Unit 5 Questions

Caroline Roberts is a 59-year-old woman who has just flown home from visiting her children and grandchildren on the opposite coast from where she currently lives. She noticed soreness in her left calf muscle, and when she noticed increased pain and swelling in her leg, she made an appointment with her provider. A diagnosis of DVT is made and the treatment plan is to admit her into the hospital for anticoagulant therapy. 1. Mrs. Roberts asks, "How soon will the heparin dissolve my blood clot?" How would you respond to this question? 2. What patient education should you provide Mrs. Roberts about anticoagulation therapy? 3. What factors predisposed this patient to DVT?

1. Anticoagulants do not dissolve blood clots that have already formed. The human body has a natural mechanism called fibrinolysis. This mechanism will slowly and naturally dissolve any blood clots. However, in the meantime, the heparin will prevent the existing clot from increasing in size. 2. The major emphasis for patients receiving anticoagulation therapy is to prevent injury that may result in internal or external bleeding. A few of the patient education tips that you will want to share with Mrs. Roberts include: Avoid activities that may cause traumatic injury. Use soft cloths and mild soap when bathing. Avoid wearing clothing that is tight or rubs. Avoid blowing or picking the nose. Avoid rectal suppositories or enemas. Watch for bleeding and examine all body fluids for the presence of blood. Avoid drugs that contain aspirin, NSAIDs, and other anticoagulants.

Lou Viega is a 66-year-old patient with cellulitis of the lower extremity, colonized with MRSA. He has been admitted to the medical unit and has been started on gentamicin IV. He expresses concern about the need for hospitalization and especially about the need for IV antibiotics. He asks you, his nurse, to explain things to him. 1. Why was gentamicin required for Mr. Viega's infection? 2. To what class of antibiotics does gentamicin belong? 3. What adverse effects are possible with this drug class? What monitoring will be required?

1. Because of MRSA's resistance, other antibiotics that are not penicillins or similar (e.g., cephalosporins) must be used. Gentamicin is typically reserved for more serious infections such as MRSA because of its higher potential for toxicity. 2. Gentamicin belongs to the aminoglycoside classification of antibiotics. 3. Gentamicin can cause renal toxicity, and assessment of renal function is a priority for this patient. The nurse should monitor daily weight, urine output, urine protein, and serum creatinine frequently. A secondary priority is assessment of both hearing and balance. Ototoxicity is a potential adverse effect of gentamicin and may affect either one or both branches of cranial nerve VII.

Genoa Brown, 43-years-old, experienced chronic kidney disease secondary to polycystic kidney disease and underwent a renal transplant 6 months ago. She has been taking cyclosporine (Neoral, Sandimmune) daily. 1. What is the purpose of the cyclosporine? 2. As the nurse, what three precautions will you review with Genoa concerning her cyclosporine treatment?

1. Cyclosporine (Neoral, Sandimmune) is a calcineurin inhibitor given for immunosuppressant effects. It is given to prevent transplant rejection, and in the treatment of psoriasis and xerophthalmia, an eye condition of diminished tear production caused by ocular inflammation. An IV form is available for transplant rejection and for severe cases of ulcerative colitis or Crohn's disease. 2. Cyclosporine is a medication with many serious adverse effects. Because the drug cannot be given with grapefruit juice due to a significant increase in serum drug level, you should review Genoa's diet and ask whether she eats grapefruit or drinks grapefruit juice. Non-juice flavored beverages are acceptable. Her renal function will be assessed by laboratory tests (e.g., creatinine), and you would also ask her about her urine output because cyclosporine may reduce urine output and to assess her renal function following the transplant. You would also review the need for vigilant observation for signs and symptoms of infection, such as low-grade fever or sore throat, and indicate that these should be reported promptly. Her WBC counts may remain normal because cyclosporine does not tend to cause bone marrow suppression.

Nathan Whitcomb is a 23-year-old college student seeking treatment in the student health clinic for recurrent cold sores (herpes simplex virus [HSV]). Like many college students, he eats on the run and seldom sleeps more than 4 to 5 hours per night. His weekends are even more hectic with his job, school, and social activities. Nathan requests something to help rid him of his existing cold sore immediately. Topical acyclovir (Zovirax) is prescribed. 1. As the nurse, how would you explain the mode of transmission and onset of symptoms for HSV to Nathan? 2. How would you respond when Nathan asked, "Is there any medication that I can take to prevent the cold sores from returning?" 3. Topical acyclovir is prescribed for this patient. What patient education would you provide?

1. Herpesviruses are usually acquired through direct physical contact with an infected person. HSV may remain in a latent, asymptomatic, nonreplicating state in sensory or autonomic nerve root ganglia for many years. Infection is lifelong. Immunosuppression, physical challenge, or emotional stress can promote active replication of the virus and reappearance of the characteristic lesions. 2. Antiviral agents are not routinely prescribed for prophylaxis due to the cost and potential adverse effects. Patients who experience particularly severe or recurrent episodes may receive low dose antiviral agents. 3. Nathan should apply the acyclovir as soon as symptoms of a herpes infection appear. The medication should be applied to all sores every 3 hours (6 times a day) for 7 days, or as directed. Sometimes, this medication may cause burning, stinging, and redness. Cold sores are contagious at all stages and can spread to other people through kissing or sharing things that touch the lips such as towels or utensils. Nathan should use disposable gloves when applying the medication to avoid spreading the infection. Lastly, a healthy lifestyle may reduce the recurrence of cold sores. This would include a balanced diet, exercise, restful sleep, and managing emotional stress. Nathan's university may have stress management and other support courses and services available that may be helpful

Dave Sweeney is a 59-year-old patient with chronic kidney disease and has been on dialysis for one year while awaiting a kidney transplant. He has begun to receive injections of epoetin alfa (Epogen, Procrit) and asks the nurse why he must receive the injections. 1. As the nurse, how would you answer Mr. Sweeney's question? 2. What teaching points would you include about this drug when providing education for Mr. Sweeney?

1. Patients with chronic kidney disease often have decreased secretion of erythropoietin from the kidneys and therefore require a medication such as epoetin alfa (Epogen) to stimulate RBC production and reduce the potential of becoming anemic, or to decrease the effects of anemia. 2. Teaching points should include the importance of monitoring the blood pressure for HTN and monitoring for adverse effects such as nausea, vomiting, constipation, or redness/pain at the injection site. Any confusion, numbness, chest pain, or difficulty breathing should be immediately reported to the health care provider. The patient should also be instructed to maintain a healthy diet and follow any dietary restrictions necessary because of renal failure.

Jessica Treadway is a 23-year-old patient, recently diagnosed with type-1 diabetes for which she has been prescribed insulin. She developed a vaginal discharge and made an appointment with her provider. She was diagnosed with a vaginal yeast infection with Candida albicans and prescribed fluconazole (Diflucan) topically for the infection. 1. Why do you think that Jessica is at risk for this type of infection? 2. What patient teaching will she need regarding this treatment?

