PHARM - Immune

The client has been prescribed amikacin. Which priority baseline function should the nurse determine needs to be monitored?

Hearing acuity Rationale: Amikacin is an antibiotic. This medication can cause ototoxicity and nephrotoxicity; therefore, hearing acuity tests and kidney function studies should be performed before the initiation of therapy. Apical pulse, liver function studies, and blood pressure are not specifically related to the use of this medication.

The nurse is assisting in preparing a plan of care for the client diagnosed with acquired immunodeficiency syndrome (AIDS) who will be receiving ganciclovir. The nurse determines that which intervention should be included in the plan of care?

Instruct the client to use an electric razor for shaving. Rationale: Ganciclovir causes neutropenia and thrombocytopenia as the most frequent side effects. For this reason, the nurse monitors the client for signs and symptoms of bleeding and implements the same precautions that are used for a client receiving anticoagulant therapy. Thus, the client should be instructed to use an electric rather than a straight razor for shaving. The medication does not have to be taken on an empty stomach or without food. Additionally, the medication does not have to be taken with an antacid; in fact, an antacid may affect absorption. The medication may cause hypoglycemia but not hyperglycemia.

The client taking metronidazole for the treatment of Trichomonas vaginalis calls the nurse employed in the primary health care provider's office concerned because of a feeling of tingling and numbness in the extremities. Which instructions should the nurse provide to the client?

Report to the clinic to see the primary health care provider immediately. Rationale: Metronidazole should be monitored for neurotoxicity. The primary health care provider should be seen if numbness or tingling occurs. Increasing fluid intake discontinuing the medication or indicating this is a harmless side effect are inappropriate options

The nurse working in a pediatric clinic is preparing to administer childhood vaccinations to a 15-month-old child. Which vaccine should be added to the child's routine immunizations at this time because the child is older than 12 months of age?

Varicella Rationale: Varicella vaccine is recommended at any visit at or after age 12 months for susceptible children (i.e., children who lack a reliable history of chickenpox and have not been vaccinated). The other vaccines are administered on or before age 1 year.

The nurse is taking a health history on the client seen in the health care clinic for the first time. When the nurse asks the client about current prescribed medications, the client tells the nurse that amprenavir is prescribed twice daily. Based on this finding, the nurse should elicit data from the client regarding the presence of which condition?

Human immunodeficiency virus (HIV) Rationale: Amprenavir is an antiretroviral agent, classified as a protease inhibitor, used to treat HIV infection. It is not used to treat peptic ulcer disease, inflammatory bowel disease, or CAD.

The nurse is preparing to administer ribavirin to the child with a diagnosis of respiratory syncytial virus (RSV). The pharmacy dispenses the medication as a powder. Which action should the nurse perform in preparation to administer the medication?

Mixing the medication as prescribed and administering by inhalation Rationale: Ribavirin is active against RSV, influenza virus types A and B, and herpes simplex virus. It is administered by inhalation, and the medication is absorbed from the lungs and achieves high concentrations in respiratory tract secretions and erythrocytes. It is not administered orally, subcutaneously, or intramuscularly.

The client has been given a prescription for trimethoprim. The nurse should determine the client understands how to use the medication properly if the client states an intention to perform which action?

Drink extra fluids while taking the medication. Rationale: Trimethoprim is a sulfonamide used to treat urinary tract infections. Each dose of trimethoprim should be taken with a full glass of water, and the client should maintain a high fluid intake. The client should not be instructed to discontinue the medication. Some forms of sulfonamides cause the urine to turn dark brown or red. This is an expected effect, and the client does not need to notify the primary health care provider.

Cyclosporine is prescribed for the client following an allogenic kidney transplant. The nurse should reinforce which instructions to the client regarding this medication?

Blood levels of the medication will need to be measured periodically. Rationale: Cyclosporine is an immunosuppressant. To avoid toxicity from high drug levels and to avoid organ rejection from low drug levels, blood levels of cyclosporine should be measured periodically. In the organ transplant client, an immunosuppressant will need to be taken for life. Oral administration is the route of choice; intravenous administration is reserved for clients who cannot take the medication orally. The most serious adverse effects are nephrotoxicity and infection.

The nurse reinforces instructions to the client prescribed to take cyclosporine oral solution. Which instruction should the nurse primarily include?

Mix the concentration with chocolate milk. Rationale: To improve palatability, the client should be taught to mix the concentrated medication solution with chocolate milk or orange juice just before administration. Grapefruit juice can raise cyclosporine levels. The client is instructed to dispense the oral liquid into a glass container using a specially calibrated pipette; mix it well and drink it immediately; fill the container with a diluent such as water and drink it to ensure ingestion of the complete dose; dry the outside of the pipette and return to its cover for storage.

The client prescribed infliximab via intravenous (IV) injection is complaining of difficulty swallowing. Which should be the initial nursing action?

Notify the registered nurse (RN). Rationale: Infliximab is a monoclonal antibody and gastrointestinal anti-inflammatory. Allergic reactions and anaphylaxis can occur from this medication and can be fatal. This complaint could be the first sign of an anaphylactic reaction. The RN must be notified, and it is imperative that the infusion be shut off as soon as possible. Then the primary health care provider must be notified. An antihistamine such as diphenhydramine then may be prescribed. Instructing the client to take deep breaths and relax is not a helpful intervention in this situation.

