EXAM #2 Book Questions
A client who has been on antibiotic therapy for peptic ulcer caused by Helicobacter pylori is diagnosed with a superinfection. What is the most appropriate response by the nurse when the client asks why the superinfection occurred? a. "The normal host flora has been destroyed by the antibiotic." b. "The infectious agent has developed resistance to the drug." c. "The infection caused by H. pylori has become severe." d. "The H. pylori restricted the growth of microorganisms."
Answer: a. "The normal host flora has been destroyed by the antibiotic." Rationale: One common adverse effect of anti-infective therapy is the appearance of secondary infections, known as superinfections, which occur when microorganisms normally present in the body are destroyed. Removal of host flora by an antibiotic gives the remaining microorganisms an opportunity to grow, allowing for overgrowth of pathogenic microbes. Host flora themselves can cause disease if allowed to proliferate without control or if they establish colonies in abnormal locations.
A nurse is caring for a client who is prescribed acetaminophen 650 mg for treatment of moderate pain. Which assessments should the nurse take into consideration when administering this drug to the client? (Select all that apply.) a. Alcohol intake b. Drug allergy c. Blood sugar levels d. Nutritional status e. Warfarin use
Answer: a. Alcohol intake; b. Drug allergy; d. Nutritional status; e. Warfarin use Rationale: Acetaminophen should not be administered to patients who consume alcohol regularly, due to the potential for drug-induced hepatotoxicity. Acetaminophen has the potential to cause serious allergic reactions with symptoms of angioedema, difficulty breathing, itching, or rash. The nurse should check the patient for allergy to the drug. The drug is not recommended in patients who are malnourished. In such cases, acute toxicity may result, leading to renal failure, which can be fatal. Acetaminophen inhibits warfarin metabolism, causing the anticoagulant to accumulate to toxic levels. Acetaminophen does not affect blood sugar levels.
A nurse is caring for a client who is prescribed oral metronidazole (Flagyl) for a fungal infection. Which health history information should the nurse obtain? a. Alcohol use b. Nutritional intake c. Sexual activity d. Nicotine use
Answer: a. Alcohol use Rationale: In combination with alcohol, or other medications that may contain alcohol, metronidazole may elicit a disulfiram reaction with excessive nausea, vomiting, and possible hypotension. The nurse should caution the client regarding alcohol use while on this medication.
A nurse is caring for a client who will be receiving a protease inhibitor (PI)-based HAART regimen. Which drug combination should the nurse expect to administer to the client? a. Darunavir + emtricitabine + tenovir b. Efavirenz + emtricitabine + tenofovir c. Raltegravir + tenofovir + emtricitabine d. Dolutegravir + abacavir + lamivudine
Answer: a. Darunavir + emtricitabine + tenovir Rationale: Darunavir + emtricitabine + tenovir is the standard drug combination for PI-based regimen. Efavirenz + emtricitabine + tenofovir are combined to create a single drug named Atripla. Raltegravir + tenofovir + emtricitabine and dolutegravir + abacavir + lamivudine are integrase inhibitor-based regimens.
A nurse is administering oral sulfamethoxazole-trimethoprim (Bactrim) to a client for treatment of urinary tract infection. Which nursing actions are appropriate? (Select all that apply.) a. Ensure the client drinks a full glass of water with each dose. b. Monitor the client's intake of calcium-fortified drinks. c. Administer the medication around the client's meal times. d. Have the client take potassium supplements with this drug. e. Give the client a glass of milk to drink in case of GI upset.
Answer: a. Ensure the client drinks a full glass of water with each dose; c. Administer the medication during the client's meal times; e. Give the client a glass of milk to drink in case of GI upset. Rationale: Oral dosages of sulfamethoxazole-trimethoprim should be administered with a full glass of water to prevent formation of crystals in the urine, which can be a serious adverse effect. The medication can be given with food or milk to prevent GI symptoms. Potassium supplements should not be taken during therapy, unless directed by the healthcare provider. Trimethoprim decreases potassium excretion and should be used with caution in patients with hyperkalemia or those taking potassium-sparing diuretics. Dairy products or calcium-fortified drinks do not interfere with the absorption of the drug.
A nurse is caring for a client receiving vancomycin intravenous infusion for treatment of a wound infected with MRSA. Which finding should the nurse report immediately to the healthcare provider? a. Hypotension and red rash on the chest area b. Joint and muscle pain with general malaise c. Chest discomfort and decreased heart rate d. Heel pain along with difficulty walking
Answer: a. Hypotension and red rash on the chest area Rationale: A reaction that can occur with rapid intravenous administration of vancomycin is red man syndrome, which results as large amounts of histamine are released in the body. The vasodilation causes the symptoms, which include hypotension, reflex tachycardia, and flushing and a red rash, most often of the face, neck, trunk, or upper body. Other significant side effects of vancomycin include superinfections, generalized tingling after IV administration, chills, fever, skin rash, hives, hearing loss, and nausea. Heel pain with difficulty walking can indicate tendonitis or tendon rupture, which is associated with fluoroquinolones.
