratory value will the nurse report to the health care provider as a potential adverse response to hydrochlorothiazide? 1 Calcium level of 9 mg/dL 2 Sodium level of 140 mEq/L 3 Chloride level of 100 mEq/L 4 Fasting blood glucose level of 140 mg/dL

4 Fasting blood glucose level of 140 mg/dL Hydrochlorothiazide can cause hyperglycemia; normal fasting blood glucose should be 60 to 110 mg/dL. Normal calcium level is approximately 8.8 to 10.3 mg/dL, normal sodium level is 135 to 147 mEq/L, and normal chloride level is 95 to 107 mEq/L.

A patient is prescribed sulfadiazine. After checking the patient's history, the nurse finds that the patient has glucose-6-phosphate dehydrogenase (G6PD) deficiency. What will the nurse do in this situation? 1 The nurse requests testing for Clostridium difficile. 2 The nurse requests culture and sensitivity testing for the patient. 3 The nurse anticipates administering sulfadiazine in a higher dose to the patient. 4 The nurse contacts the primary health care provider before administration of the drug.

4 The nurse contacts the primary health care provider before administration of the drug. Sulfadiazine belongs to the class of sulfonamides. The administration of sulfonamides to a patient with G6PD deficiency may result in hemolysis, or destruction of red blood cells. Therefore the nurse should inform the primary health care provider before administration of the drug. Culture and sensitivity testing is helpful to optimize drug selection in individual cases, but it does not help to reduce the risk of hemolysis. Clostridium difficile infection testing is required when the patient has symptoms such as watery diarrhea, abdominal pain, and fever. The nurse does not find these symptoms in this patient; therefore this test is not needed. The nurse should not administer sulfadiazine in higher doses to the patient because this may result in severe complications.

The nurse is caring for an adult male patient who is hypertensive and is being treated with transdermal clonidine patches. Which is the most appropriate site for the patient to use in applying the patches? 1 Chest 2 Forearm 3 Lower leg 4 Upper arm

4 Upper arm Transdermal clonidine patches should be applied to nonhairy areas of the skin for best contact. In an adult male patient, the chest, forearm and lower leg would typically have hair growth.

A patient is prescribed demeclocycline for the treatment of a respiratory infection. What instruction does the nurse give to the patient to ensure safe and effective administration of the drug? 1. "Avoid eating high-protein foods." 2. "Avoid eating high-calorie foods." 3. "Avoid eating low-carbohydrate foods." 4. "Avoid the consumption of dairy products."

4. "Avoid the consumption of dairy products." Food-drug interaction occurs between demeclocycline and dairy products, which results in decreased gastrointestinal absorption of demeclocycline. If the gastrointestinal absorption of demeclocycline is decreased, it may not have therapeutic effects, so the nurse should instruct the patient to avoid consumption of dairy products. Because demeclocycline does not cause any interaction with high-protein foods, low-carbohydrate foods, or high-calorie foods, the patient can consume such items.

Oral sulfamethoxazole/trimethoprim is prescribed for a patient and is being administered four times a day. What is the nurse's best action? 1. Instruct the patient about potential constipation. 2. Schedule the medication before meals and at bedtime. 3. Instruct the patient not to drink milk with the medication. 4. Call the provider to discuss changing the frequency of the dose.

4. Call the provider to discuss changing the frequency of the dose. The patient should receive sulfamethoxazole/trimethoprim twice a day. The nurse should call the health care provider to clarify this order. The medication should not be scheduled four times a day, is not expected to cause constipation, and should not have an interaction with milk.

The patient has been diagnosed with Legionnaires' disease. Which drug does the nurse anticipate the provider will order? 1. Aztreonam 2. Lincomycin 3. Daptomycin 4. Erythromycin

4. Erythromycin Macrolides, such as erythromycin, are effective against Legionella (one species of that causes Legionnaires' disease). Aztreonam, lincomycin, and daptomycin do not exert antibacterial activity against Legionella.

The nurse is caring for a patient who has been prescribed cefazolin sodium. Which nursing assessment is the priority? 1. Cardiac assessment 2. Neurologic assessment 3. History of immunizations 4. History, including allergies

4. History, including allergies Antibiotic allergy is one of the most common drug allergies. These allergies also have the potential to cause severe anaphylaxis and death and, therefore, have more importance than assessing cardiac or neurologic function or the history of immunizations.

