Pharmacology Exam 4
The health care provider is preparing to order rifampin and pyrazinamide for a female client with active tuberculosis. What question should the provider ask this client before confirming this order?
"Are you pregnant?" Explanation: Pyrazinamide and streptomycin are contraindicated in pregnancy. A regimen of INH, rifampin, and ethambutol is usually used in the treatment of pregnant women.
After teaching a client who is prescribed oral erythromycin, the nurse determines that the teaching was successful when the client states which of the following?
"I should drink a full 8-oz glass of water when I take the medicine." Explanation: Food in the stomach decreases the absorption of oral macrolides such as erythromycin. Therefore, the drug should be taken on an empty stomach with a full, 8-oz glass of water, 1 hour before or at least 2 to 3 hours after meals. The client may experience diarrhea with this drug, but it should not be bloody. Bloody diarrhea is associated with pseudomembranous colitis, which needs to be reported to the health care provider immediately. Due to its long half-life, azithromycin is usually ordered as a once-daily dose.
A nurse is teaching a client diagnosed with asthma about the disease. Which should the nurse instruct the client to avoid because it may cause bronchoconstriction?
Extremely cold temperatures Explanation: When lungs are exposed to causative stimuli, like cold air, bronchoconstriction can result. Fatigue, foods high in sodium, and direct sunlight do not cause bronchoconstriction.
A client is prescribed penicillin V orally for a strep throat. What is the mechanism of action of this medication?
It inhibits cell wall synthesis. Explanation: Beta-lactam antibacterial drugs inhibit synthesis of bacterial cell walls by binding to proteins in bacterial cell membranes. Penicillin V does not inhibit protein synthesis. Penicillin V does not inhibit protein synthesis, cause mutations, or lower the pH of a bacterium's cellular contents.
Cephalosporins are structurally and chemically related to which classes of antibiotics?
Penicillins Explanation: Cephalosporins are structurally and chemically related to penicillins.
The nurse understands that which is the highest priority when teaching about antitubercular medications?
Taking medications as prescribed Explanation: For medications to be effective, it is most important that the nurse reinforce to the client that medications should be taken as prescribed and there should be no missed doses. Eating a well balanced diet, keeping hydrated and monitoring sputum are not medication priorities.
Respiratory symptoms are treated with many types of drugs, including
anti-inflammatory agents. Explanation: Major drug groups used to treat respiratory symptoms are bronchodilating and anti-inflammatory agents, antihistamines, and nasal decongestants, antitussives, and cold remedies.
A nurse is caring for a 52-year-old client who has been diagnosed with a latent tuberculosis infection. The health care provider is considering ordering isoniazid (INH). The preexistence of what condition would require cautious use of INH in this client?
cirrhosis of the liver Explanation: Because hepatotoxicity is a potentially serious adverse effect of INH, the drug should be used cautiously in clients with liver disease.
A group of nursing students are reviewing information about the transmission of tuberculosis. The students demonstrate understanding when they state transmission occurs from person to person in which manner?
inhalation of infected aerosolized droplets Explanation: Tuberculosis is transmitted from one person to another by droplets dispersed in the air when an infected person coughs or sneezes. Tuberculosis is not transmitted via contact with blood, feces, or sweat.
The nurse is giving instructions to the client prior to discharge. The client states that he does not like to take a lot of drugs. The nurse's best response would be what?
"Failure to complete the entire treatment may result in a return of the infection." Explanation: The client should be told to complete the entire course of the treatment. Failure to do so may result in a return of the infection. All the other responses are nontherapeutic and should not be used.
The nurse has finished teaching a 15-year-old client how to use an inhaler to treat asthma. What statement by the client suggests an understanding of the teaching?
"I need to shake the inhaler well before taking the medication." Explanation: Just before each use, the client should shake the inhaler well. After shaking, proper technique involves exhaling before placing the inhaler in the mouth; taking a slow, deep breath while delivering the medication into the mouth; and holding the breath for approximately ten seconds before exhaling slowly. A subsequent dose can be administered within a few minutes of the first.
The nurse is teaching a male client with HIV about his new antiviral drug regimen. Which client statement would suggest that the teaching plan was effective?
"I should expect some nausea and vomiting." Explanation: Nausea, vomiting, diarrhea, and anorexia are common adverse effects of antiviral drugs. Effective therapy relies on adherence to the prescribed dosing schedule; although clients should avoid missing doses, they should not take additional doses to make up for those they missed. Clients should not take other medications or supplements without first speaking with the health care provider. Antiviral drugs may relieve the symptoms of HIV, but they will not cure the disease.
A patient tells you that her friend has recommended using caffeine to treat her asthma. How would you appropriately respond to this patient?
"Prescription drugs have been proven effective in treating asthma, and caffeine hasn't been. Since uncontrolled asthma can be deadly, I wouldn't recommend that you switch from your medications to caffeine." Explanation: Since, in general, herbal and dietary therapies in asthma have not been studied in controlled clinical trials, they are unproven and should be avoided. Because asthma can result in death in a matter of minutes, patients should be counseled not to use dietary or herbal supplements in place of prescribed bronchodilating and anti-inflammatory medications. Although caffeine is a mild bronchodilator, combining it with bronchodilating drugs can increase the adverse effects of those drugs.
A client with asthma has been prescribed an albuterol inhaler. What recommendation should the nurse include in client teaching?
"Stop smoking to reduce bronchoconstriction." Explanation: Cigarette smoking will increase bronchoconstriction, so the client should be encouraged to stop. The albuterol is known to cause hand tremors as a side effect; the client should mention this sign to the health care provider, but it isn't a reason to stop using the medication. The client will not require ibuprofen since the condition is not related to inflammation. The client should be encouraged to exercise more than once per week.