The nurse is educating the client about adverse effects of corticosteroids and instructs the client to contact the healthcare provider immediately if which should symptoms occur? (Select all that apply.) a. Increase of 2 pounds in weight in a day b. Notice of any swelling around the ankles c. Occurrence of loose stools or diarrhea d. Presence of blood in vomit or stools e. Changes in urine amount and color
Answer: a. Increase of 2 pounds in weight in a day; b. Notice of any swelling around the ankles; d. Presence of blood in vomit or stools Rationale: Adverse effects of corticosteroids include weight gain, sodium and fluid retention, and peptic ulcer.
A nurse is caring for a client receiving the third round of chemotherapy, which includes a drug with high emetic potential. Which antiemetic drugs should the nurse anticipate to administer to the client prior to chemotherapy administration? (Select all that apply.) a. Ondansetron (Zofran) b. Prochlorperazine (Compazine) c. Megestrol (Megace) d. Metoclopramide (Reglan) e. Lorazepam (Ativan)
Answer: a. Ondansetron (Zofran); b. Prochlorperazine (Compazine); d. Metoclopramide (Reglan); e. Lorazepam (Ativan) Rationale: Before starting therapy with agents with high emetic potential, clients may be pretreated with antiemetic drugs such as ondansetron (Zofran), prochlorperazine (Compazine), metoclopramide (Reglan), and lorazepam (Ativan). Megestrol (Megace) is a progestin used to treat advanced endometrial cancer.
A 32-year-old female client comes to the clinic to update her immunizations. Which assessment information should the nurse obtain? (Select all that apply.) a. Possibility of pregnancy b. Sensitivity to albumin c. Quarantine status d. History of actual disease e. Previous reaction to vaccines
Answer: a. Possibility of pregnancy; b. Sensitivity to albumin; d. History of actual disease; e. Previous reaction to vaccines Rationale: When assessing a client prior to administration of immunizations, the nurse should obtain a complete health history, including pregnancy or breast-feeding, previous history of actual disease (e.g., chickenpox), any previous allergic response to immunizations or to products contained within immunization (e.g., yeast sensitivity, sensitivity to eggs or albumin products), and immunization history and any unusual reactions or responses that occurred.
The nurse administers DPT, polio, Hib, and hepatitis B immunizations to a 2-month-old child. Which instruction should the nurse provide to this child's mother? a. Remain in the clinic for 30 minutes for observation. b. Administer baby aspirin for fever and discomfort. c. Call the clinic if redness develops at the site of the injections. d. Return to the clinic for the next immunizations at 6 months of age.
Answer: a. Remain in the clinic for 30 minutes for observation. Rationale: The client should be observed for any immediate adverse reactions, especially anaphylaxis, following the administration of the immunizations. Common side effects of vaccines include fever and redness/discomfort at the site of the injection. Acetaminophen, not aspirin, is recommended to treat these common side effects. Cool compresses to the injection site may help alleviate malaise, fever, or injection site soreness. The next set of immunizations for this 2-month-old child will be at 4 months of age.
In case of extravasation during administration of carmustine (BiCNU) therapy, the nurse should be prepared to administer which antidote? a. Sodium bicarbonate and normal saline b. Leucovorin (folinic acid) c. Hyaluronidase d. Epinephrine (adrenalin)
Answer: a. Sodium bicarbonate and normal saline Rationale: Before administering intravenous antineoplastic agents, the nurse should know the emergency treatment for extravasation. Extravasation of carmustine is treated with injections of equal parts of sodium bicarbonate and normal saline into the extravasation site.
A nurse is caring for 9-year-old child who is brought in to the clinic by the parent for uncontrolled high fever. The parent reports administering over-the-counter children's aspirin the last 5 days to manage the child's fever. What should be the nurse's priority assessment of this client? a. Symptoms of Reye syndrome b. Cardiovascular status c. Hepatic and kidney functions d. Metabolic alkalosis
Answer: a. Symptoms of Reye syndrome Rationale: Children under age 19 should never be administered products that contain aspirin when they have flu symptoms, fever, or chickenpox due to the risk of Reye syndrome, a potentially fatal disease.
A 28-year-old female client with breast cancer is receiving methotrexate. Which information should the nurse include during client teaching? a. Use reliable birth control measures during and after therapy. b. Use aspirin or NSAIDs such as ibuprofen for minor discomfort. c. Take oral methotrexate with food to avoid gastric upset. d. Limit oral fluid intake during therapy with methotrexate.
Answer: a. Use reliable birth control measures during and after therapy. Rationale: Many antineoplastics are contraindicated in pregnancy. Methotrexate is pregnancy category X. Pregnancy should be avoided during therapy and for at least 6 months after therapy.
