Custom: immunity 101/8/3/20_practice

A nurse is reinforcing teaching about vancomycin with a client who has an infection. Which of the following information should the nurse include in the teaching?

"Notify your provider if you experience any changes in your hearing." Vancomycin can cause ototoxicity, leading to tinnitus, loss of hearing, roaring in the ears, or permanent deafness. Any change in hearing should be reported to the provider.

A nurse is reinforcing teaching with a client with bacterial conjunctivitis of the right eye, and a prescription for an antibiotic ophthalmic ointment. Which of the following statements should the nurse make?

-"Apply the ointment in a thin line into the conjunctival sac." This is the correct procedure for applying ophthalmic ointment. The medication should be administered (in a thin line) into the conjunctival sac, rather than being placed directly on the globe of the eye. This ensures that more of the medication meets the surfaces of the eye when the client blinks.

A nurse is reviewing discharge instructions with a client newly prescribed amoxicillin-calvulanate. Which of the following client statements indicates an understanding of the teaching?

-"I can take this medication with food." Amoxicillin-clavulanate can be taken with meals, as can penicillin V and amoxicillin. Clients should take all other penicillin derivatives on an empty stomach with a full glass of water one hour before meals or 2 hr after meals.

A nurse is reinforcing teaching with a client who has diabetes mellitus and a new prescription for prednisone. Which of the following statements indicates an understanding of the teaching?

-"I should expect to feel hungrier while on this medication." Prednisone causes an increase in appetite.

A nurse is reinforcing teaching with a client who has a prescription for lisinopril. Which of the following statements indicate an understanding of the teaching?

-"I will contact my provider if I become pregnant while taking this medication." The nurse should instruct the client to notify the provider if pregnancy occurs while taking lisinopril. This medication can cause fetal injury including fetal death if taken in the second or third trimester. If a client becomes pregnant, the ACE inhibitor should be withdrawn.

A nurse is reinforcing teaching to a parent about the use of nystatin for an infant who has oral candidiasis. Which of the following statements by the parent indicates an understanding of the administration of nystatin?

-"I will swab the medication inside my baby's mouth and on her tongue." Nystatin should be applied topically to the area affected with candidiasis, usually four times daily. Adults and older children can swish the nystatin suspension around in their mouth for a period of time and then swallow it. Since infants and very young children cannot follow these directions, the medication should be applied orally using a swab.

A nurse is reinforcing teaching a client who has a new prescription for gentamycin ointment to treat a skin infection. Which of the following statements by the client indicates an understanding of the teaching?

-"I'll wash the area with soap and water before I apply the cream." The client should wash the area with soap and water and dry it thoroughly to promote absorption before applying the cream.

A nurse is reinforcing discharge teaching with a client who has hyperlipidemia and a prescription for niacin. Which of the following statements should the nurse include in the teaching?

-"You might experience flushing of the face after taking this mediation." The nurse should advise the client that niacin causes flushing of the face, neck, and ears in most clients within the first 2 hr of taking the medication.

A nurse is preparing to administer ceftriaxone 1 g IM to a client. Available is 2 g/ mL. How many mL should the nurse administer to the client? (Round to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

-0.5 mL 1 / 2 = 0.5

A nurse is preparing to administer lamivudine 150 mg PO every 12 hours. Available is lamivudine 100 mg tablets. How many tablets should the nurse administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

-1.5 tablet(s) 150 / 100 = 1.5

A nurse is preparing to administer cefixime 200 mg PO. Available is cefixime oral suspension 100 mg/5 mL. How many mL should the nurse administer? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

-10 mL 200 x 5 = 1,000 1,000 / 100 = 10

A nurse is preparing to administer indomethacin 50 mg PO. Available is indomethacin oral suspension 5 mg/mL. How many mL should the nurse administer? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

-10 mL 50 / 5 = 10 mL

A nurse is preparing to administer amoxicillin 500 mg PO to a client. The amount available is amoxicillin suspension 250 mg/5 mL. How many mL should the nurse administer? (Round to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

-10 mL 500 x 5 = 2500 2500 / 250 = 10

A nurse is preparing to administer clindamycin palmitate 225 mg PO to a client. Available is clindamycin palmitate oral suspension 75 mg/5 mL. How many mL should the nurse administer? (Round to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

-15 mL 225 x 5 = 1,125 1,125 / 75 = 15

A nurse is caring for a client who is receiving IV tobramycin and has a prescription for peak and trough blood levels with the next dose scheduled for 1800. The nurse should expect the lab to draw blood samples at which of the following times?

-1745 and 1830 Timing of the peak and trough is based on the pharmacokinetics of absorption and the half-life of the medication. The trough level is the lowest serum level after the pharmacokinetic effects have taken place. Correct timing for the trough is just prior to administering the next dose. The peak is the highest serum level of the drug; if this level is too low, then the drug will not be effective. Correct timing for the peak is 30 min after the dose finishes infusing.