A client diagnosed with tuberculosis (TB) has begun multidrug therapy. The client has asked the nurse why it is necessary to take several different drugs. How should the nurse respond to the client's question?
"The use of multiple drugs prevents the development of drug-resistant TB." Explanation: Use of multiple drugs to treat TB is necessary to prevent the development of drug-resistant TB. This approach to treatment is not necessitated by delays in testing, questionable diagnostic results, or the need to hasten the course of treatment.
The nurse is reviewing the medication instruction for the client taking acyclovir. Which statement by the client would indicate the need for additional teaching?
"This medication will maintain the symptoms and cure my disease." Explanation: Acyclovir does not cure the viral infection; it only decreases the symptoms and severity of the disease. It is important to complete the entire course of therapy. The development of a rash and/or itching can indicate that an allergic reaction is occurring as a result of the medication. The lesion's turning red can indicate a secondary bacterial infection.
The nurse is teaching a 21-year-old client with AIDS about zidovudine, a nucleoside reverse transcriptase inhibitor (NRTI) that the health care provider has prescribed for treatment of the disease. Which client statement suggests that the nurse's teaching has been successful?
"This medication will slow the progression of the disease but will not cure it." Explanation: Zidovudine and other NRTIs slow the progression of acute retrovirus infection, but they do not cure infection. Headaches are a common adverse effect of antiviral drugs; however, taking acetaminophen can reduce blood levels of zidovudine.
A middle-aged client with a complex history has begun multidrug treatment for TB. Which assessment question is most therapeutic?
"What kinds of routines would work for you to ensure that you don't miss doses of your rifampin?" Explanation: Assessments and interventions related to adherence to therapy are always a priority in the care of clients who have TB. It is necessary to address the client's smoking, but adherence to therapy is a priority, even over this important health behavior. Addressing the views of family and friends may be inappropriate and/or unnecessary. Similarly, discussing the client's part in the development of the disease may be counterproductive, depending on the client's state of mind and the particular relationship between the nurse and the client.
A client has just been diagnosed with TB. The client is extremely upset and is asking questions concerning the medications. What is an appropriate response by the nurse?
"You will have multidrug therapy for 6 to 24 months." Explanation: The nurse should tell the client that drug therapy for TB is based on the susceptibility of the infecting organism and the immunocompetence of the person affected. Usually clients with active or reactivated TB require multidrug therapy for 6 to 24 months. Telling the client not to worry and that the client needs to be calmer when discussing therapy are not therapeutic and minimize the client's concerns.
Red man syndrome symptoms
1. Flushing 2. Hypotension 3. Tachycardia 4. Red rash on upper body 5. Pruritis 6. Urticaria
A client has been started on Augmentin 250 mg P.O. every 12 hr. It is supplied in 500-mg tablets. How much will the nurse give at each dose?
1/2 tablet Explanation: The drug comes in 500-mg tablets and the order is for half that dose, so the nurse will give a 1/2 tablet.
The primary health care provider has prescribed 400 mg of acyclovir, five doses per day. The drug is available in 200-mg tablets. How many tablets should the nurse administer to the client per dose?
2 Explanation: Required dosage is 400 mg. Available drug is 200 mg. Number of tablets required is 2 (400 mg/200 mg) per dosage.
A client has been prescribed a daily dosage of Rifampin 600 mg. The available drug is in the form of a 300 mg capsules. To meet the recommended daily dose, the client will need _________ capsules.
2 Explanation: Required dose is 600 mg. Available capsule contains 300 mg of the drug. Therefore, 2 (2 x 300) capsules need to be administered.
The primary health provider has prescribed 764 mg of carbenicillin indanyl sodium to be taken orally four times a day. The available tablet contains carbenicillin indanyl sodium equivalent to 382 mg of carbenicillin. The nurse should administer how many tablet/s to the patient four times a day?
2 Explanation: The primary health provider has prescribed 764 mg of carbenicillin indanyl sodium. The available drug contains 382 mg of carbenicillin; therefore, two tablets (764/382) have to be administered four times a day.
A nurse is preparing to administer IV acyclovir to a client diagnosed with a herpes simplex viral infection. The health care provider has ordered 5 mg/kg every 8h. The client weighs 60 kg. How much medication will the nurse administer per dose?
300 mg Explanation: Each dose will contain 300 mg of acyclovir. (60 kg × 5 mg/kg = 300 mg.)
A health care provider prescribes a client 3.375 g piperacillin sodium and tazobactam (Zosyn) every six hours. After reconstitution, the concentration of the drug is 2.25 g/50 mL. Which quantity of the reconstituted solution should the nurse administer to the client?
75 mL Explanation: After reconstitution, the concentration of the drug is 2.25 g/50 mL. Concentration of drug per mL is 0.045 g (2.25/50). Therefore, to administer 3.375 mg piperacillin, 75 (3.375/0.045) mL of the reconstituted solution is required.
Penicillin would NOT be indicated for which of the following clients?
A client with gram-negative bacteria allergic to penicillin Explanation: Contraindications include hypersensitivity or allergic reactions to any penicillin preparation. An allergic reaction to one penicillin means the client is allergic to all members of the penicillin class. The potential for cross-allergenicity with cephalosporins exists, although recent data suggest that the incidence is less than 1%, lower than previously thought. Administration of cephalosporins should be avoided in individuals with life-threatening allergic reactions to penicillin (anaphylaxis, laryngeal swelling angiedema, or hives).
The health care provider has ordered penicillin V for a client. What should the nurse instruct the client to take with the medication?
A full glass of water Explanation: Clients should be instructed to take each dose of an oral penicillin with a full glass of water. Orange juice and other fluids can destroy these drugs.
The nurse administers cefuroxime to a client at least 1 hour before meals, as prescribed; however, the client experiences GI upset. Which action would be most appropriate for the nurse to do?