A client undergoing cancer chemotherapy asks the nurse why she is taking three different antineoplastics. Which is the most appropriate response by the nurse? a. "Your cancer was very advanced, and therefore it requires more medications." b. "Each drug attacks the cancer cells in a different way, increasing effectiveness of the therapy." c. "Several drugs are prescribed in order to find the right drug for your cancer." d. "One drug will cancel out the side effects of the other drugs you are receiving."
Answer: b. "Each drug attacks the cancer cells in a different way, increasing effectiveness of the therapy." 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, allowing for increased percentage of cell kill. This also allows lower doses of each individual agent to be used, thus reducing side effects. A third benefit of combination chemotherapy is reduced incidence of drug resistance.
A client taking methotrexate for cancer asks the nurse why leucovorin (folinic acid) has been prescribed. Which response by the nurse is most appropriate? a. "This drug is a vitamin to help with building up your resistance." b. "The drug protects normal cells from damage by methotrexate." c. "This is a second antineoplastic drug used to attack the cancer cells." d. "The drug will prevent arthritis that often accompanies methotrexate use."
Answer: b. "The drug protects normal cells from damage by methotrexate." Rationale: Leucovorin is administered with methotrexate to rescue normal cells and protect the client from severe bone marrow damage.
A nurse anticipates administering which drug to a client for influenza prophylaxis? a. Oseltamivir (Tamiflu) b. Amantadine (Symmetrel) c. Zanamivir (Relenza) d. Famciclovir (Famvir)
Answer: b. Amantadine (Symmetrel) Rationale: Amantadine (Symmetrel) and rimantadine (Flumadine) can be given to prevent influenza. Oseltamivir and zanamivir are classified as neuroaminidase inhibitors, which are used for treatment of influenza. Famciclovir is a drug used to treat herpesvirus infection.
A client is prescribed dexamethasone (Decadron) 2 mg twice daily by mouth. Which important point should the nurse include when teaching the client about taking this medication? a. Report changes in hearing or ringing in the ears. b. Avoid abrupt withdrawal of the medication. c. St. John's wort can increase drug levels. d. Do not use saline nasal sprays while on this drug.
Answer: b. Avoid abrupt withdrawal of the medication. Rationale: The nurse should instruct clients to not stop taking corticosteroids abruptly and to notify the healthcare provider if unable to take medication for more than 1 day due to illness. The drug must be tapered off if used longer than 1 or 2 weeks. Adrenal insufficiency and crisis may occur if the drug is stopped abruptly
A client is receiving cyclophosphamide (Cytoxan) therapy for treatment of Hodgkin's lymphoma. Which assessment finding should the nurse report to the healthcare provider? a. High blood pressure b. Blood in the urine c. High platelet count d. Mild alopecia
Answer: b. Blood in the urine Rationale: Several metabolites of cyclophosphamide may cause hemorrhagic cystitis if the urine becomes concentrated; patients should be advised to maintain high fluid intake during therapy.
The nurse is caring for a client receiving an oral antifungal medication. What should the nurse consider when administering this medication? a. Do not administer with food. b. Give with plenty of fluids. c. Alternate with capsule and oral solution. d. Can be given with an antacid.
Answer: b. Give with plenty of fluids. Rationale: The nurse should ensure adequate hydration in patients on oral or IV antifungals. Antifungal drugs are renal-toxic and adequate hydration helps to prevent adverse renal effects.
A nurse is caring for a client who has been on a prolonged interferon alfa-2b (Intron A) therapy. For what should the nurse monitor in this client? a. Nephrotoxicity b. Hepatotoxicity c. Hypertension d. Diabetes
Answer: b. Hepatotoxicity Rationale: Prolonged therapy with interferon alfa-2b can result in serious toxicities such as immunosuppression, hepatotoxicity, and neurotoxicity.
A nurse is caring for a client with rheumatoid arthritis who has been taking corticosteroids for an extended period of time. During the assessment, the nurse concludes that the client has Cushing syndrome based on which findings? (Select all that apply.) a. Abdominal discomfort b. Increased blood sugar levels c. Fat redistribution to face d. Muscular hypertrophy e. Bruising on arms and legs
Answer: b. Increased blood sugar levels; c. Fat redistribution to face; e. Bruising on arms and legs. Rationale: Long-term therapy with corticosteroids may result in Cushing syndrome, a condition that includes hyperglycemia, fat redistribution to the shoulders and face, muscle weakness, bruising, and bones that easily fracture.
What should the nurse monitor while caring for a client receiving intravenous acyclovir (Zovirax) for acute herpesvirus infection? a. Nausea and vomiting b. Kidney function tests c. Liver function tests d. Cardiovascular status
Answer: b. Kidney function tests Rationale: Nephrotoxicity and neurotoxicity are possible when acyclovir is given intravenously. Values for kidney function tests such as blood urea nitrogen (BUN) and serum creatinine may increase and should be monitored closely.
A nurse is caring for a client who has been taking methotrexate (Rheumatrex) tablets for treatment of rheumatoid arthritis. Which assessment should the nurse conduct to determine whether the client is experiencing a serious adverse effect of the medication? a. Neurologic status b. Lung sounds c. Musculoskeletal function d. Sexual dysfunction
Answer: b. Lung sounds Rationale: Pulmonary fibrosis and pneumonia are serious adverse effects of methotrexate; therefore, the nurse should obtain baseline and follow-up assessments of the client's lung sounds.