Dapsone is prescribed for the client diagnosed with acquired immunodeficiency syndrome for the treatment of toxoplasmosis. The nurse should reinforce medication instructions and determine that the client understands the instructions if the client makes which statement?

Report a sore throat to the primary health care provider. Rationale: Dapsone may be prescribed for the treatment of toxoplasmosis. The medication is taken orally on a daily basis. The medication suppresses bone marrow activity, and the complete blood count is monitored closely. If the client develops fever, sore throat, purpura, or jaundice, the PHCP is notified because this could indicate infection. Medications are available to treat nausea and vomiting; the client should not discontinue the medication if these symptoms occur, but she should contact the PHCP.

Mycophenolate mofetil is prescribed for the client as prophylaxis for organ rejection following an allogeneic renal transplant. Which instruction should the nurse most reinforce regarding administration of this medication?

Contact the primary health care provider (PHCP) if a sore throat occurs. Rationale: Mycophenolate mofetil should be administered on an empty stomach. The capsules should not be opened or crushed. The client should contact the PHCP if unusual bleeding or bruising, sore throat, mouth sores, abdominal pain, or fever occurs because these are adverse effects of the medication. Antacids containing magnesium and aluminum may decrease the absorption of the medication and therefore would not be taken with the medication. The medication may be given in combination with corticosteroids and cyclosporine.

Which report best indicates to the nurse that the client is experiencing a toxicity-related reaction to kanamycin sulfate?

Difficulty hearing Rationale: Adverse reactions associated with kanamycin sulfate include nephrotoxicity evidenced by an increased BUN and creatinine and decreased creatinine clearance. Irreversible ototoxicity as evidenced by tinnitus, dizziness, ringing in the ears, and reduced hearing, and neurotoxicity as evidenced by headache, dizziness, lethargy, and visual disturbances can occur. Gastrointestinal disturbances can occur as a frequent side effect of the medication. An elevated white blood cell count may occur as a result of the respiratory infection.

The licensed practical nurse employed in the ambulatory clinic is assisting the registered nurse prepare to administer a dose of intravenous immune globulin (IVIG). The licensed practical nurse should ensure that which medication is readily available before the medication is administered?

Epinephrine Rationale: IVIG is an immune serum that increases antibody titer and antigen-antibody reaction, providing passive immunity against infection. Anaphylactic reactions, although rare, can occur, and the nurse ensures that epinephrine is readily available when administering this medication. Protamine sulfate is the antidote for heparin. Vitamin K is the antidote for oral anticoagulants. Acetylcysteine is used to treat acetaminophen overdose.

The nurse notes that the client is receiving lamivudine. The nurse should determine that this medication has been prescribed to most likely treat which condition?

Human immunodeficiency virus (HIV) infection Rationale: Lamivudine is a nucleoside reverse transcriptase inhibitor and antiviral medication. It slows HIV replication and reduces the progression of HIV infection. It also is used to treat chronic hepatitis B and is used for prophylaxis in health care workers at risk of acquiring HIV after occupational exposure to the virus. This medication is not used to treat pancreatitis, pharyngitis, or seizures.

The client diagnosed with acquired immunodeficiency syndrome (AIDS) is prescribed intravenous (IV) pentamidine isethionate. The nurse assigned to care for the client should primarily monitor for signs of which toxic effect related to the administration of this medication?

Hypoglycemia Rationale: Pentamidine isethionate causes severe hypoglycemia that may be fatal. Other toxic effects include hypotension, dysrhythmias, leukopenia, nephrotoxicity, Stevens-Johnson syndrome, hyperglycemia, and type 1 diabetes mellitus. Anorexia and dizziness are side effects that may occur with the administration of this medication, but they are not toxic effects. Hypertension is unrelated to the administration of this medication.

Indinavir is prescribed for the client with a diagnosis of human immunodeficiency virus (HIV). Which medication instruction should the nurse reinforce to the client?

Increase fluid intake to at least 1.5 L/day. Rationale: Indinavir is an antiretroviral agent. This medication can cause kidney stones; therefore, the client is instructed to increase fluid intake to at least 1.5 L/day. The client is also instructed to report sharp back pain or the presence of blood in the urine. The client is instructed to take the medication 1 hour before or 2 hours after a large meal. If the medication needs to be taken with food, the client should consume a light meal, such as dry toast, juice, or a bowl of cereal with milk. Unexplained weight loss must be reported to the primary health care provider.

The client diagnosed with diabetes mellitus has a foot infection and is prescribed antibiotic therapy with an aminoglycoside. The nurse collects data from the client and notes that the client has a hearing loss. The nurse should take which action next?

Inform the registered nurse (RN) about the hearing loss. Rationale: A preexisting hearing loss is a contraindication for the administration of aminoglycosides because these medications can cause ototoxicity and irreversible hearing loss. The nurse should report the findings to the RN to protect the client's safety. The RN will in turn notify the primary health care provider. Have the client drink extra water to avoid toxic side effects and suggest a peak and trough to ensure safe medication administration are not beneficial because hearing loss has already occurred in this client. Nurses do not change medication prescriptions independently.

The client diagnosed as human immunodeficiency virus (HIV) seropositive has been prescribed zalcitabine as a component of treatment. The nurse should instruct the client that which laboratory test will need to be monitored while taking this medication?

Liver function studies Rationale: Zalcitabine is an antiretroviral (nucleoside reverse transcriptase inhibitor) used in the management of HIV infection with other antiretrovirals. It also has been used as a single agent in clients who are intolerant of or who progress on other regimens. It can cause serious liver damage, and liver function studies should be monitored closely.