Administer the drug with food. Explanation: If the client experiences GI upset, the nurse can administer cefuroxime with food. A decrease in the dosage is suggested in a client with renal impairment. A change in dosage, discontinuation of the drug, or use of an antacid is recommended only if prescribed by the physician.
A male client presents with symptoms of bronchospasm that occurred during a birthday party for his grandson. What medication would the nurse expect the health care provider to give the client?
Albuterol Explanation: A selective, short-acting, inhaled beta2-adrenergic agonist (e.g., albuterol) is the initial rescue drug of choice for acute bronchospasm; subcutaneous epinephrine may also be considered.
After reviewing information about drugs used to treat lower respiratory system conditions, a group of nursing students demonstrate understanding of the information when they identify which as an example of a short-acting beta-2 agonist (SABA)?
Albuterol Explanation: Albuterol is a SABA. Formoterol, salmeterol, and arformoterol are all long-acting beta-2 agonists.
The parents of a 7-year-old client who has been diagnosed with allergic asthma are being taught about their son's medication regimen. The nurse is teaching about the appropriate use of a "rescue drug" for acute exacerbations. What drug should the nurse suggests the parents to use in these situations?
Albuterol Explanation: Albuterol is a rescue drug that should be used first for all acute symptoms of shortness of breath or wheezing. Theophylline does not produce rapid symptom relief and beclomethasone is a maintenance drug. Acetylcysteine is not used in the treatment of asthma because it is used to manage secretions, which are not associated with asthma.
A nurse is discussing targeted testing for latent tuberculosis infection (LTBI) with a group of nursing students. The nurse mentions that testing should be focused on groups considered to be at high risk for infection. Which group is considered high risk?
All the above Explanation: Factors associated with high risk for LTBI include homelessness, HIV infection, immigrating from areas with high TB rates, previous exposure to an infected individual, use of injectable drugs, pre-existing diabetes mellitus, advanced or younger age, low body weight, and use of high doses of corticosteroids.
Tuberculosis typically affects the lungs but can also involve other parts of the body. Which of the following can be affected by the disease?
All the above Explanation: Tuberculosis is an infectious disease that usually affects the lungs but may involve most parts of the body, including lymph nodes, meninges, bones, joints, kidneys, and the gastrointestinal tract.
A 26-year-old female client with a skin infection has been prescribed 400 mg ampicillin to be taken orally. Which instruction should the nurse include in the client teaching plan?
Ampicillin will reduce the effectiveness of birth control pills. Explanation: Ampicillin (also penicillin V) reduces the effectiveness of birth control pills. Increasing a dosage to compensate for a missed dosage should not be done. The client should adhere to the prescribed regimen as strictly as possible. Ampicillin and penicillin V may be taken without regard to meals. The client need not avoid use of skin care products when on penicillin therapy.
A nurse works in a community setting and follows clients who have TB. Which clients would likely require the most follow-up from rifampin therapy?
An HIV-positive client Explanation: The nurse should pay special attention to the HIV-positive client because this client will require rifampin therapy for a longer period of time than the other clients. An HIV-positive person is immunocompromised, and it will take longer to fight the infection. This could increase the difficulty of adherence to the drug regimen. In addition, many of the drugs used to treat HIV are contraindicated in clients who take rifampin. Rifampin can be safely administered to nursing mothers, those with cancer, and people over 65 given certain conditions. However, their therapy should not be longer than normally required unless complications occur.
The nursing instructor is discussing the administration of azithromycin, a macrolide, with her clinical group. The instructor asks her students to identify the medication that will decrease the effects of azithromycin when administered concurrently. Which of the following medications would the students identify?
Antacids Explanation: Since antacids will decrease the effect of azithromycin and other macrolides, the two medications should not be taken concurrently.
A patient taking erythromycin (E-mycin) is having difficulty hearing the nurse. How should the nurse proceed?
Ask about the patient's hearing prior to medication therapy. Explanation: The nurse needs to know if this is an effect of the medication, or if the patient had difficulty prior to taking the medication. Hearing difficult caused by the medication is reversible. The nurse should not take steps to "make do" with the deficit until the nurse determines the extent and possible cause.
A nurse is preparing to give a client an initial dose of a penicillin preparation. What should the firstaction be for the nurse?
Ask the client if there is a history allergy to a penicillin. Explanation: Before giving the initial dose of any penicillin preparation, ask the client if he or she has ever taken penicillin and, if so, whether an allergic reaction occurred. If the client is believed to be hypersensitive and the penicillin is considered essential, a skin test can help assess the degree of hypersensitivity; the provider can use the results of the test to determine whether and how to administer a penicillin to the client. Although penicillin is a common source of drug-induced anaphylaxis, not all anaphylaxis is caused by drugs.
A patient suffers from wheezing related to asthma. Which medications will increase the bronchi of the lung?
Bronchodilators Explanation: The administration of the bronchodilator will increase the bronchi of the lungs. Anti-inflammatory agents are inhaled after the bronchodilator to decrease inflammation of the bronchi. Antihypertensive and antineoplastic agents will not increase bronchi.
The nurse is caring for a client who is HIV positive. What laboratory test is used to determine this client's ability to fight against viral infections?
CD4 Explanation: The CD4 count is the laboratory test used to determine a client's ability to fight against infections in a client with HIV. A BUN measures kidney function, an AST monitors liver function, and RBCs monitor the number of red blood cells that a client has. None of these measures will give information about the client's ability to fight infection.
Beta-lactam antibiotics, such as penicillins and cephalosporins, fight infection by inhibiting development of the causative bacteria. What specific component development do these drugs affect?
Cell wall synthesis Explanation: Beta-lactam antibacterial drugs inhibit synthesis of bacterial cell walls by binding to proteins in bacterial cell membranes. This binding produces a defective cell wall that allows intracellular contents to leak out. These do no affect DNA replication or cell division.