1. Vaginal candidiasis is a common infection associated with diabetes due to increased blood glucose levels. The perineal area is also warm, moist, and dark, all environmental factors which favor the development of yeast. 2. General measures that will help to reduce the incidence of yeast infections include allowing adequate time to air dry after showering or bathing, increasing intake of yogurt or foods with natural probiotic cultures, and wearing cotton underclothes that allow air circulation. The nurse may also need to assess Jessica's blood glucose levels and control. If readings are consistently high, better control of the diabetes may help to reduce the recurrence of yeast infections.

A 24-year-old patient reports taking acetaminophen (Tylenol) fairly regularly for headaches. The nurse knows that a patient who consumes excessive acetaminophen per day or regularly consumes alcoholic beverages should be observed for what adverse effect? 1. Hepatic toxicity . Renal damage 3. Thrombotic effects 4. Pulmonary damage

Answer: 1 Rationale: Excessive doses of acetaminophen or regular consumption of alcohol may increase the risk of hepatic toxicity when acetaminophen is used. Options 2, 3, and 4 are incorrect. Renal or pulmonary toxicity and thrombotic events are not adverse effects associated specifically with acetaminophen. Cognitive Level: Applying. Nursing Process: Assessment. Client Need: Physiological Integrity.

The nursing plan of care for a patient receiving oprelvekin (Neumega) should include careful monitoring for symptoms of which adverse effect? 1. Fluid retention 2. Severe hypotension 3. Impaired liver function 4. Severe diarrhea

Answer: 1 Rationale: Oprelvekin (Neumega) may cause significant fluid retention, which may be particularly detrimental to a patient with cardiac or renal disease. Options 2, 3, and 4 are incorrect. Severe hypotension, impaired liver function, or severe diarrhea are not associated with oprelvekin therapy and other causes should be investigated if they occur. Cognitive Level: Analyzing. Nursing Process: Planning. Client Need: Physiological Integrity.

The patient has been prescribed oxymetazoline (Afrin) nasal spray for seasonal rhinitis. The nurse will provide which of the following instructions? 1. Limit use of this spray to 5 days or less. 2. The drug may be sedating so be cautious with activities requiring alertness. 3. This drug should not be used in conjunction with antihistamines. 4. This is an over-the-counter drug and may be used as needed for congestion.

Answer: 1 Rationale: Prolonged use of oxymetazoline (Afrin) causes hypersecretion of mucus and worsening nasal congestion, resulting in increased daily use. Options 2, 3, and 4 are incorrect. This medication should not be used for longer than 5 days unless otherwise directed. It may be used with antihistamines for symptomatic relief and it is not sedating. Cognitive Level: Applying. Nursing Process: Implementation. Client Need: Physiological Integrity.

A patient has been diagnosed with tuberculosis and is prescribed Rifater (pyrazinamide with isoniazid and rifampin). While the patient is on this medication, what teaching is essential? (Select all that apply.) 1. "It is critical to continue therapy for at least 6 to 12 months." 2. "Two or more drugs are used to prevent tuberculosis bacterial resistance." 3. "These drugs may also be used to prevent tuberculosis." 4. "No special precautions are required." 5. "After 1 month of treatment, the medication will be discontinued."

Answer: 1, 2, 3 Rationale: In order to effectively treat the TB bacterium, it is critical that the medicine be taken for 6 to 12 months and possibly as long as 24 months. Antitubercular drugs such as pyrazinamide, isoniazid (INH), and rifampin are also used for prevention and treatment of patients who convert from a negative TB test to a positive, although single drug use is most often prescribed in that situation. Multiple drug therapy is necessary because the Mycobacteria grow slowly, and resistance is common. Using multiple drugs in different combinations during the long treatment period lowers the potential for resistance and increases the chances for successful therapy. Options 4 and 5 are incorrect. Precautions to avoid adverse effects are required, and the drugs will be required much longer than 1 month. Cognitive Level: Analyzing. Nursing Process: Implementation. Client Need: Physiological Integrity.

An older adult patient diagnosed with iron-deficiency anemia will be taking ferrous sulfate (Feosol). The nurse will teach which of the required administration guidelines to the patient? (Select all that apply.) 1. Take the tablets on an empty stomach if possible. 2. Increase fluid intake and increase dietary fiber while taking this medication. 3. If liquid preparations are used, dilute with water or juice and sip through a straw placed in the back of the mouth. 4. Crush or dissolve sustained-release tablets in water if they are too big to swallow. 5. Take the drug at bedtime for best results.

Answer: 1, 2, 3 Rationale: Iron preparations should be taken on an empty stomach, diluted, and taken through a straw if liquid preparations are used, and extra fluid and fiber will help prevent constipation. Options 4 and 5 are incorrect. Sustained-release medications are specially formulated to absorb slowly and should never be crushed or dissolved. Iron preparations do not need to be taken only at bedtime. Cognitive Level: Applying. Nursing Process: Implementation. Client Need: Physiological Integrity.

What patient education should be included for a patient receiving enoxaparin (Lovenox)? (Select all that apply.) 1. Teach the patient or family to give subcutaneous injections at home. 2. Teach the patient or family not to take any over-the-counter drugs without first consulting with the health care provider. 3. Teach the patient to observe for unexplained bleeding such as pink, red, or dark brown urine or bloody gums. 4. Teach the patient to monitor for the development of deep vein thrombosis. 5. Teach the patient about the importance of drinking grapefruit juice daily.

Answer: 1, 2, 3, 4 Rationale: Enoxaparin is an LMWH. Patients and family can be taught to give subcutaneous injections at home. Teaching should include instructions to not take any other medications without first consulting the health care provider and recognizing the signs and symptoms of bleeding. Enoxaparin is given to prevent development of DVT. Patients should be taught signs and symptoms of DVT to observe for and should contact their health care provider immediately if these develop or worsen while on enoxaparin therapy. Option 5 is incorrect. Grapefruit juice is known to alter the metabolism of many drugs in the liver. Even though the enoxaparin is given parenterally, it is metabolized in the liver and may be affected by compounds in the grapefruit juice. Cognitive Level: Applying. Nursing Process: Implementation. Client Need: Physiological Integrity.

The nurse would question an order for peginterferon alfa-2a (Pegasys) if the patient had which of the following conditions? (Select all that apply.) 1. Pregnancy 2. Renal disease 3. Hepatitis 4. Liver disease 5. Malignant melanoma

Answer: 1, 2, 4 Rationale: Pregnancy and renal or liver disease are contraindications to the use of immunostimulant drugs such as peginterferon alfa-2a (Pegasys). Options 3 and 5 are incorrect. Chronic hepatitis and malignant melanoma are indications for use of these drugs. Cognitive Level: Analyzing. Nursing Process: Assessment. Client Need: Physiological Integrity.