Which class of penicillin antibiotics is known as antistaphylococcal penicillins? 1. Aminopenicillins 2. Natural penicillins 3. Extended-spectrum drugs 4. Penicillinase-resistant penicillins

4. Penicillinase-resistant penicillins Penicillinase-resistant drugs are known as antistaphylococcal penicillins. These include cloxacillin, dicloxacillin, nafcillin, and oxacillin. The penicillinase-resistant penicillins are able to resist breakdown by the penicillin-destroying enzyme (penicillinase), which is commonly produced by bacteria such as staphylococci. Therefore this class of drug is called antistaphylococcal penicillins. Natural penicillin drugs, aminopenicillin drugs, and extended-spectrum drugs are easily broken down by the penicillinase enzyme. Therefore these drugs are not called antistaphylococcal penicillins.

Which medication may sometimes be overlooked when considering penicillin allergies in patients? 1. Amoxicillin (Amoxil) 2. Ampicillin (Totacillin) 3. Penicillin V potassium (V-Cillin K) 4. Piperacillin/tazobactam (Zosyn)

4. Piperacillin/tazobactam (Zosyn) The brand name of Zosyn does not have the suffix "-cillin." For amoxicillin (Amoxil), ampicillin (Totacillin), and V potassium (V-Cillin K), "amoxil" or "-cillin" is mentioned in the brand name.

Which antibiotic may cause hemolysis in a patient who has glucose-6-phosphate dehydrogenase (G6PD) deficiency? 1. Penicillin 2. Quinolone 3. Tetracycline 4. Sulfonamide

4. Sulfonamide G6PD deficiency is an inherited disorder in which the red blood cells are partially or completely deficient in the enzyme G6PD. It is an enzyme that is required in the metabolism of glucose. Sulfonamide antibiotics may cause hemolysis in a patient who has G6PD deficiency. Penicillin antibiotics, quinolone antibiotics, and tetracycline antibiotics do not cause hemolysis in patients who have G6PD deficiency.

A patient is administered cefotetan for a urinary tract infection. After 2 days, the patient complains of stomach cramps, nausea, vomiting, excessive sweating, itching, and headache. The patient also has decreased blood pressure. What does the nurse interpret from the assessment? 1. The patient had taken ranitidine in addition to the cefotetan. 2. The patient had taken probenecid in addition to the cefotetan. 3. The patient had taken methotrexate in addition to the cefotetan. 4. The patient had taken ethanol (alcohol) in addition to the cefotetan.

4. The patient had taken ethanol (alcohol) in addition to the cefotetan. Cefotetan is a second-generation cephalosporin antibiotic. Combining ethanol (alcohol) and cefotetan causes a drug-drug interaction. If the patient drinks alcoholic beverages within 72 hours of taking cefotetan, it causes a disulfiram-like reaction. Stomach cramps, nausea, vomiting, excessive sweating, itching, headache, and hypotension are symptoms of a disulfiram-like reaction. Ranitidine interacts with cefotetan and decreases the effectiveness of cefotetan. Probenecid interacts with cefotetan and increases cephalosporin levels in the body. Methotrexate does not cause any interaction with cefotetan. Methotrexate interacts with penicillin and decreases its renal elimination. As a result, methotrexate levels in the body are increased.

What is the principal indication for sulfamethoxazole-trimethoprim (SMZ-TMP)? 1. Meningeal infection 2. Bacterial pneumonia 3. Bacterial endocarditis 4. Urinary tract infection

4. Urinary tract infection The primary indication for sulfonamide therapy is urinary tract infection because these drugs achieve high concentrations in the kidneys.

Which medication may sometimes be overlooked when considering penicillin allergies in patients? 1 Amoxicillin (Amoxil) 2 Ampicillin (Totacillin) 3 Penicillin V potassium (V-Cillin K) 4 Piperacillin/tazobactam (Zosyn)

4.Piperacillin/tazobactam (Zosyn) The brand name of Zosyn does not have the suffix "-cillin." For amoxicillin (Amoxil), ampicillin (Totacillin), and V potassium (V-Cillin K), "amoxil" or "-cillin" is mentioned in the brand name.