After reviewing information about respiratory tract disorders, a group of students demonstrate understanding of the material when they identify what as the most common cause of COPD?
Cigarette smoking Explanation: Cigarette smoking is most commonly associated with chronic obstructive pulmonary disease. The client may be at greater risk for infection, but infection is not an underlying factor contributing to the disorder. Allergen exposure is more commonly related to seasonal rhinitis or asthma. Genetic inheritance is associated with cystic fibrosis.
After taking penicillin as prescribed, a client shows signs of diarrhea and informs the nurse that there is blood in the stools. Which should the nurse do next?
Contact primary healthcare provider immediately. Explanation: If diarrhea is suspected, the nurse should notify the primary healthcare provider immediately. The nurse should wait for the primary healthcare provider's instructions before continuing with the prescribed regimen. Yogurt or buttermilk may help prevent fungal superinfections, but they will not help alleviate the client's condition at this stage. Changes in the diet are not recommended unless instructed by the primary healthcare provider.
Unless hemodialysis is started within 48 hours, imipenem is contraindicated for clients with severe renal impairment. What laboratory measurement would indicate renal impairment?
Creatinine clearance Explanation: Dosage of imipenem should be reduced in most clients with renal impairment, and the drug is contraindicated in clients with severe renal impairment (CrCl of 5 mL/min or less) unless hemodialysis is started within 48 hours. For clients already on hemodialysis, the drug may cause seizures and should be used very cautiously, if at all.
The nurse notes a 25-year-old female client who is to begin antiretroviral therapy is currently taking oral contraceptives. The nurse should point out the combination can result in which interaction?
Decreased effectiveness of birth control pills Explanation: Antiretrovirals decrease the effectiveness of oral birth control agents. Combining antiretrovirals with birth control pills does not, however, increase the risk of vaginal bleeding, increase serum levels of the antiretroviral, or decrease the effectiveness of antiviral therapy.
A client has been prescribed metronidazole for treatment of Giardia. What instruction is most important for the nurse to give to this client?
Do not drink alcohol while taking this medication. Explanation: Clients who are receiving metronidazole should not drink alcohol because the client will develop a disulfiram-type reaction if alcohol is consumed while the client is receiving metronidazole.
A male patient is taking indinavir (Crixivan) for HIV. To decrease the risk of kidney stones, the nurse's teaching plan will include which of the following?
Drink 1 to 2 L of water a day Explanation: Indinavir may produce severe adverse effects such as kidney stones. To decrease the potential for kidney stones, the patient should drink at least 1 to 2 L of water a day. Increasing physical activity, avoiding acetaminophen, or decreasing fatty foods will not decrease the risk of kidney stones.
A client is admitted to the emergency department with inspiratory stridor and air hunger. When anticipating treatment, the nurse will prepare which medication for administration?
Epinephrine Explanation: Epinephrine may be injected subcutaneously in an acute attack of bronchoconstriction. Ipratropium is administered by inhalation for maintenance therapy of bronchoconstriction related to chronic bronchitis and inflammation. It is not administered for an acute attack of bronchoconstriction. Cromolyn stabilizes mast cells and prevents the release of bronchoconstrictive and inflammatory substances when mast cells are confronted with allergens and other stimuli. It is not used for acute attacks. Pseudoephedrine is not administered for acute bronchoconstriction.
A client with AIDS is treated with several drugs that work at different portions of the life cycle of the virus. This multiple drug therapy is called which?
HAART Explanation: The multiple drug therapy used for AIDS is called HAART, which stands for highly active antiretroviral therapy. DOT stands for directly observed therapy, used with tuberculosis (TB) patients. RICE stands for rest, ice, compression, and elevation, which is used for injuries. RACE is used for fires and stands for rescue, alarm, contain, and extinguish.
A client with active AIDS is infected with a retrovirus. This virus is better known as which?
HIV Explanation: HIV, the virus that causes acquired immunodeficiency syndrome (AIDS), is a retrovirus. CMV stands for cytomegalovirus. HSV refers to herpes simplex virus. DSV is a distractor for this question.
An older adult client has been prescribed an inhaled corticosteroid for the treatment of chronic obstructive pulmonary disease. When administering the drug, what action should the nurse perform to reduce the client's risk for developing oral candidiasis?
Have the resident rinse his or her mouth after each dose of the drug. Explanation: Rinsing may reduce a person's risk of developing oral candidiasis during treatment with inhaled corticosteroids. It would be incorrect to discourage deep inhalation of the medication. Gargling prior to administration is ineffective, and prophylactic medications are not used.
Antivirals are used to treat infections caused by viruses. In particular, acyclovir is useful to treat which infection?
Herpes zoster Explanation: Its antiviral spectrum is limited to the herpes viruses, including HSV, herpes zoster virus, Epstein-Barr virus, and CMV.
A common reaction associated with the intravenous administration of vancomycin is "red man syndrome." What is the cause of red man syndrome?
Histamine release Explanation: Red man syndrome is a histamine reaction characterized by hypotension and skin flushing.
A nurse is providing health education to a client recently diagnosed with asthma and prescribed albuterol and ipratropium. Which of the client's statements suggests a need for clarification by the nurse?
I'll keep taking my medications until I'm not experiencing any more symptoms." Explanation: Antiasthma medications should normally be taken on a regular schedule, not solely based on immediate symptoms. They should not be discontinued in the absence of symptoms. Increasing fluid intake, limiting caffeine, and adhering to the administration schedule are correct actions.
A male client who has undergone surgery of the urinary tract is administered cephalosporins to prevent infections. When assessing the client on the day after the surgery, the nurse notices that he has an elevated temperature. Which nursing intervention would be most appropriate in this case?