An oral powder form of nelfinavir is prescribed for the client diagnosed with human immunodeficiency virus (HIV). The nurse should reinforce instructions regarding the preparation of the medication and instruct the client to mix the powder with which substance?

Milk Rationale: Nelfinavir is an antiviral medication used in the treatment of HIV infection when antiretroviral therapy is warranted. It is available in tablet and powder form. The powder form is prepared by mixing the dose with a small amount of water, milk, formula, soy milk, or dietary supplements. The powder is not mixed with acidic foods or juices such as apple juice or applesauce, orange juice, or grapefruit juice.

The nurse is reinforcing medication instructions to the client with a diagnosis of human immunodeficiency virus (HIV) who is prescribed saquinavir. Which instruction should the nurse most appropriately provide the client in regard to taking this medication?

Within 2 hours after a full meal Rationale: Saquinavir is an antiviral medication. It is administered within 2 hours after a full meal. If the medication is taken without food in the stomach, it may result in no antiviral activity

The client who received a kidney transplant is taking azathioprine, and the nurse reinforces instructions about the medication. Which statement by the client indicates a need for further teaching?

"I need to discontinue the medication after 14 days of use." Rationale: Azathioprine is an immunosuppressant medication that is taken for life. Because of the effects of the medication, the client must watch for signs of infection, which are reported immediately to the PHCP. The client should also call the PHCP if more than one dose is missed. The medication may be taken with meals to minimize nausea.

The nurse reinforces medication instructions to the client who had a kidney transplant about therapy with cyclosporine. Which statement by the client should indicate a need for further teaching?

"I need to obtain a yearly influenza vaccine." Rationale: Cyclosporine is an immunosuppressant medication. Because of the medication's effects, the client should not receive any vaccinations without first consulting the PHCP. The client should report decreased urine output or cloudy urine, which could indicate kidney rejection or infection, respectively. The client must be able to self-monitor blood pressure to check for the side effect of hypertension. The client needs meticulous oral care and dental cleaning every 3 months to help prevent gingival hyperplasia.

The nurse is assisting in caring for the client diagnosed with a respiratory tract infection who is prescribed intravenous tobramycin sulfate. The nurse is instructed to monitor for adverse effects of the medication. The nurse should determine that which finding is most indicative of an adverse effect of this medication?

Vertigo Rationale: Ringing in the ears and vertigo are two symptoms that may indicate dysfunction of cranial nerve VIII. Ototoxicity is a frequent adverse effect of therapy with aminoglycosides and could result in permanent hearing loss. If this occurs, the primary health care provider should be notified. Nausea, vomiting, and hypotension are rare side effects of the medication.

The client newly diagnosed with gout has been prescribed allopurinol. The nurse should question the primary health care provider if the dose for which medication already prescribed has not changed?

Warfarin sodium Rationale: Allopurinol is an antigout medication that may increase the effect of oral anticoagulants. Warfarin sodium is an anticoagulant, and if this medication was prescribed for the client, the nurse should verify the prescription. The dose of warfarin sodium may need to be decreased. Adenosine is an antidysrhythmic. Digoxin is a cardiac glycoside. Ergonovine maleate is an antimigraine medication.

The client is prescribed sulfisoxazole. Which measure should the nurse monitor to determine if the therapy is effective?

White blood cell count Rationale:Sulfisoxazole is an anti-infective used primarily to treat urinary tract infections. The effectiveness of the medication may be evaluated by monitoring the client's white blood cell count, which should decrease to within normal limits with therapy. The client should also experience relief of symptoms. This medication is not used as an antihypertensive, hypoglycemic agent, or to treat anemia.

Ketoconazole is prescribed for an assigned client. The nurse should prepare to administer the medication in which manner?

With food Rationale: Ketoconazole is an antifungal medication. It should be administered with food to minimize gastrointestinal irritation. Options 2, 3, and 4 are incorrect. The medication requires acidity and should be administered at least 2 hours apart from an antacid.

The nurse has reinforced discharge instructions to the mother of a child who is prescribed tetracycline to treat Rocky Mountain spotted fever (RMSF). Which statement by the mother indicates the best understanding regarding the administration of the medication?

"I need to use a straw when I give the medication." Rationale: Because tetracycline hydrochloride can cause staining of the teeth, straws should be used, and the mouth should be rinsed after administration. Option 4 is not necessary. The medication should be administered 1 hour before or 2 hours after the administration of milk. A full glass of water rather than a sip should be taken with the medication.

Saquinavir is prescribed for the client diagnosed as human immunodeficiency virus (HIV) seropositive. The nurse should reinforce medication instructions and determine that the client needs further teaching if the client makes which statement?

"I will take the medication on an empty stomach." Rationale: Saquinavir is an antiretroviral (protease inhibitor) used in combination with other antiretroviral medications in the management of HIV infection. It is administered with meals and is best absorbed if the client consumes high-calorie, high-fat meals. It can cause photosensitivity, and the client is instructed to avoid sun exposure.

Efavirenz, an antiviral medication, is prescribed for the client diagnosed with human immunodeficiency virus (HIV) infection. Which time should the nurse instruct the client to be best to take this medication?

At bedtime Rationale:Because the medication causes temporary nervous system side effects during the first 2 to 4 weeks of therapy, the client is instructed to take the medication at bedtime. Because of the nervous system effects, taking the medication with breakfast, lunch and dinner are not recommended administration times.