Metronidazole (Flagyl) is being used to treat a patient's Giardia lamblia infection, a protozoan infection of the intestines. Which of the following are appropriate to teach this patient? (Select all that apply.) 1. Metronidazole may leave a metallic taste in the mouth. 2. The urine may turn dark amber brown while on the medication. 3. The metronidazole may be discontinued once the diarrhea subsides to minimize adverse effects. 4. Taking the metronidazole with food reduces GI upset. 5. Current sexual partners do not require treatment for this infection.

Answer: 1, 2, 4, 5 Rationale: Metronidazole may cause a metallic drug taste during therapy and may cause urine to darken. Taking the drug with food or milk may help reduce GI effects. Current sexual partners do not usually require treatment for Giardia infections because Giardia is not an STI; it affects the GI tract. Option 3 is incorrect. The entire course of metronidazole therapy should be completed, even if symptoms are diminished or absent, to ensure adequate treatment. Cognitive Level: Applying. Nursing Process: Implementation. Client Need: Physiological Integrity.

A patient has been diagnosed with genital herpes and has been started on oral acyclovir (Zovirax). What should be included in the teaching instructions for this patient? (Select all that apply.) 1. Increase fluid intake up to 2 L per day. 2. Report any dizziness, tremors, or confusion. 3. Decrease the amount of fluids taken so that the drug can be more concentrated. 4. Take the drug only when having the most itching or pain from the outbreak. 5. Use barrier methods such as condoms for sexual activity.

Answer: 1, 2, 5 Rationale: Acyclovir can be renal toxic and fluids should be increased throughout therapy. Neurotoxicity may occur and increasing dizziness, tremors, or any confusion should be reported immediately. Acyclovir does not prevent transmission of the disease and transmission may occur even if the host is asymptomatic. Barrier methods for sexual activity should be used. Options 3 and 4 are incorrect. Fluid intake should be increased, not decreased, and the drug must be taken consistently throughout the entire course of therapy. Suppressive therapy may also be ordered. Cognitive Level: Applying. Nursing Process: Implementation. Client Need: Physiological Integrity.

A 2-year-old patient is receiving vincristine (Oncovin) for Wilms' tumor. Which of the following findings will the nurse monitor to prevent or limit the main adverse effect for this patient? (Select all that apply.) 1. Numbness of the hands or feet 2. Angina or dysrhythmias 3. Constipation 4. Diminished reflexes 5. Dyspnea and pleuritis

Answer: 1, 3, 4 Rationale: The most serious adverse effect of vincristine is nervous system toxicity. Numbness of the feet or hands, constipation related to decreased peristalsis, and diminished reflexes are all signs of neurotoxicity. Options 2 and 5 are incorrect. Cardiac and pulmonary toxicities are not associated with vincristine. Cognitive Level: Analyzing. Nursing Process: Evaluation. Client Need: Physiological Integrity.

A patient with a congenital coagulation disorder is given aminocaproic acid (Amicar) to stop bleeding following surgery. The nurse will carefully monitor this patient for development of which of the following adverse effects? (Select all that apply.) 1. Anaphylaxis 2. Hypertension 3. Hemorrhage 4. Headache 5. Hypotension

Answer: 1, 4, 5 Rationale: Adverse effects of aminocaproic acid (Amicar) include headache, anaphylaxis, and hypotension. Options 2 and 3 are incorrect. Aminocaproic acid is given to prevent excessive bleeding and hemorrhage in patients with clotting disorders. It may cause hypotension, not HTN. Cognitive Level: Applying. Nursing Process: Evaluation. Client Need: Physiological Integrity.

The patient receiving heparin therapy asks how the "blood thinner" works. What is the best response by the nurse? 1. "Heparin makes the blood less thick." 2. "Heparin does not thin the blood but prevents clots from forming as easily in the blood vessels." 3. "Heparin decreases the number of platelets so that blood clots more slowly." 4. "Heparin dissolves the clot."

Answer: 2 Rationale: Anticoagulants do not change the viscosity (thickness) of the blood. Instead, anticoagulants modify the mechanisms by which clotting occurs. Options 1, 3, and 4 are incorrect. Heparin does not make the blood less viscous or actually thinner and does not decrease the number of platelets or dissolve existing clots. Cognitive Level: Applying. Nursing Process: Implementation. Client Need: Physiological Integrity.

A patient has started clopidogrel (Plavix) after experiencing a transient ischemic attack. What is the desired therapeutic effect of this drug? 1. Anti-inflammatory and antipyretic effects 2. To reduce the risk of a stroke from a blood clot 3. Analgesic as well as clot-dissolving effects 4. To stop clots from becoming emboli

Answer: 2 Rationale: Antiplatelet drugs such as clopidogrel are given to inhibit platelet aggregation and, thus, reduce the risk of thrombus formation. Options 1, 3, and 4 are incorrect. Antiplatelet drugs do not exert anti-inflammatory, antipyretic, or analgesic effects. The antiplatelet and anticoagulant drugs do not prevent emboli formation. Thrombolytics dissolve existing blood clots. Cognitive Level: Analyzing. Nursing Process: Evaluation. Client Need: Physiological Integrity.

A patient is started on efavirenz (Sustiva) for HIV. What should the nurse teach the patient about this drug? 1. Efavirenz (Sustiva) will cure the disease over time. 2. Efavirenz (Sustiva) will not cure the disease but may significantly extend the life expectancy. 3. Efavirenz (Sustiva) will be used prior to vaccines. 4. Efavirenz (Sustiva) will prevent the transmission of the disease.

Answer: 2 Rationale: Drug therapy with efavirenz (Sustiva) and other HAART drugs has not produced a cure but has resulted in a significant number of therapeutic successes with increased life span. Options 1, 3, and 4 are incorrect. There is currently no vaccine for HIV although research is ongoing. The drug does not cure the disease. Evidence has shown that HIV treatment significantly decreases viral loads and thus decreases the risk of transmission, but this has not yet been proven in all cases of infection. Cognitive Level: Applying. Nursing Process: Implementation. Client Need: Physiological Integrity.

A patient who is undergoing cancer chemotherapy asks the nurse why she is taking three different chemotherapy drugs. What is the nurse's best response? 1. "Your cancer was very advanced and therefore requires more medications." 2. "Each drug attacks the cancer cells in a different way, increasing the effectiveness of the therapy." 3. "Several drugs are prescribed to find the right drug for your cancer." 4. "One drug will cancel out the side effects of the other."

Answer: 2 Rationale: Effectiveness of chemotherapy is increased by use of multiple drugs from different classes that attack cancer cells at different points in the cell cycle. Thus, lower doses of each individual agent can be used to reduce side effects. A third benefit of combination chemotherapy is reduced incidence of drug resistance. Options 1, 3, and 4 are incorrect. A combination of drugs is given for most cancers regardless of how advanced the cancer is. The multidrug is not given to find the right drug because many may exert therapeutic effects. The drugs do not "cancel out" each other but work together. Cognitive Level: Applying. Nursing Process: Implementation. Client Need: Physiological Integrity.