Inform the primary health care provider. Explanation: The nurse should immediately report an increase in the client's body temperature to the primary health care provider. The nurse should consult the provider before increasing, decreasing, or discontinuing the dosage. The nurse should measure and record the fluid intake if there is a decrease in the urine output.
A nurse is administering levalbuterol to a client. The nurse would administer this drug by which route?
Inhalation Explanation: Levalbuterol is administered only as an inhalant by nebulizer.
The nurse is providing education to a client with asthma on the therapeutic action of inhaled corticosteroid agents. How will the nurse describe the action?
Inhaled corticosteroid agents reduce airway inflammation. Explanation: Inhaled corticosteroid agents suppress the release of inflammatory mediators, block the generations of cytokines, and decrease the recruitment of airway eosinophils. Inhaled corticosteroid agents do not depress the central nervous system or reduce bronchodilation or respiratory rate.
A student asks the pharmacology instructor if there is a way to increase the benefits and decrease the risks of antibiotic therapy. What would be an appropriate response by the instructor?
It is important to use antibiotics cautiously and to teach clients to complete the full course of an antibiotic prescription. Explanation: To prevent or contain the growing threat of drug-resistant strains of bacteria, it is very important to use antibiotics cautiously, to complete the full course of an antibiotic prescription, and to avoid saving antibiotics for self-medication in the future. A client and family teaching program should address these issues, as well as the proper dosing procedure for the drug (even if the client feels better) and the importance of keeping a record of any reactions to antibiotics. Thus, taking drugs not prescribed for the particular illness tends to maximize risks and minimize benefits. Also, if the infection is viral, antibacterial drugs are ineffective and should not be used.
A client taking isoniazid is worried about the side effects/adverse reactions. The nurse tells the client that a common adverse reaction of isoniazid is which of the following?
Jaundice Explanation: Jaundice is an adverse reaction related to isoniazid therapy. Insomnia, joint pain, and myalgia are not related to isoniazid therapy.
When discussing cephalosporins with the nursing class, the pharmacology instructor explains that this classification of drug is primarily excreted through which organ?
Kidney Explanation: The cephalosporins are primarily metabolized in the liver and excreted in the urine. These drugs cross the placenta and enter breast milk. They are not excreted through the lungs, the liver, or the skin.
In which condition present in the client should macrolides be used with caution?
Liver dysfunction Explanation: All macrolides should be used with caution in clients with liver dysfunction. Pre-existing liver disease is a contraindication. Diabetes, hypertension and glaucoma are not contraindicated.
The nurse should monitor the client for which common side effects of erythromycin therapy?
Nausea, vomiting, and diarrhea Explanation: Gastrointestinal problems (e.g., nausea, vomiting, and diarrhea) are common side effects of erythromycin and other macrolides. Headache, fever, ophthalmic drainage, urticaria, shortness of breath and sore throat are no common side effects.
A young adult has been receiving Keflex P.O. for the last 5 days to treat a respiratory infection. The nurse is concerned when the client reports urinating only once in the last 16 hours. What should the nurse consider as the cause?
Nephrotoxicity Explanation: Nephrotoxicity may develop from administration of cephalosporins. An early sign of this adverse reaction is decreased urine output. The nurse should measure and record fluid intake and output and notify the primary healthcare provider if output is less than 500 ml/day. Decreased urine output is not a sign of Steven-Johnson syndrome. It also is not indicative of a superinfection. There is no indication of dehydration existing.
A client is hospitalized due to nonadherence to an antitubercular drug treatment for a diagnosis of tuberculosis (TB). Which intervention is most important for the nurse to implement?
Observing the client taking the medications Explanation: Directly observed therapy in which a health care provider observes the client taking each dose of anti-TB drugs is recommended for all drug regimens and is considered mandatory in this case. The medications are not administered parenterally. The family should be instructed on the medication regime, but this action is not imperative in maintaining compliance. Tablets missing from the bottle may not necessarily have been taken correctly by the client.
A nurse is caring for a client with severe and life-threatening pseudomembranous colitis caused by C. difficile. Which drug would the nurse expect the client's provider to order?
Oral vancomycin Explanation: Oral vancomycin is used to treat staphylococcal enterocolitis and pseudomembranous colitis caused by C. difficile when the colitis fails to respond to metronidazole.
The health care provider suspects a client may be infected with an antibiotic-resistant pathogen. The nurse caring for this client knows that what course of action is best used to determine whether this type of pathogen is present?
Perform culture and susceptibility tests. Explanation: Before prescribing an antibiotic, the health care provider should review culture and susceptibility reports and local susceptibility patterns to determine if an antibiotic-resistant pathogen is present in the client. Complete blood counts and electrolyte values are standard procedure lab tests. Spinal fluid checks are performed to detect anomalies such as meningitis.
A HIV-positive patient is being treated with didanosine as part of the antiretroviral therapy. Which of the following symptoms should the nurse monitor for and immediately report to the care provider?
Peripheral neuropathy Explanation: The nurse should immediately report symptoms of peripheral neuropathy to the care provider. Headache and taste alteration are some of the mild adverse effects of the drug and are not cause for immediate concern. Excoriation is an adverse effect of imiquimod and does not occur in patients being administered didanosine.
A client undergoing penicillin therapy shows improvement and confirms feeling better. Which intervention is the nurse most likely to perform in such a situation?
Record assessments on client's chart. Explanation: When the client shows and verbally confirms improved health, it should be recorded on the client's chart. If the patient's condition has improved, the client will show an increased appetite, but there is no need to instruct the client to increase dietary intake. The primary health provider need not be informed about the condition immediately unless the client shows signs of deterioration or complications. The nurse should inquire about previous drug allergies before the start of therapy.
The nurse is caring for a client who is receiving IV vancomycin. The nurse infuses the medication at the prescribed rate to prevent what from occurring?