Saquinavir is prescribed for the client who is diagnosed with human immunodeficiency virus (HIV) seropositive. The nurse should reinforce medication instructions about which health care measure to the client?

Avoid sun exposure. Rationale: Saquinavir is an antiretroviral (protease inhibitor) used with other antiretroviral medications to manage HIV infection. Saquinavir is administered with meals and is best absorbed if the client consumes high-calorie, high-fat meals. Saquinavir can cause photosensitivity, and the nurse should instruct the client to avoid sun exposure.

The client with a diagnosis of human immunodeficiency virus (HIV) who has contracted tuberculosis (TB) asks the nurse how long the medication therapy lasts. Which duration of treatment should the nurse explain to the client?

9 total months and at least 6 months after cultures convert to negative Rationale: The client with TB who is coinfected with HIV requires that antitubercular therapy last longer than usual. The prescription is usually for a total of 9 months and at least 6 months after sputum cultures convert to negative.

Nalidixic acid is prescribed for the client diagnosed with a urinary tract infection. Reviewing the client's record, the nurse notes that the client is prescribed warfarin on a daily basis. Which prescription should the nurse anticipate because the client is taking this oral anticoagulant?

A reduction in the anticoagulation dosage Rationale: Nalidixic acid can intensify the effects of oral anticoagulants. When an oral anticoagulant is combined with nalidixic acid, a reduction in the anticoagulant dosage may be needed.

The client has been prescribed nitrofurantoin sodium. The nurse should determine the therapy is effective if which result is noted?

Absence of dysuria Rationale: Nitrofurantoin sodium is an antibacterial agent and is used to treat acute urinary tract infection or as chronic suppressive treatment of urinary tract infection. It is not effective with systemic bacterial infections. Because dysuria is a sign of a urinary tract infection, this is the only correct option.

The child is diagnosed with tinea capitis of the scalp. Oral griseofulvin has been prescribed for the child, and the nurse provides instructions regarding the administration of the medication. Which instructions should the nurse include to the mother?

Administer the medication with milk. Rationale: Griseofulvin (topical and oral) is the treatment of choice for tinea capitis. For topical treatment to be effective, topical medication must penetrate the hair follicles. Topical therapy alone is not effective, and oral medication is prescribed. Because the medication is insoluble in water, absorption of the medication is improved if it is taken with a high-fat meal or with milk.

The client diagnosed with acquired immunodeficiency syndrome (AIDS) has begun therapy with zidovudine. The nurse should monitor which laboratory result during treatment with this medication?

Complete blood count (CBC) Rationale: A common side/adverse effect of therapy with zidovudine is leukopenia and anemia. The nurse monitors the complete blood count results for these changes.

The nurse is assigned to care for the client with a diagnosis of toxoplasmosis. The primary health care provider has prescribed sulfasalazine. The nurse preparing to administer the medication should determine that this medication is in which drug category?

Sulfonamide Rationale: Sulfasalazine is a sulfonamide and produces anti-inflammatory and antibacterial effects.

The nurse has a routine prescription to instill erythromycin ointment into the eyes of the newborn. The nurse should explain to the parents that this medication is used for which primary purpose?

To protect the newborn from contracting an eye infection from the birth process Rationale: The use of eye prophylaxis with an agent such as erythromycin protects the newborn from contracting a conjunctival infection during birth. This infection, called ophthalmia neonatorum, results from maternal vaginal infection with chlamydia or gonorrhea. This prophylaxis is mandatory in the United States.

Lamivudine is prescribed for the client diagnosed with human immunodeficiency virus (HIV) who is prescribed zidovudine. Which should the nurse reinforce in the medication instructions to the client?

To report vomiting or abdominal pain to the primary health care provider Rationale: Lamivudine is an antiretroviral agent administered in combination with zidovudine to delay the appearance of zidovudine resistance. Lamivudine is well absorbed orally with or without food. Peripheral neuropathy can occur with its use, and the client is instructed to notify the primary health care provider if burning, numbness, or tingling of the hands, arms, feet, or legs occurs. Pancreatitis, evidenced by nausea, vomiting, and abdominal pain, is also an adverse effect of the medication and requires primary health care provider notification.

The nurse is emphasizing discharge instructions to the mother of the child who has been prescribed tetracycline hydrochloride. The nurse should most appropriately stress the importance of which instruction?

Use a straw when the child is taking the medication. Rationale:Because tetracycline hydrochloride can stain the teeth, straws should be used and the mouth should be rinsed after administration. The medication should be administered 1 hour before or 2 hours after the administration of milk.

The nurse is caring for the client diagnosed with a skin infection who is prescribed amoxicillin 500 mg every 8 hours. Which sign/symptom should indicate to the nurse that the client is experiencing a frequent side effect related to the medication?

Vaginal drainage Rationale: Amoxicillin is a type of penicillin. Frequent side effects include mild gastrointestinal disturbances, headache, and oral or vaginal candidiasis. A less common but more harmful adverse effect that can occur includes superinfection, such as potentially fatal antibiotic-associated colitis, which results from altered bacterial balance. Symptoms include severe abdominal cramps, severe watery diarrhea, and fever.

The client who is diagnosed with human immunodeficiency virus (HIV) seropositive has been taking stavudine. The nurse should monitor which parameter closely while the client is taking this medication?