Darbepoetin (Aranesp) is ordered for each of the following patients. The nurse would question the order for which condition? 1. A patient with chronic renal failure 2. A patient with AIDS who is receiving anti-AIDS drug therapy 3. A patient with hypertension 4. A patient on chemotherapy for cancer

Answer: 3 Rationale: Darbepoetin (Aranesp) and other similar drugs should not be used or are used cautiously in the patient with HTN because they may increase the blood pressure. Options 1, 2, and 4 are incorrect. Chronic renal failure, AIDS, and cancer chemotherapy are all indications for the use of darbepoetin. Cognitive Level: Analyzing. Nursing Process: Evaluation. Client Need: Physiological Integrity.

When planning to teach the patient about the use of epoetin alfa (Epogen, Procrit), the nurse would give which of the following instructions? 1. Eating raw fruits and vegetables must be avoided. 2. Frequent rest periods should be taken to avoid excessive fatigue. 3. Skin and mucous membranes should be protected from traumatic injury. 4. Exposure to direct sunlight must be minimized and sunscreen used when outdoors.

Answer: 2 Rationale: Epoetin alfa (Epogen, Procrit) is ordered to treat anemia and the patient with anemia may experience periods of excessive fatigue and weakness related to the diminished oxygen-carrying capacity from low RBC counts. Adequate rest periods should be planned and patients taught to avoid overexertion until the epoetin alfa has had therapeutic effects and the RBC counts improve. Options 1, 3, and 4 are incorrect. Avoiding fresh fruits or vegetables is not necessary for a patient who is taking epoetin alfa but may be appropriate for a patient with low WBC counts. Patients with anemia do not necessarily have low platelet counts (thrombocytopenia) and do not need to routinely avoid activities that may cause direct tissue injury. Limiting direct sun exposure and wearing sunscreen are excellent health practices but are not required as part of epoetin alfa therapy. Cognitive Level: Applying. Nursing Process: Planning. Client Need: Physiological Integrity.

To best monitor for therapeutic effects from filgrastim (Granix, Neupogen), the nurse will assess which laboratory finding? 1. Hemoglobin and hematocrit 2. White blood cell or absolute neutrophil counts 3. Serum electrolytes 4. Red blood cell count

Answer: 2 Rationale: Filgrastim stimulates granulocytes (WBCs). Options 1, 3, and 4 are incorrect. Filgrastim does not stimulate RBC production, affect Hgb or Hct, or have a direct effect on serum electrolytes. Cognitive Level: Applying. Nursing Process: Evaluation. Client Need: Physiological Integrity.

A patient with type 2 diabetes treated with oral antidiabetic medication is receiving oral fluconazole (Diflucan) for treatment of chronic tinea cruris (jock itch). The nurse instructs the patient to monitor blood glucose levels more frequently because of what potential drug effect? 1. Fluconazole (Diflucan) antagonizes the effects of many antidiabetic medications, causing hyperglycemia. 2. Fluconazole (Diflucan) interacts with certain antidiabetic drugs, causing hypoglycemia. 3. Fluconazole (Diflucan) causes hyperglycemia. 4. Fluconazole (Diflucan) causes hypoglycemia.

Answer: 2 Rationale: Fluconazole (Diflucan) inhibits the hepatic CYP enzymes and interacts with many drugs. Hypoglycemia may result if fluconazole is administered concurrently with certain oral antidiabetic medications, including glyburide. Options 1, 3, and 4 are incorrect. Fluconazole does not directly cause hypoglycemia or hyperglycemia. Hypoglycemia, not hyperglycemia, is a possible effect caused by drug interactions. Cognitive Level: Analyzing. Nursing Process: Implementation. Client Need: Physiological Integrity.

The nurse is evaluating drug effects in a patient who has been given interferon alfa-2b (Intron-A) for hepatitis B and C. Which of the following is a common adverse effect? 1. Depression and thoughts of suicide 2. Flulike symptoms of fever, chills, or fatigue 3. Edema, hypotension, and tachycardia 4. Hypertension, renal or hepatic insufficiency

Answer: 2 Rationale: Interferon alfa-2b (Intron-A) commonly causes flulike symptoms in up to 50% of patients receiving the drug. Options 1, 3, and 4 are incorrect. Depression with suicidal thoughts, hypo- or hypertension, tachycardia, edema, and renal or hepatic insufficiency are not common adverse effects of the drug. Cognitive Level: Analyzing. Nursing Process: Evaluation. Client Need: Physiological Integrity.

A patient with a severe systemic fungal infection is to be given amphotericin B (Fungizone). Before starting the amphotericin infusion, the nurse premedicates the patient with acetaminophen (Tylenol), diphenhydramine (Benadryl), and prednisone (Deltasone). What is the purpose of premedicating the patient prior to the amphotericin? 1. It delays the development of resistant fungal infections. 2. It decreases the risk of hypersensitivity reactions to the amphotericin. 3. It prevents hyperthermia reactions from the amphotericin. 4. It works synergistically with the amphotericin so a lower dose may be given.

Answer: 2 Rationale: Many patients develop fever and chills, vomiting, and headache at the beginning of therapy with amphotericin that subside as treatment continues. Cardiac arrest, hypotension, and dysrhythmias are possible with severe hypersensitivity reactions. A combination of antipyretics (e.g., acetaminophen), antihistamines (e.g., diphenhydramine), and corticosteroids (e.g., prednisone) may be given preinfusion to prevent or reduce these adverse reactions. Options 1, 3, and 4 are incorrect. Giving premedication will not reduce the development of resistant fungal strains or increase the action of amphotericin. Although many patients develop a fever, this would not be considered a true hyperthermic reaction. Cognitive Level: Analyzing. Nursing Process: Implementation. Client Need: Physiological Integrity.

A patient will be discharged after surgery with a prescription for penicillin. When planning at-home instructions, what will the nurse include? 1. Penicillins can be taken while breast-feeding. 2. The entire prescription must be finished. 3. All penicillins can be taken without regard to eating. 4. Some possible side effects include abdominal pain and constipation.

Answer: 2 Rationale: Many people will discontinue medication after improvement is noted. All antibiotic regimens must be completed to prevent recurrence of infection unless allergy or significant adverse effects occur that warrant discontinuing or changing the drug used. Options 1, 3, and 4 are incorrect. Some penicillins (e.g., amoxicillin) should be taken with meals, whereas all others should be taken 1 hour before or 2 hours after meals. Penicillins should be used with caution during breast-feeding. Penicillins, along with other antibiotics, tend to cause diarrhea and not constipation. Cognitive Level: Analyzing. Nursing Process: Planning. Client Need: Physiological Integrity.

A 32-year-old female has been started on amoxicillin (Amoxil, Trimox) for a severe UTI. Before sending her home with this prescription, the nurse will provide which instruction? 1. Teach her to wear sunscreen. 2. Ask her about oral contraceptive use and recommend an alternative method for the duration of the ampicillin course. 3. Assess for hearing loss. 4. Recommend taking the pill with some antacid to prevent gastrointestinal upset.