Red man syndrome Explanation: The nurse must be careful to infuse vancomycin at the prescribed rate to prevent the occurrence of red man syndrome. With this syndrome, the client's face and upper trunk becomes bright red, and it has led to cardiovascular collapse.
A client who has been receiving intravenous (IV) vancomycin begins to report neck and back pain as well as feeling hot and having chills. The nurse assesses the client and notices that the neck is red. The client's temperature is 102 degrees F; BP is 86/58. This client is showing signs and symptoms of which syndrome?
Red-man syndrome Explanation: Clients taking vancomycin can develop red-man syndrome, the signs of which include decreased BP, fever, chills, paresthesias, and erythema of the neck and back. Cushing's syndrome is related to increased cortisol levels. Toxic shock syndrome is related to a bacterial infection often resulting from prolonged use of superabsorbent tampons. Stevens-Johnson syndrome is a potentially deadly skin disease that usually results from a drug reaction.
A 70-year-old man is being treated for herpes zoster virus. He has been prescribed acyclovir (Zovirax). The clinic nurse should prioritize assessments of which of the following?
Renal function Explanation: The risk for nephrotoxicity is higher in older patients because with advancing age, renal function diminishes and drug excretion becomes less effective. Serious adverse effects or cumulative toxicity can result. It is important for the nurse to be aware of and assess the older patient's neurologic, cardiac, and respiratory functions. However, they would not be as important as the renal function because of the medication being taken.
A patient is being discharged from a health care facility. The patient is, however, required to continue with antiviral therapy at home. Which point should the nurse include in the teaching plan to educate the patient?
Report adverse reactions to the primary health care provider. Explanation: The nurse should instruct the patient to report adverse reactions to the primary health care provider. The nurse should also tell the patient to report any increase in temperature, even if it is a slight increase. If the patient misses a dose, the next dose should be taken as soon as remembered, but it should not be doubled. The nurse should also instruct the patient to take the drug exactly as directed for the full course of therapy, even if the symptoms of the infection disappear.
The client with asthma has been ordered an inhaler and the nurse is teaching how to prevent Candida infections. Which would the nurse include in the instructions?
Rinse mouth with water after each use. Explanation: The client should be taught to rinse his mouth out with water after using oral inhalers to prevent a Candida oral infection. Candida is a yeast that can grow in the mouth, it is important that they have good oral hygiene but rinsing the mouth is sufficient. The client would not brush teeth between puffs, nor would they clean a spacer with alcohol. A spacer allows for better usage of the drug especially in children.
A patient with TB is admitted to a health care facility. The nurse is required to administer an antitubercular drug through the parenteral route to this patient. Which of the following precautions should the nurse take when administering frequent parenteral injections?
Rotate injection sites for frequent parenteral injections. Explanation: The nurse should be careful to rotate injection sites when administering frequent parenteral injections. At the time of each injection, the nurse inspects previous injection sites for signs of swelling, redness, and tenderness. The nurse should monitor any signs of liver dysfunction monthly in patients who are being administered antitubercular drugs. The nurse should ensure that pyridoxine, and not streptomycin, is administered to the patient to promote nutrition, but this is only administered if the patient has been living in impoverished conditions and is malnourished. The nurse should monitor patient's vital signs every four hours and not once every morning.
A nurse is caring for a patient who has a serious infection. The patient is being treated with combination therapy of a cefazolin and an aminoglycoside. The nurse will be sure to monitor which of the following?
Serum BUN and creatinine levels Explanation: Patients receiving combination therapy of a cefazolin and an aminoglycoside will need to be monitored for nephrotoxicity and therefore would need serum BUN and creatinine levels done. Serum sodium and potassium levels as well as aspartate aminotransferase should be monitored when receiving sodium penicillin G. PT and PTT should be monitored when a patient is receiving aztreonam, a monobactam antibiotic.
Common, potentially serious, adverse effects of antibiotic drugs include:
Skin rash Explanation: Examine skin for any rash or lesions, examine injection sites for abscess formation, and note respiratory status—including rate, depth, and adventitious sounds to provide a baseline for determining adverse reactions. Report nausea, vomiting, diarrhea, skin rash, recurrence of symptoms for which the antibiotic drug was prescribed, or signs of new infection (e.g., fever, cough, sore mouth, drainage). These problems may indicate adverse effects of the drug, lack of therapeutic response to the drug, or another infection. Pain, constipation, and hypopnea are not common adverse effects of antibiotic drugs.
The nurse is caring for a 38-year-old client who is beginning treatment with albuterol. Which should the nurse identify as a potential adverse effect of the drug?
Tachycardia Explanation: Adverse effects of adrenergic bronchodilators such as albuterol include tachycardia, arrhythmias, palpitations, restlessness, agitation, and insomnia. Bronchodilators do not cause polydipsia, nausea or diarrhea.
While calculating the drug dose of anti-viral medications for children who have AIDS a pediatric nurse uses what?
The child's weight Explanation: Antiviral medication dosages for children are calculated according to weight. There are no scientific data available concerning dosages because of the seriousness of the disease. The ethical dilemma using children in drug studies is always a concern. Children must be monitored very carefully for adverse effects on kidneys, bone marrow, and the liver. The complications and severity of the disease may determine which drug is prescribed.
A 45-year-old client is prescribed acyclovir for the treatment of genital herpes. Which is an expected outcome for this client?
The client will experience fewer recurrences. Explanation: Acyclovir and other antiviral medications can be prescribed to reduce the lesions, pain, and itching associated with herpes simplex infections. When administered as prophylaxis, treatment results in fewer recurrences. However, the drugs do not cure infection or prevent its transmission.
Which client should not receive erythromycin as ordered at 8 a.m.?