Gait Rationale: Stavudine is an antiretroviral used to manage HIV infection in clients who do not respond to or who cannot tolerate conventional therapy. The medication can cause peripheral neuropathy, and the nurse should monitor the client's gait closely and ask the client about paresthesia.

The nurse employed in a neighborhood health care clinic notes that the primary health care provider has prescribed oseltamivir. The nurse should reinforce teaching the client specific home care measures after determining this medication was prescribed for which condition?

Influenza virus Rationale: Oseltamivir is an oral antiviral medication used to treat influenza A and B virus. It is not used to treat herpes simplex, herpes zoster, or varicella zoster.

The client taking fexofenadine is scheduled for allergy skin testing and tells the nurse in the primary health care provider's office that a dose was taken that morning. Which should the nurse anticipate happening as a result?

The client will need to reschedule the appointment. Rationale: Fexofenadine is an antihistamine, which provides relief of symptoms caused by allergy. Antihistamines should be discontinued for at least 3 days (72 hours) before allergy skin testing to avoid false-negative readings. This client should have the appointment rescheduled for 3 days after discontinuing the medication.

Vancomycin has been prescribed for the client. The nurse should plan to monitor which item associated with effectiveness of this medication?

Therapeutic serum levels Rationale: Vancomycin is classified as a tricyclic glycopeptide antibiotic and acts by producing a bactericidal effect. Therapeutic serum levels are drawn on a regular basis to ensure effectiveness of this medication. The nurse should monitor hearing acuity, kidney function studies, and heart rate and blood pressure because this medication can be ototoxic, nephrotoxic, and cardiotoxic; however, these findings are not associated specifically with the effectiveness of this medication.

Stavudine is prescribed for the client diagnosed with advanced human immunodeficiency virus (HIV). The nurse reinforcing medication instructions to the client should instruct the client about the importance of reporting which sign/symptom to the primary health care provider?

Tingling in the extremities Rationale: Peripheral neuropathy, characterized by numbness, tingling, or pain in the hands or feet, can occur frequently with this medication and is an adverse effect. Headache, diarrhea (not constipation), and fatigue are side effects of the medication.

The nurse is preparing to administer pentamidine isethionate to an assigned client by the intramuscular route. Which most appropriate parameter should the nurse monitor while administering this medication?

Blood pressure (BP) Rationale: Pentamidine isethionate is an anti-infective medication. Life-threatening and fatal hypotension can occur following the administration of this medication. The client must be in a supine position with frequent BP checks following administration.

The clinic nurse prepares to administer an MMR (measles, mumps, rubella) vaccine to the child. The nurse should administer this vaccine by which method?

Subcutaneously in the outer aspect of the upper arm Rationale: The MMR vaccine is administered subcutaneously in the outer aspect of the upper arm. The gluteal muscle is most often used for intramuscular injections. The MMR vaccine is not administered by the intramuscular route.

Moxifloxacin is prescribed for the client with a diagnosis of community-acquired pneumonia. The client needs to take the medication for 10 days, and the nurse reinforces instructions to the client about the medication. Which statement by the client best indicates an understanding of the medication instructions?

"I need to wear sunscreen and protective clothing when outdoors." Rationale: Moxifloxacin is a fluoroquinolone. Increased sensitivity of the skin to sunlight can occur, and the client is instructed to avoid excessive sunlight and artificial ultraviolet light. The client should wear sunscreen and protective clothing when outdoors. The client should also drink fluids liberally and avoid the use of antacids because antacids will decrease absorption of the medication. The medication can cause inflamed and ruptured tendons, and the client is instructed to notify the primary health care provider if inflammation or tendon pain occurs.

The nurse is assigned to care for the client diagnosed with herpes simplex virus (HSV) prescribed acyclovir. The nurse is monitoring for adverse effects of the medication. Which laboratory result should the nurse primarily monitor to identify an adverse effect associated with the use of this medication?

Blood urea nitrogen (BUN) Rationale: The most common reaction related to the administration of this medication is phlebitis and inflammation at the intravenous site of infusion. Reversible nephrotoxicity manifested as elevations in serum creatinine and blood urea nitrogen also occurs in some clients. The cause of nephrotoxicity is the deposition of acyclovir in the renal tubules. The risk of renal injury is increased by dehydration and by the use of other nephrotoxic medications.

Amikacin is prescribed for a client with a diagnosed bacterial infection. The nurse instructs the client to contact the primary health care provider (PHCP) immediately if which occurs?

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

The client prescribed metronidazole calls the clinic nurse to report dark discoloration of the urine. The nurse should interpret that the client's report warrants which nursing action at this time?

Instruct the client to increase oral fluid intake. Rationale: Metronidazole can produce a variety of untoward effects, but they rarely require termination of treatment. Harmless darkening of the urine may occur, and the client should be told of this effect. It is not necessary to discontinue the medication or call the primary health care provider. Increasing fluid intake is a good health measure but will not prevent this side effect from occurring.

The nurse is assisting in caring for the client receiving amphotericin B intravenously (IV) to treat disseminated candidiasis. The nurse reviews the plan of care and should implement which priority action during the administration of the medication?

Monitors urinary output Rationale: Amphotericin B is a toxic medication that can produce symptoms during administration such as chills, fever, headache, vomiting, and impaired renal function. The medication is also very irritating to the IV site, commonly causing thrombophlebitis. The nurse administering this medication watches for all of these problems.