A nurse is caring for a client who is experiencing pseudomembranous colitis. Which medication should the nurse anticipate administering? a. Pentamidine (Pentam) b. Metronidazole (Flagyl) c. Atovaquone (Malarone) d. Caspofungin (Cancidas
Answer: b. Metronidazole (Flagyl) Rationale: Off-label uses of metronidazole include the pharmacotherapy of pseudomembranous colitis and Crohn's disease. Pentamidine is used for treatment of P. carinii. Atovaquone is an antimalarial drug. Caspofungin is used for treatment of candidiasis.
A nurse is caring for a client receiving tamoxifen for breast cancer prophylaxis. For which serious adverse effects should the nurse monitor while the client is on this medication? (Select all that apply.) a. Hypotension b. Stroke c. Uterine cancer d. Cataracts e. Hot flashes
Answer: b. Stroke; c. Uterine cancer Rationale: The most serious problem associated with tamoxifen use is the increased risk of uterine cancer. Black Box warning also include risk for thromboembolic disease, including stroke, pulmonary embolism, and deep vein thrombosis. Hypertension and edema occur in about 10 percent of patients taking the drug. Ocular toxicity is not an adverse effect of tamoxifen. Hot flashes are a common adverse effect of the drug.
A nurse is preparing to administer a broad-spectrum antibiotic to a client with a severe respiratory infection. Which is an important nursing action to take prior to administering the medication? a. Reviewing the results of the culture and sensitivity test b. Obtaining a specimen for culture and sensitivity testing c. Performing a peak and trough level of the antibiotic d. Determining the course antibiotic therapy based on half-life
Answer: b. Obtaining a specimen for culture and sensitivity testing Rationale: Because antibiotic therapy alters the composition of infected fluids, samples for culture and sensitivity (C & S) testing should be collected prior to starting pharmacotherapy. However, laboratory testing and identification may take several days. With severe infections, therapy is often begun with a broad-spectrum antibiotic. After laboratory testing is completed, the drug may be changed to a narrow-spectrum antibiotic. Drug levels (peak and trough) will be monitored for drugs with known severe adverse effects. The course of the antibiotic therapy is determined by the licensed healthcare provider, not by the nurse.
A client will be taking mebendazole (Vermox) for a pinworm infection. What information should the nurse include regarding administration of this drug? a. The drug should be taken with a low-fat meal. b. Only a single dose of the drug will be taken. c. The medication should be swallowed whole. d. Increase fiber in the diet to prevent constipation.
Answer: b. Only a single dose of the drug will be taken. Rationale: For pinworm infections, a single dose of the medication is usually sufficient; other infections require 3 consecutive days of therapy. The drug is most effective when chewed and taken with a fatty meal. However, high-fat foods may increase the absorption of the drug. As the worms die, some abdominal pain, distention, and diarrhea may be experienced. Constipation is not an adverse effect of the drug.
For which client conditions should the nurse anticipate administering antibiotic therapy for chemoprophylactic purposes? (Select all that apply.) a. Neurologic abnormality b. Prosthetic heart valve c. Dental surgical procedure d. Chronic respiratory infection e. Kidney transplantation
Answer: b. Prosthetic heart valve; c. Dental surgical procedure; e. Kidney transplantation Rationale: Patients who might receive prophylactic antibiotics include those who have a suppressed immune system, those who have experienced deep puncture wounds such as from dog bites, and those who have prosthetic heart valves and are about to have a medical or dental procedure.
A nurse is caring for a client who will be receiving a vaccination to confer passive immunity. Which agent should the nurse anticipate administering to the client? a. Poliovirus, inactivated (poliovax) b. Rh0(D) immune globulin (RhoGAM) c. Pneumococcal, polyvalent (Pneumovax 23) d. Measles, mumps, and rubella (MMR II)
Answer: b. Rh0(D) immune globulin (RhoGAM) Rationale: To confer passive immunity, the individual is given antibodies—in the form of immunoglobulins—against the foreign agent. This form of immunity has a fast onset, but lasts only 3-6 months, and the immune system does not mount a response. The administration of RhoGAM is an example of this type of indication. The other agents are vaccines that confer active immunity.
The nurse should monitor a transplant patient for the major adverse effect of cyclosporine therapy by evaluating which laboratory test? a. Complete blood count (CBC) b. Serum creatinine c. Liver enzymes d. Electrolyte levels
Answer: b. Serum creatinine Rationale: The primary adverse effect of cyclosporine occurs in the kidneys, with up to 75 percent of patients experiencing reduction in urine output. Serum creatinine level is a good indicator of renal function.