Answer: 2 Rationale: Penicillin antibiotics such as amoxicillin (Amoxil, Trimox) may significantly decrease the effectiveness of oral contraceptives and another method of birth control should be suggested during the time the drug is taken. Options 1, 3, and 4 are incorrect. Sunburning and hearing loss are not adverse effects commonly associated with penicillin. Cognitive Level: Applying. Nursing Process: Assessment. Client Need: Physiological Integrity.

The nurse is teaching a community health class to a group of young adults who have recently immigrated to the United States about preventing hepatitis B. What is the most effective method of preventing a hepatitis B infection? 1. Peginterferon alfa-2a (Pegasys) 2. Hepatitis B vaccine (Engerix-B) 3. Adefovir dipivoxil (Hepsera) 4. Entecavir (Baraclude)

Answer: 2 Rationale: The best method of preventing hepatitis B (HBV) infections is to complete a series of the HBV vaccination. Three doses of the vaccine provide up to 90% of patients with protection following exposure to the virus. Options 1, 3, and 4 are incorrect. Treatment of acute HBV infection is symptomatic because no specific therapy is available. Interferons such as peginterferon alfa-2a (Pegasys) or antiviral drugs such as adefovir dipivoxil (Hepsera) or entecavir (Baraclude) only treat the disease by stopping viral replication to reduce the length of the disease process or by boosting the body's defenses. Cognitive Level: Applying. Nursing Process: Implementation. Client Need: Physiological Integrity.

The nurse notes that the patient has reached his nadir. What does this finding signify? 1. The patient is receiving the highest dose possible of the chemotherapy. 2. The patient is experiencing bone marrow suppression and his blood counts are at their lowest point. 3. The patient has peaked on his chemotherapy level and should be going home in a few days. 4. The patient is experiencing extreme depression and will be having a psychiatric consult.

Answer: 2 Rationale: The nadir is the point of greatest bone marrow suppression, as measured by the lowest neutrophil count. Options 1, 3, and 4 are incorrect. The nadir does not refer to chemotherapy dose, level, or client symptoms. Cognitive Level: Applying. Nursing Process: Assessment. Client Need: Physiological Integrity.

A patient has been prescribed fluticasone (Flonase) to use with oxymetazoline (Afrin). How should the patient be taught to use these drugs? 1. Use the fluticasone first, then the oxymetazoline after waiting 5 minutes. 2. Use the oxymetazoline first, then the fluticasone after waiting 5 minutes. 3. The drugs may be used in either order. 4. The fluticasone should be used only if the oxymetazoline fails to relieve the nasal congestion.

Answer: 2 Rationale: The oxymetazoline (Afrin) should be used first, followed by the fluticasone (Flonase) in 5 to 10 minutes. When a decongestant and corticosteroid nasal spray are used together, the decongestant spray should be used first to allow time for the nasal passages to open, allowing the corticosteroid to reach deeper into the nasal passages. Options 1, 3, and 4 are incorrect. The drugs are ordered in combination for better control of nasal rhinitis. The oxymetazoline should not be used for over 5 days unless otherwise directed. Cognitive Level: Applying. Nursing Process: Implementation. Client Need: Physiological Integrity.

A patient with HIV has been taking lopinavir with ritonavir (Kaletra) for the past 8 years and has noticed a redistribution of body fat in the arms, legs, and abdomen (lipodystrophy). The nurse will evaluate this patient for what other additional adverse effects associated with this drug? (Select all that apply.) 1. Renal failure 2. Hyperglycemia 3. Pancreatitis 4. Bone marrow suppression 5. Hepatic failure

Answer: 2, 3, 5 Rationale: Hyperglycemia, pancreatitis, and hepatic failure are adverse effects associated with lopinavir with ritonavir (Kaletra). Options 1 and 4 are incorrect. Renal failure and bone marrow suppression are not adverse effects associated with this drug. Cognitive Level: Analyzing. Nursing Process: Evaluation. Client Need: Physiological Integrity.

A patient with a history of hypertension is to start drug therapy for rheumatoid arthritis. Which of the following drugs would be contraindicated, or used cautiously, for this patient? (Select all that apply.) 1. Aspirin 2. Ibuprofen (Advil, Motrin) 3. Acetaminophen (Tylenol) 4. Naproxen (Aleve) 5. Methylprednisolone (Medrol)

Answer: 2, 4, 5 Rationale: NSAIDs such as ibuprofen and naproxen have been shown to increase the risk of serious thrombotic events, MI, and stroke which can be fatal. These drugs should be used cautiously or avoided in patients with HTN. Corticosteroids such as methylprednisolone may cause fluid retention, which may increase the patient's blood pressure. Cautious and frequent monitoring will be required if the patient takes this drug. Options 1 and 3 are incorrect. Aspirin or acetaminophen will not increase the patient's blood pressure. Acetaminophen would only provide pain relief without treating the underlying inflammation associated with RA. Cognitive Level: Analyzing. Nursing Process: Implementation. Client Need: Physiological Integrity.

A patient diagnosed with pernicious anemia is to start cyanocobalamin (Nascobal) injections. Which of the following patient statements demonstrates an understanding of the nurse's teaching? (Select all that apply.) 1. "I need to be careful to avoid infections." 2. "I will need to take this drug for the rest of my life." 3. "I should increase my intake of foods that contain vitamin B ." 4. "I need to take the liquid preparation through a straw." 5. "I may be able to switch over to nasal sprays once my vitamin B levels are normal."

Answer: 2, 5 Rationale: The patient with pernicious anemia is unable to absorb vitamin B from the stomach and must take lifelong supplements of the vitamin. Once vitamin levels reach normal, a weekly nasal spray may be ordered. Options 1, 3, and 4 are incorrect. Because patients with pernicious anemia lack a factor (intrinsic factor) that allows gastric absorption of vitamin B , oral use is not effective and increasing the amount of foods containing the vitamin will not be effective. Patients with pernicious anemia have a decrease in RBCs, not WBCs, and are not at increased risk for infections. Cognitive Level: Applying. Nursing Process: Implementation. Client Need: Physiological Integrity

A patient on chemotherapy has a complete blood count (CBC) drawn and the nurse calculates the absolute neutrophil count (ANC). The white blood cell (WBC) count is 2,500 mm with 0.22 segmented neutrophils (segs) and 0.06 banded neutrophils (bands). What is the ANC? 1. 18.93 2. 89 3. 700 4. 2500.28

Answer: 3 Rationale: ANC = WBC times the number of neutrophils (segs plus bands). 2,500 × (0.22 + 0.06) = 700. Options 1, 2, and 4 are incorrect. Using the preceding formula does not result in these values. Cognitive Level: Applying. Nursing Process: Implementation. Client Need: Physiological Integrity.

A nurse is preparing to administer a hepatitis B vaccination to a patient. Which of the following would cause the nurse to withhold the vaccination and check with the health care provider? 1. The patient smokes cigarettes, one pack per day. 2. The patient is frightened by needles and injections. 3. The patient is allergic to yeast and yeast products. 4. The patient has hypertension.