The nurse notes that zidovudine (AZT) has recently been prescribed for the client. The client states, "I've been getting a little nauseated, and I've had a couple of headaches since I was prescribed the AZT. Does this mean I can't take the medicine?" The nurse should make which response to the client?

"These symptoms may become more tolerable as you adjust to ongoing therapy." Rationale: The initial adverse effects of zidovudine include headache, malaise, insomnia, rash, diarrhea, and fever. As zidovudine therapy proceeds, these symptoms become more tolerable. If anemia or neutropenia occurs, the medication will be discontinued or the therapy will be temporarily interrupted.

The client is prescribed oral erythromycin. The nurse should reinforce which instruction regarding the administration of this medication?

Take on an empty stomach. Rationale: Oral erythromycin should be administered on an empty stomach with a full glass of water. Administration is not dependent on physical activity or a specific time of day.

Itraconazole is prescribed for the client diagnosed with a fungal infection of the hands. Which statement by the client best indicates an understanding of the medication?

"If my urine becomes very dark, I should contact my primary health care provider." Rationale: Itraconazole is an antifungal medication. The client should be instructed to take the medication with food because it increases the absorption of the medication. Fluids should be increased to prevent constipation, which can occur as a side effect. Hepatitis is an adverse reaction associated with the medication, and if the client develops any anorexia, abdominal pain, unusual tiredness or weakness, dark urine, or jaundice, the primary health care provider should be notified.

The nurse is caring for the client diagnosed with tuberculosis (TB). Rifampin, 600 mg by mouth daily is prescribed for the client. The nurse reinforces instructions to the client regarding the administration of this medication. Which statement by the client indicates an understanding of the instructions?

"I will need to take the medication for months." Rationale: The client needs to avoid alcohol while taking this medication. The medication should be taken on an empty stomach with 8 ounces of water 1 hour before or 2 hours after meals. The client should be told that urine, feces, sweat, and tears may turn red-orange. The client should also be instructed that doses should not be skipped and that the medication needs to be taken as prescribed for the full length of therapy, which may range from 6 to 9 months up to 1 year. The nurse should note any elevation of the alkaline phosphatase, which would indicate possible hepatotoxicity.

The nurse is reviewing instructions to a client diagnosed with otitis media who is prescribed amoxicillin 500 mg orally every 8 hours. The nurse should determine that which statement by the client most indicates an understanding of the adverse effects related to the medication?

"If I get diarrhea, I need to call the doctor." Rationale:Amoxicillin is a penicillin. Adverse reactions include superinfections such as potentially fatal antibiotic-associated colitis, which results from altered bacterial balance. Symptoms include abdominal cramps, severe watery diarrhea, and fever. The medication does not cause dizziness. The client should not independently stop the medication.

The client with diagnosed acquired immunodeficiency syndrome (AIDS) and Pneumocystis jiroveci infection has been receiving pentamidine. The client develops a temperature of 101° F (38.3° C). The nurse continues to monitor the client, knowing that this sign would most likely indicate which condition?

A result of another infection caused by the leukopenic effects of the medication. Rationale: Frequent side/adverse effects of this medication include leukopenia, thrombocytopenia, and anemia. The client should be monitored routinely for signs and symptoms of infection.

Tacrolimus is prescribed for the client. Which disorder in the client's record should the nurse note that indicates the medication needs to be administered with caution?

Renal insufficiency Rationale: Tacrolimus is used with caution in immunosuppressed clients and those with renal or hepatic function impairment. It is contraindicated in clients with hypersensitivity to this medication or hypersensitivity to cyclosporine.

The client with a diagnosis of human immunodeficiency virus (HIV) prescribed an oral solution of ritonavir complains about the taste of the solution. Which response should the nurse give the client?

"Mix the oral solution with chocolate milk." Rationale: Ritonavir oral solution is preferably administered with a food substance. It may be mixed with chocolate milk or a dietary supplement to improve the taste. The client also is instructed to consume the dose within 1 hour of mixing. It is not necessary to notify the primary health care provider. Taking the medication at bedtime or refrigeration of the medication will not have an effect on the taste of the oral solution.

Zidovudine is prescribed for an adult client diagnosed with human immunodeficiency virus (HIV). Which statement by the nurse should provide the best instruction to the client about the medication?

"Space the medication doses evenly around the clock." Rationale: Zidovudine interferes with HIV replication, slowing the progression of HIV infection. The client is instructed to space the doses of the medication evenly around the clock. Food or milk does not affect the gastrointestinal absorption of the medication. The client is instructed to continue therapy for the full length of treatment. The client also is instructed not to take any medication, including aspirin, without the primary health care provider's approval.

The nurse is reinforcing dietary instructions to the client prescribed cyclosporine. Which priority food item should the nurse instruct the client to avoid?

Grapefruit juice Rationale: A compound present in grapefruit juice inhibits metabolism of cyclosporine. As a result, the consumption of grapefruit juice can raise cyclosporine levels by 50% to 100%, thereby greatly increasing the risk of toxicity. Grapefruit juice needs to be avoided. Red meats; orange juice; and green, leafy vegetables are acceptable to consume.

Ketoconazole is prescribed for a client with a diagnosis of candidiasis. Which interventions should the nurse include when administering this medication? Select all that apply.

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

The nurse is assigned to care for the client diagnosed with cytomegalovirus retinitis and acquired immunodeficiency syndrome (AIDS) who is receiving foscarnet. The nurse should monitor the results of which laboratory study while the client is taking this medication?