A nurse is preparing to administer vancomycin 250 mg PO. The amount available is vancomycin 125 mg/capsule. How many capsules should the nurse administer to the client with each dose? (Round to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

-2 capsule 250 / 125 = 2

A nurse is preparing to administer fosamprenavir 1400 mg PO. Available is fosamprenavir 700 mg tablets. How many tablets should the nurse administer? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

-2 tablet(s) 1400 / 700 = 2

A nurse is preparing to administer dexamethasone 3 mg PO. Available is dexamethasone 1.5 mg tablets. How many tablets should the nurse administer? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

-2 tablet(s) 3 / 1.5 = 2

A nurse is preparing to administer amoxicillin 500 mg PO. Available is amoxicillin 250 mg tablets. How many tablets should the nurse administer? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

-2 tablet(s) 500 / 250 = 2

A nurse is preparing to administer erythromycin stearate 500 mg PO. Available is erythromycin stearate 250 mg tablets. How many tablets should the nurse administer? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use trailing zero.)

-2 tablet(s) 500 / 250 = 2

A nurse is preparing to administer aspirin 650 mg PO. Available is aspirin 325 mg tablets. How many tablets should the nurse administer? (Round to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

-2 tablet(s) 650 / 325 = 2

A nurse is preparing to administer a dexamethasone 1.5 mg/kg/day PO to divide equally every 6 hr to a preschool-age child who weighs 22 lb. Available is dexamethasone oral solution 1 mg/mL. How many mL should the nurse administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

-3.8 mL 22 lb / 2.2 kg = 10 1.5 mg x 10 kg = 15 15 mg / 1 mg = 15 24 hrs / 6 hrs = 4 hrs 15 mg / 4 hrs = 3.75 Round to the nearest tenth... 3.75 = 3.8 mL

A nurse is preparing to administer amoxicillin 300 mg PO. The amount available is amoxicillin oral solution 250 mg/5 mL. How many mL should the nurse administer? (Round the answer to the nearest tenth/whole number. Use a leading zero if it applies Do not use trailing zero.)

-6 mL 300 x 5 = 1,500 1,500 / 250 = 6

A nurse is preparing to administer liquid mycostatin 600,000 units PO every 8 hr. Available is mycostatin 100,000 units/mL. How many mL should the nurse administer per dose? (round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

-6 mL 600,000 / 100,000 = 6

A nurse is preparing to administer amoxicillin 350 mg PO. Available is amoxicillin 250 mg/5 mL. How many mL should the nurse administer? (Round to the nearest whole number.)

-7 mL 350 x 5 = 1,750 1,750 / 250 = 7

A nurse is reviewing guidelines for prophylactic antibiotic therapy. The nurse identify that prophylactic antibiotic therapy is not recommended for which of the following clients?

-A client who has a fever of unknown origin A fever of unknown origin is not an indication for prophylactic antibiotic therapy.

A nurse is caring for a client who received an injection of penicillin G procaine and begins to experience an anaphylactic reaction. Which of the following actions should the nurse take first?

-Administer epinephrine subcutaneously Epinephrine, a catecholamine, is the priority medication to administer for a client who experiences an anaphylactic reaction. Epinephrine reduces edema and promotes bronchial dilation and increases arterial blood pressure to counteract the most severe manifestations of anaphylaxis. Epinephrine can be administered subcutaneously or intravenously. The nurse should apply the urgent versus nonurgent priority-setting framework. Using this framework, the nurse should consider urgent needs (constricted airway, and decreased cardiac perfusion) the priority need because they pose more of a threat to the client. The nurse might also need to use Maslow's hierarchy of needs, the ABC priority-setting framework, or nursing knowledge to identify which finding is the most urgent.

A nurse is caring for a child who is allergic to penicillin. Which of the following medications should the nurse identify as contraindicated for the child?

-Amoxicillin-clavulanate (Augmentin) Penicillin is the most common medication allergy. Clients who are allergic to one penicillin should be considered allergic to all penicillins. There is also a risk of cross-sensitivity to cephalosporins. Vancomycin, erythromycin, and clindamycin are often effective and safe alternatives for clients who are allergic to penicillin.

A nurse is presenting information about the meningococcal conjugate (MCV4) vaccine at a health fair. Which of the following individuals are candidates for the immunization?

-An 18-year-old adolescent who lives in a college The Centers for Disease Control and Prevention does recommend that an adolescent living in a dormitory receive the vaccine.

A nurse in a provider's office is collecting data from a client who has systemic lupus erythematosus (SLE) and takes hydroxychloroquine to reduce skin inflammation. The nurse should identify that which of the following is an adverse effect of this medication?

-Blurred vision An adverse effect of hydroxychloroquine is retinopathy.

A nurse is reinforcing teaching with a client who reports taking echinacea. Which of the following information should the nurse provide the client?

-Echinacea can decrease effects of immunosuppressant medications Echinacea might cause a short-term boost to the immune system. It can interact with immunosuppressant medications and decrease their effectiveness.

A nurse is monitoring a client's IV site. The nurse should report which of the following findings as manifestations of phlebitis? (Select all that apply.)

