FINAL PHARM (EVERYTHING INCLUDED)

A nurse is preparing to administer penicillin therapy. The nurse would expect to administer penicillin cautiously to clients with which of the following

1.) History allergies2.) Asthma3.) Bleeding disorders

A nurse is preparing a plan of care for an older adult client who is receiving sulfonamide therapy. Which of the following would the nurse include in the plan of care to reduce the likeihood causing renal damage?

1.) Increase fluid intake up to 2000mL if tolerated 2.) Use sulfonamides cautiously in clients with renal impairment

A woman who is pregnant tells the nurse she has not had any vaccines but wants to begin so she can protect her unborn child. Which vaccine(s) may be administered to this patient? a. Gardasil vaccine b. Trivalent influenza vaccine c. MMR vaccine d. Varivax vaccine

ANS: B The influenza vaccine is recommended for pregnant women and should be given. Gardasil is given to young women who are not yet sexually active. The MMR is contraindicated because rubella can cause serious teratogenic effects. Varivax is contraindicated during pregnancy.

The nursing instructor is explaining the best way to assess whether active immunity has developed from the administration of the hepatitis B series. What would the instructor cite as the best assessment method?

Serum antibody levels

The Vancomycin blood level ordered prior to the third dose comes back elevated. Which of the following lab values are most important for the nurse to assess?a) BUN and creatinineb) Amylase and lipasec) Culture and sensitivityd) SGPT and bilirubin

a) BUN and creatinine

The pt was placed on IV Vancomycin. Which of the following assessments date is most important to monitor for pt's who receive IV Vancomycin?a) IV insertion site.b) Wound site.c) Bowel sounds.d) Heart sounds.

a) IV insertion site.

The client receiving chemotherapy is prescribed oprelvekin (Neumega) as part of the treatment regimen. Which explanation by the nurse of the rationale for the drug is most accurate?a. It promotes white blood cell production.b. It reverses bone marrow suppression.c. It stimulates platelet cell production.d. It reduces excessive immature white cells.

c. It stimulates platelet cell production.Rationale: Oprelvekin is used to enhance the production of platelets in patients who are at risk for thrombocytopenia caused by cancer chemotherapy. The drug shortens the time that the patient is thrombocytopenic and very susceptible to adverse bleeding events.

What are the adverse effects of erythromycin?a. rash, diarrhea, pain at injection siteb. superinfections of the flora; photosensitivity; discoloring of teethc. rash, fever, numbness in hands and feetd. nausea, vomiting, abdominal cramping

d

The nurse should monitor the client receiving filgrastim (Neupogen) for which common adverse effect?a. Hypoglycemiab. Elevated liver enzymesc. Elevated serum creatinined. Bone pain

d. Bone painRationale: Bone pain may occur in up to 33 percent of patients receiving filgrastim. Bone pain tends to occur 2-3 days prior to rise in circulating WBC due to the production of WBCs in bone marrow. Other common adverse effects of the drug include fatigue, rash, epistaxis, decreased platelet counts, neutropenic fever, nausea, and vomiting.

The nurse is caring for a 70-year-old client with hypovolemia who is receiving a blood transfusion. Assessment findings reveal crackles on chest auscultation and distended neck veins. What is the nurse's initial action?A. Slow the transfusion.B. Document the finding as the only action.C. Stop the blood transfusion and turn on the normal saline.D. Assess the client's pupils."

Answer A is correct. The client is exhibiting symptoms of fluid volume excess; slowing the rate is the proper action. The nurse would not stop the infusion of blood, as in answer C, and answers B and D would not help.

Which is a complication of vancomycin IV infusions?a. Cardiomyopathyb. Neurotoxicityc. Red man syndromed. Angioedema

When infused too rapidly, clients receiving vancomycin may develop hypotension accompanied by flushing or itching of the head, face, neck, and upper trunk area. This phenomenon is called red man syndrome.

"The nurse is preparing to initiate a blood transfusion. The client has a peripheral intravenous infusion in their left arm that the physician has ordered not be slowed or rate reduced. The nurse prepares to start another line in the right arm. The client asks the nurse to use the existing site to avoid the trauma of having another line started. Which of the following statements by the nurse is correct?A. ""That will be fine""B. "I will need to infuse the blood through a separate IV line."C. "I will let the physician know about your preferences."D. "We will need to assess the line before I can make a determination about your request.""

Answer: B "Rationale: A blood infusion must be administered via aseparate IV line. The other responses indicate to the client their request isbeing considered"

"Following surgery, the client requires a blood transfusion. The main reason the nurse wants to complete the unit transfusion within a four-hour period that blood:"A. Hanging for a longer four hours creates an increased risk of sepsisB. May clot in the bagC. May evaporateD. May not clot in the recipient after this time period

Correct A Hanging for a longer four hours creates an increased risk of sepsis, which is why the nurse wants to complete the unit transfusion in less than four hours. The remaining items are not likely to happen.