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

The client with a diagnosis of acquired immunodeficiency syndrome (AIDS) has a low T4 count. The nurse initiates prophylactic treatment as prescribed with aerosolized pentamidine isethionate and should monitor for which expected outcome?

The client has a respiratory rate and depth within normal limits for activity level. Rationale: Aerosolized pentamidine is given prophylactically to clients with a T4 count below 200 to prevent Pneumocystis jiroveci pneumonia, which is the most common opportunistic infection that occurs in clients with AIDS. A respiratory rate and depth within normal limits for activity level would indicate that the client was not experiencing the respiratory difficulty that is associated with pneumonia. Standard precautions are always maintained on all clients. Although weight loss and electrolyte imbalance can occur in the client with AIDS, these options are not related to this medication.

The client diagnosed with tuberculosis (TB) is prescribed rifampin. The nurse should reinforce which instruction regarding this medication?

Wear glasses instead of soft contact lenses. Rationale: Soft contact lenses may be permanently damaged by the orange discoloration that rifampin causes in body fluids. Any sign of jaundice should always be reported. If rifampin is not tolerated on an empty stomach, it may be taken with food. The client may be on the medication for 12 months even if cultures are negative.

The nurse is admitting the client to the nursing unit who is scheduled for several diagnostic tests. When obtaining a medication history, the nurse discovers that the client is prescribed tacrolimus daily. On further data collection, which should the nurse expect to note in the client history?

Allogenic liver transplant Rationale: Tacrolimus is an immunosuppressant medication used in the prophylaxis of organ rejection in clients receiving allogenic liver transplants. It should be used concurrently with adrenal corticosteroids. It may also be used in clients receiving kidney, bone marrow, heart, pancreas, and small bowel transplants.

The client diagnosed with acquired immunodeficiency syndrome and Pneumocystis jiroveci infection has been prescribed pentamidine isethionate. The nurse assisting in caring for the client should monitor the client most closely for which adverse effect?

Anemia Rationale: Pentamidine isethionate is an anti-infective medication. Adverse effects of this medication include leukopenia, thrombocytopenia, and anemia. The client should be monitored routinely for signs and symptoms of these adverse effects. The client also should have ongoing monitoring of a number of parameters because of the nature and side effects of the medication, including blood glucose, blood urea nitrogen, serum creatinine, complete blood cell count, liver function studies, and serum calcium and magnesium levels.

The 15-year-old child is scheduled to receive a series of the hepatitis B vaccine. The child arrives at the clinic for the first dose. The nurse collects data on the child before administering the vaccine and should ask the child about a history of an allergy to which primary product?

Baker's yeast Rationale: A contraindication to receiving the hepatitis B vaccine is a previous anaphylactic reaction to common baker's yeast. An allergy to eggs, penicillin, and sulfonamides is unrelated to the contraindication to receiving this vaccine.

The nurse is providing vaccine information to the second-day postpartum client who received a rubella vaccine. The nurse should instruct the client to avoid which action after receiving this vaccine?

Becoming pregnant for 2 to 3 months Rationale: Rubella vaccine is a live attenuated virus that provides active immunity for 15 years. Because rubella is a live vaccine, it is potentially teratogenic during the organogenesis phase of fetal development. To avoid this risk, the nurse advises the client to avoid becoming pregnant for 2 to 3 months after receiving the vaccine. Abstinence from sexual intercourse is unnecessary, but an effective form of contraception should be used. The vaccine may cause local or systemic reactions that are mild and self-limiting. Options 1 and 2 are not significant or related to this vaccine.

The client is prescribed tacrolimus to prevent organ rejection. The nurse should expect to administer the dose with which medication that is also normally prescribed?

Prednisone Rationale: Tacrolimus is used for the prevention of organ rejection in clients receiving an organ transplant. Concurrent use of glucocorticoids is recommended during administration of this medication. Prednisone is a glucocorticoid. Fluconazole is an antifungal agent. Carbamazepine is an anticonvulsant. Erythromycin is an antibiotic.

The client diagnosed as human immunodeficiency virus (HIV) seropositive is prescribed stavudine. Which measure should the nurse assess most closely while the client is taking this medication?

Presence of paresthesias Rationale: Stavudine is an antiretroviral (protease inhibitor) used in the management of HIV infection in clients who do not respond to or who cannot tolerate conventional therapy. The medication can cause peripheral neuropathy; the nurse should monitor closely the client's gait and ask the client about paresthesias.

The client diagnosed with acquired immunodeficiency syndrome (AIDS) is taking nevirapine. The nurse should monitor for which side/adverse effects of the medication? Select all that apply.

Rash Hepatotoxicity Rationale: Nevirapine is a nonnucleoside reverse transcriptase inhibitor that is used to treat HIV infection. It is used in combination with other antiretroviral medications to treat HIV. Adverse effects include rash, Stevens-Johnson syndrome, hepatitis, and increased transaminase levels. Hyperglycemia, peripheral neuropathy, and reduced bone density are not side/adverse effects of this medication.

The nurse is reviewing the laboratory results for the client receiving tacrolimus. Which laboratory result should indicate to the nurse that the client is experiencing an adverse effect of the medication?

Blood glucose of 200 mg/dL Rationale: A blood glucose level of 200 mg/dL is elevated above the normal range of 70 to 110 mg/dL and suggests an adverse effect. Other adverse effects include neurotoxicity evidenced by headache; tremor; insomnia; gastrointestinal (GI) effects such as diarrhea, nausea, and vomiting; hypertension; and hyperkalemia.