A client asks the nurse why the healthcare provider prescribed a nonsteroidal anti-inflammatory drug (NSAID) for mild joint pain. Which response by the nurse is most appropriate? a. The drug has the least risk for adverse effects. b. The drug responds to all inflammatory conditions. c. The drug is most effective for relieving acute pain. d. The drug provides pain relief for specific infections.
Answer: b. The drug responds to all inflammatory conditions. Rationale: NSAIDs are widely prescribed for mild to moderate nonspecific inflammation. The drug will exhibit the same inhibitory actions regardless of the cause of the inflammation.
A client is being prescribed penicillin for an upper respiratory infection. What information should the nurse emphasize in providing instructions to the client? a. The antibiotic therapy can be taken while breast-feeding. b. The entire prescription must be completed as instructed. c. The medication can be taken without regard to eating. d. The most common side effect is urinary discoloration.
Answer: b. The entire prescription must be completed as instructed. Rationale: The nurse should advise patients to take prescribed anti-infective drugs for the full length of therapy. Stopping antibiotic therapy prematurely allows some pathogens to survive, thus promoting the development of resistant strains. Penicillin has few serious adverse effects, with diarrhea, nausea, and vomiting being the most common adverse effects.
A nurse is caring for a client who tested positive for HIV infection and will be starting highly active antiretroviral therapy (HAART). What is the most accurate information the nurse can provide about HAART? a. The main purpose of the therapy is to prevent HIV transmission. b. The goal of the therapy is to keep plasma HIV levels as low as possible. c. The primary target of the therapy is HIV present in the lymph nodes. d. The aim of the therapy is to restore and preserve immunologic function.
Answer: b. The goal of the therapy is to keep plasma HIV levels as low as possible. Rationale: The goal of HAART is to reduce the plasma HIV RNA to its lowest possible level. However, HIV is harbored in locations other than the blood, such as lymph nodes; therefore, elimination of the virus from the blood is not a cure.
During discharge teaching, the nurse reviews the medications with the client. While discussing celecoxib (Celebrex), what information should the nurse emphasize? a. The drug will cause blood to clot more easily. b. The medication should be taken with food. c. The drug is compatible with most OTC medications. d. The most serious side effect is abdominal pain.
Answer: b. The medication should be taken with food. Rationale: The nurse should instruct the client to take celecoxib (Celebrex) with food or milk to decrease gastric upset (dyspepsia). Because they do not inhibit COX-1, COX-2 inhibitors do not produce adverse effects on the digestive system and lack any effect on blood coagulation.
A nurse is caring for a client who will be receiving chloroquine (Aralen) for acute infection with malaria. Which nursing action is most appropriate to take prior to administration of this drug? a. Obtain a comprehensive travel history. b. Send stool sample for O & P testing. c. Conduct a baseline visual exam. d. Assess respiratory status.
Answer: c. Conduct a baseline visual exam. Rationale: Chloroquine can cause retinal toxicity, including blurred vision, photophobia, and difficulty focusing. Because chloroquine can cause retinal toxicity, it is contraindicated in patients with pre-existing retinal or visual field changes.
When the client is started on antiretroviral drugs for management of HIV infection, which information is important for the nurse to provide the client? a. This drug therapy will cure the disease over a period of time. b. This drug regimen can extend life expectancy. c. This drug therapy is used prior to giving the vaccine. d. This drug regimen is available throughout the world.
Answer: b. This drug regimen can extend life expectancy. Rationale: Although pharmacotherapy for HIV-AIDS has not produced a cure, many patients with HIV infection are able to live symptom-free with the disease for a longer time because of medications. Along with better patient education and prevention, successes in pharmacotherapy have produced a 70 percent decline in the death rate due to HIV-AIDS in the United States.
A client diagnosed with a systemic fungal infection is prescribed amphotericin B (Fungizone). The nurse should include which information during client education? a. "Drug therapy will be for a very short time, probably 2-4 weeks." b. "Carefully inspect all intramuscular injection sites for bruising." c. "Notify the clinic if you gain 2 pounds or more in a 24-hour period." d. "You can stop the medication when you start feeling better."
Answer: c. "Notify the clinic if you gain 2 pounds or more in a 24-hour period." Rationale: Amphotericin B (Fungizone) causes some degree of kidney damage in 80 percent of patients who take the drug. Excessive weight gain or edema may indicate renal dysfunction, so the nurse should instruct the patient to report a weight gain of more than 1 kg (2 lbs) in a 24-hour period.
A nurse should administer hepatitis A immunoglobulin (HAIg) to which client? a. A 6-year-old child who lives in a rural area b. A client who uses illicit drugs intravenously c. A client traveling to a country where HAV is prevalent d. A male client who has sex with other men
Answer: c. A client traveling to a country where HAV is prevalent Rationale: Hepatitis A immunoglobulin (HAIg) is administered as prophylaxis for patients traveling to endemic areas and to close personal contacts of infected patients to prevent transmission of the virus. A single intramuscular (IM) dose of HAIg can provide passive protection and prophylaxis for about 3 months. On the other hand, HAV vaccine (Havrix, VAQTA) is indicated for all children ages 2-18, travelers to countries with high HAV infection rates, men who have sex with men, and illegal drug users.