Answer: 3 Rationale: An allergy to yeast or yeast products is a contraindication to the hepatitis B vaccination. Options 1, 2, and 4 are incorrect. Smoking, HTN, and a fear of needles or injections are not contraindications for the drug. These conditions may be managed with appropriate health teaching. Cognitive Level: Applying. Nursing Process: Assessment. Client Need: Physiological Integrity.

What important information should be included in the patient's education regarding taking ciprofloxacin (Cipro)? 1. The drug can cause discoloration of the teeth. 2. Fluid intake should be decreased to prevent urine retention. 3. Any heel or lower leg pain should be reported immediately. 4. The drug should be taken with an antacid to reduce gastric effects

Answer: 3 Rationale: Fluoroquinolones such as ciprofloxacin (Cipro) have been associated with an increased risk of tendinitis and tendon rupture. Any heel or lower leg pain should be reported immediately for evaluation. Options 1, 2, and 4 are incorrect. Ciprofloxacin will not cause discoloration of the teeth, and fluids should be encouraged during use of the drug. Taking antacids concurrently with ciprofloxacin may significantly impair absorption of the drug. Cognitive Level: Analyzing. Nursing Process: Implementation. Client Need: Physiological Integrity.

What is the most effective treatment method for the nausea and vomiting that accompanies many forms of chemotherapy? 1. Administer an oral antiemetic when the patient complains of nausea and vomiting. 2. Administer an antiemetic by intramuscular injection when the patient complains of nausea and vomiting. 3. Administer an antiemetic prior to the antineoplastic medication. 4. Encourage additional fluids prior to administering the antineoplastic medication.

Answer: 3 Rationale: For maximum effect, patients should be given an antiemetic prior to the start of treatment. Options 1, 2, and 4 are incorrect. Waiting to give an antiemetic until after the chemotherapy has started may result in a delay in treatment of the nausea and vomiting. IM injections are usually avoided during chemotherapy because of an increased risk of infection. Fluids are encouraged throughout chemotherapy but will not prevent or treat the nausea and vomiting that may occur. Cognitive Level: Applying. Nursing Process: Implementation. Client Need: Physiological Integrity.

The patient has been taking aspirin for several days for headache. During the assessment, the nurse discovers that the patient is experiencing ringing in the ears and dizziness. What is the most appropriate action by the nurse? 1. Question the patient about history of sinus infections. 2. Determine whether the patient has mixed the aspirin with other medications. 3. Tell the patient not to take any more aspirin. 4. Tell the patient to take the aspirin with food or milk.

Answer: 3 Rationale: High doses of aspirin can produce side effects of tinnitus, dizziness, headache, and sweating. These symptoms should be reported to the health care provider. Options 1, 2, and 4 are incorrect. Sinus infections may cause dizziness if the eustachian tubes are blocked but should not cause tinnitus. The nurse should assess whether any of the patient's medications also contain aspirin, but most OTC combination remedies include acetaminophen and not aspirin. Taking aspirin with food or milk may decrease the incidence of GI upset but will not prevent tinnitus. Cognitive Level: Analyzing. Nursing Process: Implementation. Client Need: Physiological Integrity.

Which of the following findings would suggest that myelosuppression is occurring in a patient who is taking zidovudine (Retrovir)? 1. Increase in serum blood urea nitrogen (BUN) levels 2. Increase in white blood cell (WBC) count 3. Decrease in platelet count 4. Decrease in blood pressure

Answer: 3 Rationale: Myelosuppression is the declining ability of the bone marrow to produce blood cells. A decrease in platelet count may indicate myelosuppression is occurring. Options 1, 2, and 4 are incorrect. An increase in BUN or a decrease in blood pressure does not indicate myelosuppression. A decrease, rather than increase, in WBC count would be expected if myelosuppression is occurring. Cognitive Level: Analyzing. Nursing Process: Evaluation. Client Need: Physiological Integrity.

Which of the following is the best advice that the nurse can give a patient with viral rhinitis who intends to purchase an over-the counter combination cold remedy? 1. Dosages in these remedies provide precise dosing for each symptom that you are experiencing. 2. These drugs are best used in conjunction with an antibiotic. 3. It is safer to use a single-drug preparation if you are experiencing only one symptom. 4. Since these drugs are available over the counter, it is safe to use any of them as long as needed.

Answer: 3 Rationale: Single-symptom OTC preparations are preferred over multiuse preparations to avoid additional drugs that are not needed for symptom relief and to decrease risk of additional adverse effects. Options 1, 2, and 4 are incorrect. Dosing ofany OTC preparation is carefully calculated to provide precise dosing for age and symptoms. Antibiotics may be required for serious infections, but for common symptoms OTC remedies are recognized as safe and effective. However, they should not be used indefinitely without consultation with a healthcare provider. Cognitive Level: Applying. Nursing Process: Implementation. Client Need: Physiological Integrity.

A patient has been diagnosed with a fungal nail infection. The health care provider has prescribed griseofulvin (Fulvicin). The nurse will include which of the following in her teaching to the patient? 1. Drug therapy will be for a very short time, probably 2 to 4 weeks. 2. Carefully inspect all intramuscular injection sites for bruising. 3. Notify the provider if symptoms of infection worsen. 4. Limit fluid intake to approximately 1,000 mL/day.

Answer: 3 Rationale: Systemic antifungal drugs have little or no antibacterial activity. An increase or worsening in symptoms of infection may indicate a superinfection with bacteria. Options 1, 2, and 4 are incorrect. Griseofulvin (Fulvicin) is given PO only; it is not given IM. Fluid intake should be increased with this medication because it can affect renal function. The full course of therapy should be completed. Cognitive Level: Analyzing. Nursing Process: Implementation. Client Need: Physiological Integrity.

A patient with deep vein thrombosis is receiving an infusion of heparin and will be started on warfarin (Coumadin) soon. While the patient is receiving heparin, what laboratory test will provide the nurse with information about its therapeutic effects? 1. Prothrombin time (PT) 2. International Normalized Ratio (INR) 3. Activated partial thromboplastin time (aPTT) 4. Platelet count

Answer: 3 Rationale: Therapeutic effects of heparin are monitored by the aPTT. While the patient is receiving heparin, the aPTT should be 1.5 to 2 times the patient's baseline, or 60 to 80 seconds. Options 1, 2, and 4 are incorrect. A PT or INR is used to monitor the effectiveness of warfarin (Coumadin). Platelets are not affected by anticoagulant therapy and are not useful in monitoring the therapeutic effects of the drug. Cognitive Level: Analyzing. Nursing Process: Evaluation. Client Need: Physiological Integrity.