-Erythema at the insertion site Erythema is a reddened area at the insertion site and is a manifestation of phlebitis. -Warmth at insertion site Responses to inflammation include warmth and redness of the affected tissue. -Streak formation along the vein Streak formation is a classic indicator of advanced phlebitis.

A nurse is preparing to administer buspirone to a client who has generalized anxiety disorder. The nurse should plan to monitor the client for which of the following adverse reactions?

-Headache The nurse should monitor the client for a headache, which is one of the most common adverse reactions to buspirone.

A nurse is preparing to administer prednisone to a client for treatment of rheumatoid arthritis. Which of the following findings indicates to the nurse the treatment is effective?

-Improved range of motion Prednisone is a glucocorticoid that produces anti-inflammatory and immunosuppressive effects. The client should experience a reduction in pain and inflammation and improved range of motion in joints. Clients who have arthritis in only a few joints can receive intra-articular injections but should refrain from overusing these joints to prevent injury.

A nurse is reinforcing teaching with a client about treatment of methicillin-resistant Staphylococcus aureus (MRSA). Which of the following information should the nurse include in the teaching?

-Infections become resistant to high doses of antibiotics The nurse should include in the teaching that high doses of antibiotics can cause bacteria to become resistant.

A nurse is preparing to administer the first dose of etanercept to a client who has rheumatoid arthritis. Which of the following actions should the nurse take?

-Inject the medication subcutaneously into the client's upper arm Etanercept is a tumor necrosis factor antagonist used to slow the progression of moderate to severe rheumatoid arthritis. Medications from this class are administered subcutaneously and etanercept should be injected once weekly. If the client is taught to self-administer etanercept, the anterior thigh and abdominal sites should be used and the client should rotate sites so that no injection is placed in an area, which is bruised, red, or tender from a previous injection.

The nurse is preparing to administer ear drops to an adult client. Which of the following actions should the nurse plan to take?

-Pull the pinna upward and backward The nurse should straighten the ear canal prior to instillation of medications so the medication can flow the entire length of the canal. For the adult, the nurse should pull the pinna upward and outward.

A nurse is reviewing the medical record of a client who just returned to the unit following surgery and notes the client has a history of anaphylaxis in response to penicillin. The client's postoperative prescriptions include a dose of cephalexin. Which of the following actions should the nurse take?

-Request that the surgeon prescribe a different antibiotic The nurse should inform the surgeon of the client's previous reaction to penicillin because receiving a dose of cephalexin places the client at risk for an anaphylactic reaction due to a cross-sensitivity with penicillin.

A nurse is caring for an older adult client who has a prescription for captopril. For which of the following possible adverse effects should the nurse instruct the client to notify the provider immediately?

-Sore throat A sore throat, fever, easy bruising, and bleeding are manifestations of neutropenia, which is a serious adverse effect of captopril and other angiotensin-converting enzyme inhibitors (ACE inhibitors). The nurse should inform the client to notify the provider immediately if any of these manifestations occur.

A nurse is reviewing a client's peak and trough levels of gentamicin. The peak should be 6 to 8 mcg/mL and the trough should be 0.5 to 1 mcg/mL. The client's peak is 10 mcg/mL and his trough is 2.3 mcg/mL. Which of the following clinical manifestations should the nurse expect with these findings? (Select all that apply.)

-Tinnitus Trough and peak levels that exceed the expected reference range indicate toxicity, with manifestations that include nausea, vertigo, unsteadiness, and tinnitus. These are signs of ototoxicity, which is generally irreversible. -Persistent headache Trough and peak levels that exceed the expected reference range indicate toxicity, with manifestations that include nausea, vertigo, unsteadiness, and a persistent headache. These are signs of ototoxicity, which is generally irreversible.

A nurse is reinforcing discharge teaching with a client who has pulmonary tuberculosis and is to start taking rifampin. Which of the following information should the nurse include?

-Urine and other secretions will turn orange Rifampin will turn the urine and other secretions a harmless reddish-orange color. This includes sputum, tears, and sweat.

A nurse is caring for a client who just received a dose of IV ampicillin. Which of the following client reactions requires priority intervention by the nurse?

-Wheezing Wheezing indicates constriction of the airway, which might occur as part of an anaphylactic reaction following administration of ampicillin and requires immediate intervention. The nurse should apply the ABC priority-setting framework. This framework emphasizes the basic core of human functioning—having an open airway, being able to breathe in adequate amounts of oxygen, and circulating oxygen to the body's organs via the blood. An alteration in any of these can indicate a threat to life, and is therefore the nurse's priority concern. When applying the ABC priority-setting framework, airway is always the highest priority because the airway must be clear and open for oxygen exchange to occur. Breathing is the second-highest priority in the ABC priority setting framework because adequate ventilator effort is essential in order for oxygen exchange to occur. Circulation is the third-highest priority in the ABC priority setting framework because delivery of oxygen to critical organs only occurs if the heart and blood vessels are capable of efficiently carrying oxygen to them.