Upon discharge, the nurse discusses with the client the types of over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs) that are available. Which drug, if mentioned by the client, requires further teaching by the nurse? a. Aspirin (Ecotrin) b. Ibuprofen (Advil, Motrin) c. Acetaminophen (Tylenol) d. Naproxen (Naprosyn, Aleve)
Answer: c. Acetaminophen (Tylenol) Rationale: Although acetaminophen shares the analgesic and antipyretic properties of these other drugs, it has no anti-inflammatory action and is not classified as an NSAID.
The nurse is caring for a client receiving a series of antineoplastic drugs for treatment of lung cancer. Which lab results should the nurse monitor to assess the client's risk for infection? a. BUN and serum creatinine b. Serum electrolytes c. Complete blood count d. Bone scan
Answer: c. Complete blood count Objective: Describe the nurse's role in the pharmacological management of cancer. Rationale: The nurse should monitor for low white blood counts resulting from bone marrow suppression. The complete blood count (CBC) with differential will provide information regarding the client's white blood cell count, as well as leukocyte and neutrophil counts.
A nurse is caring for a pediatric client with Wilms tumor and is receiving vincristine (Oncovin) for treatment. The nurse should routinely perform which assessment when caring for this client? a. Level of consciousness b. Respiratory effort c. Nutritional intake d. Abdominal sounds
Answer: d. Abdominal sounds Rationale: Severe constipation is common and paralytic ileus may occur in young children receiving vincristine. Therefore, the nurse should frequently conduct an abdominal assessment.
A client has been taking aspirin for several days to treat a mild back pain that is not relieved. The client is also experiencing ringing in the ears and dizziness. Which nursing action is most appropriate? a. Tell the client he will need an antibiotic for a sinus infection. b. Determine the dose of aspirin, as it may need to be increased. c. Instruct the client not to take any more doses of the aspirin. d. Advise the client to take the aspirin with food or milk.
Answer: c. Instruct the client not to take any more doses of the aspirin. Rationale: High doses of aspirin can produce side effects of tinnitus or ringing in the ears, dizziness, headache, and sweating. The nurse should instruct the client not to take any more doses of the aspirin until further evaluation by the healthcare provider.
A nurse is caring for a client who is receiving high doses of chloroquine (Aralen) for acute infection with malaria. Which is the most appropriate action for the nurse to take? a. Monitor the client's respirations the first 30 minutes after taking the first dose. b. Ensure that daily weights are taken every morning and documented in the chart. c. Obtain baseline neurologic and cardiovascular status, and assess regularly. d. Administer the medication with antacids to prevent gastrointestinal distress.
Answer: c. Obtain baseline neurologic and cardiovascular status, and assess regularly. Rationale: At higher doses of the drug chloroquine, CNS and cardiovascular toxicity may be observed. Symptoms include confusion, convulsions, reduced reflexes, hypotension, and dysrhythmias. Antacids and laxatives containing aluminum and magnesium can decrease chloroquine absorption and must not be given within 4 hours of each other.
A nurse is caring for a newborn whose mother has an HIV infection. Which pharmacotherapy intervention should the nurse implement? a. Oral administration of trimethoprim-sulfamethoxazole (Bactrim) within 24 hours of birth b. Intravenous administration of zidovudine following confirmation of HIV status in 1 week c. Oral administration of zidovudine immediately after delivery and for the next 6 weeks d. Intramuscular administration of HIV vaccine, with a booster shot within 6 months
Answer: c. Oral administration of zidovudine immediately after delivery and for the next 6 weeks Rationale: To decrease the risk of HIV transmission to the newborn, the regimen includes oral administration of zidovudine to the newborn to begin immediately after delivery and continuing for 6 weeks following delivery. Starting antiretroviral therapy more than 48 hours after birth is ineffective in preventing the infection. In addition to antiretrovirals, infants born to women with HIV infection usually receive trimethoprim-sulfamethoxazole at 4-6 weeks of age to prevent Pneumocystis jiroveci pneumonia.
A client is prescribed paromomycin (Humatin) for an intestinal amebiasis infection. For which serious adverse effect should the nurse monitor in the client? (Select all that apply.) a. Agranulocytosis b. Peripheral neuropathy c. Ototoxicity d. Transient leukopenia e. Nephrotoxicity
Answer: c. Ototoxicity; e. Nephrotoxicity Rationale: Serious adverse effects of paromomycin include ototoxicity and nephrotoxicity.
A nurse is preparing to administer immunostimulant therapy to a client. Which client condition would warrant immediate notification of the healthcare provider? a. Viral infection b. Immunodeficiency c. Pregnancy d. Cancer
Answer: c. Pregnancy Objective: Describe the nurse's role in the pharmacologic management of immune disorders. Rationale: Immunostimulant drugs should be used with high precaution in pregnant clients due to the neurological adverse effects, which can harm the fetus. Viral infection, immunodeficiency disease, and cancer are indications for use of immunostimulant drugs.