A patient is receiving a thrombolytic drug, alteplase (Activase), following an acute myocardial infarction. Which of the following effects is most likely attributed to this drug? 1. Skin rash with urticaria 2. Wheezing with labored respirations 3. Bruising and epistaxis 4. Temperature elevation of 38.2°C (100.8°F)

Answer: 3 Rationale: Thrombolytic agents such as alteplase (Activase) dissolve existing clots rapidly and continue to have effects for 2 to 4 days. All forms of bleeding must be monitored and reported immediately. Options 1, 2, and 4 are incorrect. Skin rash, urticaria, labored respirations with wheezing, or temperature elevation are not directly associated with alteplase, and other causes should be investigated. Cognitive Level: Analyzing. Nursing Process: Evaluation. Client Need: Physiological Integrity.

A patient has a prescription for fluticasone (Flonase). Place the following instructions in the order in which the nurse will instruct the patient to use the drug. 1. Instill one spray directed high into the nasal cavity. 2. Clear the nose by blowing. 3. Prime the inhaler prior to first use. 4. Spit out any excess liquid that drains into the mouth.

Answer: 3, 2, 1, 4 Rationale: When an intranasal inhaler is used, the device should be primed prior to the first use; the nasal passages should be cleared by blowing; the drug should be instilled by spray directed high into the nasal passages; and any liquid that drains into the mouth should be spit out. Cognitive Level: Applying. Nursing Process: Implementation. Client Need: Health Promotion and Maintenance.

The nurse is counseling a mother regarding antipyretic choices for her 8-year-old daughter. When asked why aspirin is not a good drug to use, what should the nurse tell the mother? 1. It is not as good an antipyretic as is acetaminophen. 2. It may increase fever in children under age 10. 3. It may produce nausea and vomiting. 4. It increases the risk of Reye's syndrome in children under 19 with viral infections.

Answer: 4 Rationale: Aspirin and salicylates are associated with an increased risk of Reye's syndrome in children under 19, especially in the presence of viral infections. Options 1, 2, and are incorrect. Acetaminophen is not significantly different from aspirin or salicylates for the treatment of fever. Use of aspirin or salicylates should not increase fever although it may cause nausea or vomiting related to GI irritation; however, it is not contraindicated in children specifically for this reason. Cognitive Level: Applying. Nursing Process: Implementation. Client Need: Physiological Integrity.

A 32-year-old female patient is started on metronidazole (Flagyl) for treatment of a trichomonas vaginal infection. What must the patient eliminate from her diet for the duration she is on this medication? 1. Caffeine 2. Acidic juices 3. Antacids 4. Alcohol

Answer: 4 Rationale: Concurrent use of alcohol during metronidazole treatment may cause a disulfiram-like reaction with excessive nausea, vomiting, and possible hypotension. Options 1, 2, and 3 are incorrect. Caffeine, acidic juices, and antacids do not need to be avoided while taking metronidazole. Cognitive Level: Applying. Nursing Process: Implementation. Client Need: Physiological Integrity.

A 55-year-old female patient is receiving cyclosporine (Neoral, Sandimmune) after a heart transplant. The patient exhibits a white blood cell count of 12,000 cells/mm , a sore throat, fatigue, and a low-grade fever. The nurse suspects which of the following conditions? 1. Transplant rejection 2. Heart failure 3. Dehydration 4. Infection

Answer: 4 Rationale: Due to immune system suppression by the cyclosporine (Neoral, Sandimmune), infections are common. While the WBC count is slightly elevated, this drug suppresses the function of the immune cells (T-cells) and does not suppress bone marrow production of WBCs. Options 1, 2, and 3 are incorrect. Prevention of transplant rejection is a therapeutic indication for the use of cyclosporine. The patient's symptoms of sore throat and low-grade fever are not symptomatic of heart failure or dehydration. Cognitive Level: Analyzing. Nursing Process: Assessment. Client Need: Physiological Integrity.

Which of the following statements by a patient who is taking cyclosporine (Neoral, Sandimmune) would indicate the need for more teaching by the nurse? 1. "I will report any reduction in urine output to my health care provider." 2. "I will wash my hands frequently." 3. "I will take my blood pressure at home every day." 4. "I will take my cyclosporine at breakfast with a glass of grapefruit juice."

Answer: 4 Rationale: Grapefruit juice increases cyclosporine levels 50% to 200%, resulting in drug toxicity. Options 1, 2, and 3 are incorrect. These statements reflect an understanding of the nurse's teaching. Hand washing is important to prevent infection. Renal toxicity and HTN are adverse effects of cyclosporine therapy. Cognitive Level: Analyzing. Nursing Process: Evaluation. Client Need: Physiological Integrity.

A 5-year-old child is due for prekindergarten immunizations. After interviewing her mother, which of the following responses may indicate a possible contraindication for giving this preschooler a live vaccine (e.g., measles, mumps, and rubella [MMR]) at this visit and would require further exploration by the nurse? 1. Her cousin has the flu. 2. The mother has just finished her series of hepatitis B vaccines. 3. Her arm became very sore after her last tetanus shot. 4. They are caring for her grandmother who has just finished her second chemotherapy treatment for breast cancer.

Answer: 4 Rationale: Live vaccines may be contraindicated when patients present an exposure risk of the infectious agent to immunocompromised people such as those on chemotherapy or immunosuppressant therapy. Options 1, 2, and 3 are incorrect. Assuming that the cousin has a normal and active immune system, the cousin's flu would not be a contraindication. The mother would not be at risk and because she has received recent vaccinations, assessment of her immune system would have been completed at that time. Localized soreness or tenderness is a potential (mild) adverse effect of immunizations and can be managed symptomatically. Cognitive Level: Analyzing. Nursing Process: Assessment. Client Need: Physiological Integrity.

A patient was prescribed chloroquine (Aralen) prior to a trip to an area where malaria is known to be endemic. The nurse will instruct the patient to remain on the drug for up to 6 weeks after returning, and the patient asks why this is necessary. What is the nurse's best response? 1. "You may be carrying microscopic malaria parasites back with you on clothes or other personal articles." 2. "It helps prevent transmission to any of your family members." 3. "It will prevent any mosquito that bites you from picking up the malaria infection." 4. "It continues to kill any remaining malarial parasites that may have been acquired during the trip that are in your red blood cells."

Answer: 4 Rationale: Malarial parasites (Plasmodium) concentrate in RBCs and prophylactic treatment with choloroquine (Aralen) for 2 weeks prior and up to 6 weeks after a trip is necessary to prevent infection or to treat any Plasmodium that has entered the host's system. Options 1, 2, and 3 are incorrect. Chloroquine (Aralen) will not prevent transmission to family members or to mosquitoes that bite the host. Malaria is not transmitted by direct contact and family members would not be at risk. Malaria is carried in the blood system and would not be carried on clothes or other personal articles. Cognitive Level: Analyzing. Nursing Process: Implementation. Client Need: Physiological Integrity

While educating the patient about hydrocortisone (Cortef), the nurse would instruct the patient to contact the health care provider immediately if which of the following occurs? 1. There is a decrease of 1 kg (2 lb) in weight. 2. There is an increase in appetite. 3. There is tearing of the eyes. 4. There is any difficulty breathing.