The client with elevated liver enzymes Explanation: The medication is metabolized by the liver and excreted in the bile. The client with elevated liver enzymes will not be able to tolerate this medication. There is a risk it will build up in the system. The other situations are not contraindications for taking erythromycin.
The nurse is caring for a 38-year-old client who has been diagnosed with asthma and is prescribed albuterol. What assessment finding should the nurse most likely attribute to adverse medication effects?
The client's heart rate is 99 beats/min. Explanation: Adverse effects of these drugs, which can be attributed to sympathomimetic stimulation, include central nervous system (CNS) stimulation, gastrointestinal upset, cardiac arrhythmias, hypertension, angina, sweating, pallor, and flushing. Adrenergic agents do not cause polydipsia, fever, or diarrhea.
A patient with skin lesions due to a viral infection has been prescribed topical application of an antiviral. Which of the following points should the nurse inform the patient regarding the therapy and the infection?
The drug will not prevent the spread of the disease to others. Explanation: The nurse should inform the patient that application of the drug does not prevent the spread of the disease to others. Topical drugs should be applied with a finger cot or gloves but not with bare hands. The nurse should instruct the patient to cover all lesions and not leave them open. The nurse should also stress the importance of avoiding sexual contact during lesions irrespective of contraceptive measures.
A client is administered a nucleotide reverse transcriptase inhibitor in combination with a nonnucleotide reverse transcriptase inhibitor. What is the rationale when administering these medications together?
They have synergistic antiviral effects. Explanation: Because the two types of drugs inhibit reverse transcriptase by different mechanisms, they may have synergistic antiviral effects. A synergistic effect occurs when the effect between two or more substances produce an effect greater than the sum of their individual effects. The use of two medications may decrease compliance because of the burden of taking two medications. Using two medications will not decrease the length of the illness nor will it decrease all opportunistic infections.
The nurse explains that prophylactic antitubercular therapy is suggested for which people?
Those who have been in close contact with a person with tuberculosis (TB) Explanation: Prophylactic antitubercular therapy is suggested for people who have been in close contact with a person with tuberculosis; clients whose tuberculin skin test has become positive in the last two years; and all clients younger than 35 years of age with a positive skin test.
A health care center is conducting a seminar on cephalosporins drugs. During the question-and-answer period, the audience wants examples of conditions that can be treated by cephalosporins. Which of the following infections should the nurse state as examples?
Urinary tract infections Explanation: Cephalosporins are used to treat urinary tract infections, skin infections, and hospital-acquired pneumonias. Cephalosporins are not used to treat hemolysis or jaundice. Nausea and diarrhea are some of the adverse reactions that can occur when a patient is on cephalosporins therapy.
The nurse is caring for a 23-year-old female client who uses oral contraceptives and has been prescribed ampicillin for treatment of a respiratory infection. What information is most important for the nurse to share with this client?
Use a type of barrier birth control while you are taking this antibiotic. Explanation: Clients taking oral contraceptives should be encouraged to use a barrier type of birth control during penicillin therapy; the penicillin will cause a decreased effectiveness of the contraceptive agent. The client should not be told to stop taking the oral contraceptive. This will not cause a heavier menses. The interaction between oral contraceptives and ampicillin will not cause an increased chance of bleeding, as that interaction is between large doses of penicillins and anticoagulants.
A client is being assessed by the home care nurse for the appropriate use of a metered-dose inhaler. Instructions concerning which intervention will assist a client in the proper use of the device?
Using a spacer Explanation: The client should be instructed to use a spacer to increase compliance and accuracy of administration. An asthma spacer is an add-on device used to increase the ease of administering aerosolized medication from a metered-dose inhaler (MDI). The corticosteroid should be administered after the bronchodilator. The increase in fluids will not affect the administration of the inhaler. The client should hold the breath for several seconds after administration of the inhaler.
The nurse is preparing a client who is receiving antiretroviral therapy for discharge. Which precautions should the nurse point out to reduce the effects of photosensitivity?
Wear protective clothing when outside. Explanation: The nurse should encourage the client to wear protective clothing while going out in the sun to reduce the effect of photosensitivity. While increasing the fluid intake is recommended to avoid dehydration, it does not help combat the effects of photosensitivity. There is no need to avoid indoor lights as the skin becomes sensitive to sunlight but not indoor lights. The use of tanning beds should be avoided.
A 49-year-old client is diagnosed with TB. The client has a history of alcoholism but has been sober for 3 months now. The client has been prescribed INH. What should the nurse ensure is obtained before initiating the therapy?
baseline liver function test values Explanation: For a TB client, the nurse should obtain baseline liver function test values and schedule serial liver function tests throughout therapy. In addition, a nurse should ensure a baseline A1C evaluation for clients who are diabetics, because INH may cause hyperglycemia. Clients with preexisting anemias should have a baseline complete blood count (CBC), because they are at risk for hematologic disorders. For clients with a history of seizures, perform a baseline neurologic examination. Also assess baseline visual acuity. All other assessments such as height, weight, serum glucose level, and bone mass are not applicable to INH therapy.
A client is taking rifampin (Rifadin) for active TB. The nurse should stress that what may be caused by the use of this drug?
body fluids such as urine, saliva, tears, and sputum may become discolored. Explanation: Rifampin can discolor body fluids red-orange. The client should be informed that this is an expected adverse effect and is harmless. However, wearers of soft contact lenses should be cautioned that the lenses may be permanently discolored and that hard contacts or regular glasses should be used during the therapy. Although rifampin is often well tolerated, it may cause GI disturbances such as nausea and vomiting, anorexia, flatulence, cramps, and diarrhea. Cardiac arrhythmias, seizures, and facial flushing are not typically associated with the use of this drug.