A client receiving chemotherapy treatment for leukemia has been taking prednisone for the last 6 months. During the assessment, the nurse concludes that the client may be experiencing adrenal crisis based on which findings? a. Hyperglycemia with polyuria and polydipsia b. Shortness of breath and shallow respirations c. Profound hypotension and increased heart rate d. Eye pain accompanied by visual disturbances
Answer: c. Profound hypotension and tachycardia Rationale: Adrenal insufficiency and crisis may occur with profound hypotension, tachycardia, and other adverse effects if a corticosteroid regimen is stopped abruptly.
A nurse is caring for a client diagnosed with hepatitis C virus (HCV) infection. Which pharmacotherapies should the nurse anticipate to administer to this client? (Select all that apply.) a. HCV immunoglobulin b. Twinrix c. Ribavarin d. Tenofovir disoproxil (Viread) e. Pegylated interferon (PEG-IFN) f. Telaprivir (Incivek)
Answer: c. Ribavarin; e. Pegylated interferon (PEG-IFN); f. Telaprivir (Incivek) Rationale: Current pharmacotherapy for chronic HCV infection includes PEG-IFN, the antiviral ribavirin, and protease inhibitors (e.g., boceprivir (Victelis) and telaprivir (Incivek)). The three-drug combination produces a more sustained viral inhibition, especially in patients with cirrhosis. Postexposure prophylaxis of HCV with immunoglobulins is not recommended, because its effectiveness has not been demonstrated. Twinrix is a hepatitis A and B virus combination vaccine. Tenofovir disoproxil is an approved pharmacotherapy for chronic hepatitis B infection.
Which information should the nurse emphasize when providing education to a client receiving drug therapy for HIV-AIDS? a. It will take about 1 year of therapy to reduce plasma HIV to undetectable levels. b. Genotypic drug testing is performed to determine the client's resistance to the therapy. c. Strict adherence to the drug regimen promotes effectiveness of the therapy. d. The medications can help the client become a long-term nonprogressor.
Answer: c. Strict adherence to the drug regimen promotes effectiveness of the therapy. Rationale: To be successful, antiretroviral therapy requires strict patient compliance with a complex regimen. The goal of antiretroviral therapy is to reduce plasma HIV RNA to less than 75 copies/mL. For most patients, 12-24 weeks of HIV pharmacotherapy is required to achieve this level. Genotypic drug testing identifies specific mutations in viral genes that are associated with drug resistance for the different classes of HIV medications. This genotypic testing assists in determining which drugs(s) would be most effective for each patient. Long-term nonprogressors (LTNPs) have genetic factors that have allowed them to live with HIV for a long time without progressing to AIDS.
A client has been prescribed oral tetracycline for treatment of severe acne. Which assessment finding is most important for the nurse to communicate with the healthcare provider? a. The client's nutritional status b. The pathogen causing the acne c. The client's pregnancy status d. The presence of open lesions
Answer: c. The client's pregnancy status Rationale: Tetracyclines, when taken by the mother, can cause teeth discoloration in the developing fetus. As such, the medication should not be used during the second half of pregnancy. The benefits of antibiotic use in pregnant women must be carefully weighed against the potential risks to the fetus.
A nurse is administering pneumonia vaccinations to older adults during a community health fair. Which significant information should the nurse emphasize with the clients regarding this immunization? a. The immunization is free of charge. b. The immunization is required annually. c. The immunization can decrease mortality. d. The immunization can eradicate the disease.
Answer: c. The immunization can decrease mortality. Rationale: Of the vaccine-preventable diseases, pneumococcal pneumonia is the most lethal, with about 4,250 deaths occurring annually in the United States. The Centers for Disease Control and Prevention (CDC, 2015) recommends 1 or 2 doses of the pneumococcal vaccine for adults age 19 and older. Nurses play a key role in encouraging patients to be vaccinated according to established guidelines.
A client undergoing antineoplastic therapy is also prescribed filgrastim (Neupogen). The client asks the nurse why he is receiving this new medication. Which would be the best response by the nurse? a. This drug works with chemotherapy to attack cancer cells. b. This drug helps reduce nausea during chemotherapy. c. This drug helps decrease the risk of opportunistic infections. d. This drug will help prevent hair loss during chemotherapy.
Answer: c. This drug helps decrease the risk of opportunistic infections. Rationale: The administration of filgrastim often prevents or shortens the time period of neutropenia, thus lowering the risk of opportunistic infections and allowing the patient to maintain an optimum dosing schedule.
A client asks the nurse why the healthcare provider did not prescribe the usual antibiotic for the same infection. Which is the best response by the nurse? a. "It does not matter which antibiotic is taken." b. "If you are not better in 10 days, return to the office." c. "You do not want to take the same antibiotic all the time." d. "Bacteria can become resistant to some antibiotics."