Answer: 4 Rationale: Side effects that need to be reported immediately include difficulty breathing; heartburn; chest, abdomen, joint, or bone pain; nosebleed; blood in sputum when coughing, vomitus, urine, or stools; fever; chills or signs of infection; increased thirst or urination; fruity breath odor; falls; or mood swings. Options 1, 2, and 3 are incorrect. An increase in weight due to fluid retention may occur but not a decrease in weight. An increase in appetite is a common effect from corticosteroids. An increase in tearing of the eyes is not associated with corticosteroids. Cognitive Level: Analyzing. Nursing Process: Implementation. Client Need: Physiological Integrity.

The nurse is admitting a patient with rheumatoid arthritis. The patient has been taking prednisone (Orasone) for an extended time. During the assessment, the nurse observes that the patient has a very round moon-shaped face, bruising, and an abnormal contour of the shoulders. What does the nurse conclude based on these findings? 1. These are normal reactions with the illness. 2. These are probably birth defects. 3. These are symptoms of myasthenia gravis. 4. These are symptoms of adverse drug effects from the prednisone.

Answer: 4 Rationale: Signs and symptoms of bruising and a characteristic pattern of fat deposits in the cheeks (moon face), shoulders (buffalo hump), and abdomen are common adverse effects associated with long-term prednisone use. Options 1, 2, and 3 are incorrect. These symptoms are not indicative of the disease process, birth defects, or myasthenia gravis. Cognitive Level: Analyzing. Nursing Process: Assessment. Client Need: Physiological Integrity.

A patient has been prescribed tetracycline. When providing information regarding this drug, the nurse should include what information about tetracycline? 1. It is classified as a narrow-spectrum antibiotic with minimal adverse effects. 2. It is used to treat a wide variety of disease processes. 3. It has been identified to be safe during pregnancy. 4. It is contraindicated in children younger than 8 years.

Answer: 4 Rationale: Tetracycline has the ability to cause permanent mottling and discoloration of teeth and therefore is not advised for children younger than 8 years of age. Options 1, 2, and 3 are incorrect. Tetracyclines have one of the broadest spectrums of the antibiotics, and all antibiotics have significant adverse effects. Tetracycline is contraindicated in pregnancy. Cognitive Level: Analyzing. Nursing Process: Implementation. Client Need: Physiological Integrity.

Superinfections are an adverse effect common to all antibiotic therapy. Which of the following best describes a superinfection? 1. An initial infection so overwhelming that it requires multiple antimicrobial drugs to treat successfully 2. Bacterial resistance that creates infections that are difficult to treat and are often resistant to multiple drugs 3. Infections requiring high-dose antimicrobial therapy with increased chance of organ toxicity 4. The overgrowth of normal body flora or of opportunistic organisms such as viruses and yeast no longer held in check by normal, beneficial flora

Answer: 4 Rationale: When normal host flora are decreased or killed by antibacterial therapy, opportunistic organisms such as viral and fungal infections may occur. Options 1, 2, and 3 are incorrect. Bacterial resistance and organ toxicity may be adverse drug effects of antibacterial therapy but do not describe superinfections. The use of multiple antibiotics for severe infections is a therapeutic use of the drugs. Cognitive Level: Applying. Nursing Process: Assessment. Client Need: Physiological Integrity.

A patient has received a prescription for zanamivir (Relenza) for flulike symptoms. The patient states, "I think I'll hold off on starting this. I don't feel that bad yet." What is the nurse's best response? 1. "The drug has a stable shelf life so you can save it for later 2. "It can be saved for later but you will also require an antibiotic to treat your symptoms if you wait." 3. "It can be started within two weeks after the onset of symptoms." 4. "To be effective, it must be started within 48 hours after the onset of symptoms."

Answer: 4 Rationale: Zanamivir (Relenza) must be started within 48 hours after the onset of symptoms to be effective. Options 1, 2, and 3, are incorrect. Immunity begins approximately 2 weeks after influenza immunization. Waiting longer than 48 hours before taking the drug will not shorten the infection period, and the drug should not be saved for later. Cognitive Level: Applying. Nursing Process: Implementation. Client Need: Physiological Integrity.

Which of the following statements by a patient who is undergoing antineoplastic therapy would be of concern to the nurse? (Select all that apply.) 1. "I have attended a meeting of a cancer support group." 2. "My husband and I are planning a short trip next week." 3. "I am eating six small meals plus two protein shakes a day." 4. "I am taking my 15-month-old granddaughter to the pediatrician next week for her baby shots." 5. "I am going to go shopping at the mall next week."

Answer: 4, 5 Rationale: Patients and family members should avoid receiving live virus vaccinations or exposure to chickenpox. The patient could have an exacerbation or a more pronounced episode of the disease. The patient should not care for the granddaughter if vaccination with live viruses is planned. The patient should also avoid crowds, especially in enclosed spaces when possible, to minimize exposure risk. The nurse should discuss measures to minimize the risk of infections if the patient desires to go shopping. Options 1, 2, and 3 are incorrect. Attending a support group, maintaining normal activities when possible, and eating small, frequent meals with sufficient protein are routine care measures during chemotherapy. Cognitive Level: Analyzing. Nursing Process: Assessment. Client Need: Physiological Integrity.

Ramon de la Cruz is a 27-year-old financial analyst who has recently begun chemotherapy for treatment of Hodgkin's lymphoma. He has tolerated the chemotherapy fairly well but has experienced mild, daily nausea with occasional vomiting, usually controlled by granisetron (Kytril). His main concern is the fatigue he experiences and the impact it has on his work. He also admits that he has been experiencing anorexia and "just doesn't feel like eating much," something which may be contributing to his fatigue. He has lost 2 kg (more than 4 lb) since his last clinic visit 2 weeks ago. 1. As Ramon's nurse, how might you manage his chemotherapy related nausea and anorexia? 2. What suggestions might assist Ramon in managing his fatigue?

As the nurse, you should assess whether Ramon is taking the antinausea drug granisetron (Kytrel) regularly or on a prn basis. If he consistently experiences nausea, taking the drug regularly rather than prn may provide better results. Additional antiemetic therapy, perhaps supplementing or switching to another drug group, may be needed. Small sips of ginger ale, without carbonation if desired, may also help relieve nausea. Supplementing his diet with high-protein drinks and eating smaller more frequent meals may increase oral and caloric intake. Ramon may benefit from a dietary consult, and you could explore this option with him. Improved fluid and caloric intake will keep him in optimal health during the time of his chemotherapy and may help to reduce some of the drug-related fatigue. 2. If Ramon's job allows him to work at home, this might be a viable option during periods of extreme fatigue. Frequent rest breaks while at work, especially if a break room is available in which to lie down, may allow Ramon to continue to work during this time. His employer may be able to offer a shortened work-week, and he could explore medical leave options with the Human Resources department. If there are financial concerns, a social services referral may be advisable.