A client prescribed rifaximin for diarrhea has developed frank bleeding in the stool. What intervention should the nurse anticipate being implemented to best ensure client safety?
changing to a different antibiotic Explanation: Because of its very limited systemic absorption (97% eliminated in feces), health care providers cannot use rifaximin to treat systemic infections, including infections due to invasive strains of E. coli. Therefore, diarrhea occurring with fever or bloody stools requires treatment with alternative agents. Changing the route or supplementing with vitamin K will not aid in treatment.
A client is prescribed isoniazid (INH) for the treatment of latent tuberculosis (TB). What assessment data identifies a significantly increased risk for the development of liver damage?
consumes alcohol daily Explanation: The client's history of alcohol use is a risk factor for liver damage resulting from hepatotoxicity. Hepatotoxicity, a potentially serious adverse effect of INH therapy, is associated with alcohol consumption—even if alcohol use is stopped during the therapy. Research has not demonstrated an association of such an increased risk between INH therapy and either Asian ethnicity, age, or tobacco use.
The nurse is collaborating with the health care provider (HCP) of a client who presented with signs and symptoms of an infection. What information should the nurse prioritize so that the HCP can prescribe the proper antibiotic?
culture and sensitivity test results Explanation: Antibiotics are best selected based on culture results that identify the type of organism causing the infection and sensitivity testing that shows what antibiotics are most effective in eliminating the bacteria. First day of symptoms of infection is likely already known if culture and sensitivity testing has been performed. Although measurement of intake and output is one indicator of renal function, a blood-urea-nitrogen test and assessment of creatinine levels would be better ways of assessing renal function, which will be used to determine dose of medication but not for selection of the correct antibiotic. The white blood cell count with differential would indicate the possibility of an infection but are not needed in choosing the proper antibiotic.
A client with an upper respiratory infection has been prescribed macrolides. Which changes during an ongoing assessment would lead the nurse to notify the health care provider?
decrease in blood pressure increase in respiratory rate sudden increase in temperature Explanation: The nurse must notify the primary health care provider if there is a decrease in blood pressure, increase in respiratory rate, or sudden increase in temperature during an ongoing assessment after administration of the drug. Regular urine output or pulse rate within usual parameters need not be reported to the health care provider because these would be normal findings.
Which of the following drugs are considered to be macrolides?
erythromycin azithromycin (Zithromax) clarithromycin (Biaxin) Explanation: The macrolides, which include erythromycin, azithromycin (Zithromax), and clarithromycin (Biaxin), have similar antibacterial spectra and mechanisms of action. Metronidazole (Flagyl) and linezolid (Zyvox) are considered miscellaneous antibacterials.
A nurse practitioner is teaching a health class in the local high school. The NP informs the class about hepatitis B. What occupation does the NP inform the class is at the greatest risk for contracting hepatitis B?
healthcare workers Explanation: Healthcare workers are at especially high risk for contracting hepatitis B due to needle sticks and contact with the blood of infected clients. Police officers and educators are not considered at high risk for contracting hepatitis B although they do face some risk because of contact with blood and body fluids. Restaurant workers face no significantly increased risk.
A nurse is caring for an older adult client with tuberculosis. The client has been prescribed ethambutol. Which adverse reactions of ethambutol should the nurse assess for?
optic neuritis Explanation: The nurse should assess for optic neuritis as it is one of the more severe reactions of ethambutol. Hypersensitivity and epigastric distress are adverse reactions associated with isoniazid. Vertigo is an adverse reaction of rifampin.
A client comes to the clinic for a follow-up visit. The nurse notes a sunburn-like appearance to the client's skin. The client's history reveals the use of ciprofloxacin. The nurse interprets which adverse effect regarding this finding?
photosensitivity Explanation: A superinfection refers to the overgrowth of bacterial or fungal microorganisms not affected by the antibiotic administered. Pseudomembranous colitis is a severe, life-threatening form of diarrhea that occurs when normal flora of the bowel is eliminated and replaced with Clostridium difficile (C. diff) bacteria. Anaphylactic reaction is a severe exaggerated allergic reaction.
What event triggers the development of a superinfection?
proliferation of antibiotic-resistant microorganisms Explanation: Superinfection is an infection after the occurrence of a previous infection, typically caused by microorganisms that are resistant to the antibiotics used earlier. None of the other options accurately describe this condition as it is associated with antibiotic-resistant microorganisms.
The nurse has administered the first dose of a client's newly-prescribed penicillin. What assessment finding should the nurse interpret as adverse effect that suggests a more serious concern?
rash to the face and trunk Explanation: A rash poses no threat in and of itself but suggests the possibility of drug intolerance or hypersensitivity. A modest decrease in blood pressure or level of consciousness would be less clinically significant. The nurse must address the client's pain, but this is unlikely to be a consequence of antibiotic use.
When fighting the human immunodeficiency virus (HIV), the nurse knows that the drug regimen usually includes which?
several medications, which combined are the most effective treatment. Explanation: Several medications that work on different phases of the viral life cycle have been shown to be most effective in HIV treatment. A single medication is not as effective as multiple-medication treatment. How a client tolerates a medication is important, but with HIV it is not the reason for multiple medications. Providers do not try to make medication treatment plans difficult, this hinders compliance.
A client 45-years-old just received a heart transplant. One of the clients medications is ganciclovir. The nurse knows this medication was prescribed why?
to prevent CMV infection. Explanation: Ganciclovir is given often to transplant clients to prevent CMV infection. Ganciclovir is not used for blood pressure regulation; it is an antiviral agent. Ganciclovir is not prescribed for prevention of influenza A; it is prescribed for prevention of CMV. Anemia and leukopenia are adverse reactions that can occur while being treated with ganciclovir.
The client reports cough, low-grade fever, anorexia, and night sweats. The client has also been coughing up blood at times. What disease does this client most likely have?
tuberculosis Explanation: Symptoms of active TB include night sweats, cough, low-grade fever, fatigue, weight loss, and anorexia.