The nurse is caring for a postrenal transplantation client with prescription for cyclosporine. If the nurse notes an increase in one of the client's vital signs and the client is complaining of a headache, which vital sign is most likely increased?

Blood pressure Rationale: Hypertension can occur in a client taking cyclosporine, and because this client is also complaining of a headache, the blood pressure is the vital sign to be monitored most closely. Other adverse effects include infection, nephrotoxicity, and hirsutism.

The client diagnosed with an infected leg wound that is draining purulent material has a prescription for sodium hypochlorite to be used in the care of the wound. The nurse should perform which priority action while using this solution?

Rinse off the solution immediately following irrigation. Rationale: Sodium hypochlorite is a chloride solution used for irrigating and cleaning either necrotic or purulent wounds. It cannot be used to pack purulent wounds because the solution is inactivated by copious pus. (It can be used to pack necrotic wounds, however.) It should not come into contact with healing or normal tissue, and it should be rinsed off immediately if used for irrigation. The solution is unstable and must be prepared on a regular basis (per agency and pharmacy procedures).

The nurse is reviewing the results of serum laboratory studies drawn on a client diagnosed with acquired immunodeficiency syndrome (AIDS) who is receiving didanosine. The nurse determines that the client may have the medication discontinued by the primary health care provider (PHCP) if which significantly elevated result is noted?

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

The nurse is reinforcing instructions to the client about the use of ceftriaxone, an antibiotic, for treating cervical gonorrhea. The nurse should determine a need for further teaching if the client makes which statement?

"I will take the pills for 20 full days." Rationale: If the client indicates she will be taking pills for 20 days, further teaching is needed. Cervical gonorrhea is treated with one (125 mg) injection of ceftriaxone or one (400 mg) oral dose of cefixime. Allergies to penicillin may contraindicate giving ceftriaxone, and slight discomfort at the injection site is common.

Methenamine is prescribed for the client diagnosed with a gram-positive urinary tract infection. The nurse should question the prescription if which preexisting disorder is noted in the client's record?

Cirrhosis Rationale: Methenamine is contraindicated in clients with renal or hepatic disease or those with severe dehydration. The nurse would question the primary health care provider's prescription for this medication in the client with cirrhosis.

The client with a diagnosis of urinary tract infection is beginning medication therapy with nitrofurantoin. The nurse should realize the need for further teaching if the client states which item will need to be avoided?

Rhubarb Rationale: When a client is taking nitrofurantoin, the urine pH must be maintained in an acid range. The client should consume an acid-ash diet. Rhubarb will reduce the acidity of the urine and should be avoided by the client taking this medication

The client is prescribed trimethoprim-sulfamethoxazole for a recurrent urinary tract infection (UTI). The nurse should reinforce which most appropriate instructions to the client regarding this medication?

"Take each dose with 8 oz of water, and drink extra water each day." Rationale: Trimethoprim-sulfamethoxazole is a sulfonamide. The client takes each dose with 8 oz of water and drinks several extra glasses of water each day. The client should space doses evenly around the clock for stable blood levels and should take medication for the full course of therapy. The client should report rashes or other skin changes, which could indicate an allergy to sulfa.

The client diagnosed with acquired immunodeficiency syndrome has been prescribed zidovudine. The nurse reviewing the primary health care provider's prescription, should expect to note that which laboratory test has been prescribed?

Complete blood count (CBC) Rationale: Zidovudine is a nucleoside-nucleotide reverse transcriptase. An adverse effect of this medication therapy is granulocytopenia and anemia. The nurse carefully monitors the CBC results for these changes. With early human immunodeficiency virus infection or in the client who is asymptomatic, CBC levels are monitored monthly for 3 months, then every 3 months thereafter. In clients with advanced disease, these levels are monitored every 2 weeks for the first 2 months, and then once a month if the medication is tolerated well.

The client diagnosed with acquired immunodeficiency syndrome (AIDS) has an opportunistic respiratory fungal infection and is prescribed intravenous amphotericin B. The nurse assisting in caring for the client should primarily monitor for which sign that indicates an adverse effect of the medication?

Decreased urine output Rationale: Clients receiving amphotericin B may develop nephrotoxicity. Clients should be monitored for oliguria, hematuria, cloudy urine, decreased urine output, and elevated renal function laboratory values. Amphotericin B does not cause the urine to turn orange. Pale stools indicate hepatotoxicity as does jaundice; hepatotoxicity is not an adverse effect.

The nurse is caring for a client prescribed an oral hypoglycemic agent that has just been diagnosed with a urinary tract infection. The primary health care provider plans to treat the infection with sulfamethoxazole. The nurse should expect that because of medication interactions, the primary health care provider will adjust which prescription?

Lower dose of the oral hypoglycemic Rationale: Sulfonamide antibiotics such as sulfamethoxazole can intensify the effects of warfarin, phenytoin, and oral hypoglycemics. Many oral hypoglycemic agents are classified as sulfonylureas. When combined with sulfonamides, these medications may require a reduction in dosage.

The nurse should emphasize which statement when reinforcing instructions to a client about the use of indinavir?

Moisture can affect the potency of the medication. Rationale: To maximize absorption, the medication should be administered with water but on an empty stomach. It is not to be administered with a large meal or a high-protein snack. The medication should be stored at room temperature and protected from moisture because moisture can degrade the medication and affect its potency.