Answer: d. "Bacteria can become resistant to some antibiotics." Rationale: Antibiotics help promote the development of drug-resistant bacterial strains by killing populations of bacteria that are sensitive to the drug. The remaining bacteria possess mutations that make them insensitive to the effects of the same antibiotic. Using a different antibiotic can decrease possibility of drug resistance by these pathogens.
Which statement by a client taking cyclosporine would indicate a need for further teaching by the nurse? a. "I will report any reduction in urine output to my healthcare provider." b. "I will wash my hands frequently and thoroughly." c. "I will take my blood pressure at home every day." d. "I will take cyclosporine at breakfast with a glass of grapefruit juice."
Answer: d. "I will take cyclosporine at breakfast with a glass of grapefruit juice." Rationale: Grapefruit juice will increase cyclosporine levels 50 percent to 200 percent, resulting in drug toxicity. Thus, the nurse should instruct the client to avoid taking cyclosporine with grapefruit juice. Handwashing is important to prevent infection while taking cyclosporine. Renal toxicity and hypertension are adverse effects of cyclosporine therapy for which the client should monitor and which the client should report to the healthcare provider.
A nurse is caring for a client with diabetes who is being treated for infection with Candida. When administering fluconazole (Diflucan) to this client, which nursing action is most appropriate? a. Instruct the client to chew the tablet. b. Double the dose the next day if a dose is missed. c. Provide at least eight glasses of water daily. d. Assess the client for signs of hypoglycemia.
Answer: d. Assess the client for signs of hypoglycemia. Rationale: Hypoglycemia may result if fluconazole is administered concurrently with certain oral hypoglycemics, including glyburide. Therefore, the most appropriate nursing action is to assess the client for signs of hypoglycemia.
A nurse caring for a client who has an HIV infection should monitor for effectiveness of antiretroviral therapy using which laboratory test? a. Complete blood count b. Absolute neutrophil count c. Blood cultures d. CD4 lymphocyte count
Answer: d. CD4 lymphocyte count. . Rationale: Two laboratory tests used to monitor the progress of pharmacotherapy of HIV are absolute CD4 T-cell count and measurement of HIV RNA in the plasma. The number of CD4 T-cells is an important indicator of immune function and predicts the likelihood of opportunistic disease and the need for prophylactic antibiotic therapy; however, it does not indicate how rapidly HIV is replicating. CD4 counts are performed every 3-6 months to assess the degree of effectiveness of antiretroviral therapy.
A client who is receiving cyclosporine after a heart transplant exhibits a sore throat, fatigue, low-grade fever, and white blood count of 12,000 cells/mm3. The nurse should anticipate planning interventions for which client condition? a. Transplant rejection b. Heart failure c. Dehydration d. Infection
Answer: d. Infection. Rationale: Transplant patients on immunosuppressant therapy are at high risk for infections, and the client is exhibiting such symptoms. Therefore, the nurse should plan to implement interventions for treatment and management of an infection.
A nurse is caring for a client who is prescribed nystatin (Mycostatin) suspension for oral candidiasis. Which instruction is most appropriate for the nurse to provide with administration of this drug? a. Take the medication with meals to prevent nausea and vomiting. b. Swallow the medication dose quickly, and drink a full glass of water. c. Apply the medication in affected areas of the mouth using a swab applicator. d. Swish the liquid medication in the mouth for approximately 2 minutes.
Answer: d. Swish the medication in the mouth for 2 minutes. Rationale: For adults with oral candidiasis, the drug should be swished in the mouth for at least 2 minutes. The medication is applied with a swab to the affected area in infants and children because swishing is difficult or impossible
A client has been prescribed ciprofloxacin (Cipro) 500 mg twice daily by mouth. Which information should the nurse include during client teaching about administration of this medication? a. The dose must be taken on an empty stomach to increase absorption. b. The client can have an unlimited amount of caffeinated drinks. c. The drug can be taken with an antacid to decrease GI symptoms. d. The dose should not be taken with supplements containing iron.
Answer: d. The dose should not be taken with supplements containing iron. Rationale: Fluoroquinolones, such as ciprofloxacin, should not be taken concurrently with multivitamins or mineral supplements, because calcium, magnesium, iron, or zinc ions can reduce the absorption of some fluoroquinolones by as much as 90 percent. Antacids can also decrease the absorption of ciprofloxacin. Ciprofloxacin may be administered with food to diminish adverse GI effects. Caffeine consumption should be restricted to prevent excessive nervousness, anxiety, or tachycardia.
A nurse is caring for a client receiving gentamicin for treatment of a Pseudomonas infection. Which assessment finding should the nurse report to the healthcare provider immediately? a. Dysrhythmia b. Constipation c. Diuresis d. Tinnitus
Answer: d. Tinnitus Rationale: Aminoglycosides, such as gentamicin, are noted for their neurotoxic effect. Neurotoxicity may manifest as ototoxicity and produce a loss of hearing or balance, which may become permanent with continued use of the medication. Dysrhythmias, constipation, and diuresis are not adverse effects of aminoglycosides.