Halfway through the administration of blood, the female client complains of lumbar pain. After stopping the infusion Nurse Hazel should:a. Increase the flow of normal salineb. Assess the pain furtherc. Notify the blood bankd. Obtain vital signs."

Correct AThe blood must be stopped at once, and then normal saline should be infused to keep the line patent and maintain blood volume.

The nurse has obtained a unit of blood from the blood bank and has checked the blood bag properly with another nurse. Just before the beginning transfusion, the nurse assessess which of the following items?A. Vital signs B. Skin Color C. Urine ouput D. Latest hematocrit level.

Correct Answer AChange in vital signs during the transfusion from the baseline may indicate that a transfusion reaction is occuring. This is why nurse assesses vital signs before the procedure and again after 15 mintues. The other options do not identify assessment that are required just before beginning a transfusion.

"The physician orders 2 units of packed RBCs to be administered to the client. At 0600 the night shift nurse initiates the first unit's transfusion before going off shift. At 1000 the day shift nurse notes the IV line has clotted off and the transfusion has not been completed. The nursing assessment revealed the transfusion was only approximately 75% complete. Which of the actions by the nurse is most appropriate?A. Advise the blood bank about the delay for the next unit.B. Restart another peripheral line with 0.9% NS and restartthe blood transfusion with the remaining blood unit.C. Discontinue the transfusion.D. Document the amount infused thus far and continue the transfusion."

"Answer C Rationale: A unit of blood should be administeredwithin a 4 hour period of time. The nurse should discontinue thetransfusion, document the findings and notify the blood bank. Theagency policy will need to be followed concerning the documentationprocess and notification of appropriate personnel. Continuing thetransfusion with the "open" unit will expose the client to an increaserisk of injury."

The anthrax vaccine is recommended for which groups of people? (Select all that apply.)A. Military personnelB. VeterinariansC. Workers who process imported animal hairD. Emergency department health care providers

A , B, C People at risk for exposure to the anthrax bacterium include military personnel, veterinarians, and workers who process imported animal hair.

The nurse must administer a tetracycline antibiotic to a patient who takes an oral calcium supplement with each meal. When should the nurse administer the tetracycline?A. 2hrs before mealsB. 30 minutes before mealsC. With mealsD. 1 hr after meals

A. 2 hours before meals

The nurse is caring for a patient who is diagnosed with tuberculosis. The patient tells the nurse that the provider plans to order a prophylactic antitubercular drug for family members and asks which drug will be ordered. The nurse will expect the provider to order which drug? a. Isoniazid (INH) b. Pyrazinamide c. Rifampin (Rifadin) d. Streptomycin

ANS: A INH is the drug of choice for prophylactic treatment of patients who have had close contact with a patient who has tuberculosis

A patient is being treated with isoniazid (INH), rifampin, and pyrazinamide in phase I of treatment for tuberculosis. The organism develops resistance to isoniazid. Which drug will the nurse anticipate the provider will order to replace the isoniazid? a. Ciprofloxacin (Cipro) b. Ethambutol (Myambutol) c. Kanamycin d. Streptomycin sulfate

ANS: B If there is bacterial resistance to isoniazid, the first phase may be changed to ethambutol, rifampin, and pyrazinamide. Ciprofloxacin, kanamycin, and streptomycin are not generally first-line antitubercular drugs.

A woman who is 6 weeks pregnant develops a vaginal yeast infection and asks the nurse what she can use to treat it. The nurse will make which recommendation? a. Apply over-the-counter Gyne-Lotrimin cream. b. Ask her provider about nystatin vaginal tablets. c. Request a prescription for oral fluconazole (Diflucan). d. Use over-the-counter Monistat-3 suppositories.

ANS: B Nystatin vaginal tablets are the safest to use during pregnancy. Monistat-3 is contraindicated during the first trimester of pregnancy. Oral fluconazole will have systemic side effects and is pregnancy category C or D.

After administering sulfonamides to a client, the nurse observes the he has developed a fever, cough and muscular aches. the nurse also observes that he has developed lesions in the form of red wheals on the neck and the mouth. the nurse interprets these findings as indicating which of the following?

1.) Stevens-Johnsons syndrome

A client with a fever is ordered to receive sulfonamides for an infection. the nurse needs to evaluate the client for which of the following during the course of therapy. select all

1.) respond to drug therapy2.) occurrence of the adverse reactions3.) decrease in temperature

A client is being discharged with a prescription for sulfasalazine which of the following would the nurse include in the discharge plan?

1.) use protective sunscreen or cover exposed areas when going outside2.) finish the entire course of sulfonamide even when you feel betterE.) Keep follow up appointments

A patient will begin taking streptomycin as part of the medication regimen to treat tuberculosis. Before administering this medication, the nurse will review which laboratory values in the patients medical record?a. Complete blood count (CBC) with differential white cell count b. Blood urea nitrogen (BUN) and creatinine c. Potassium and magnesium levels d. Serum fasting glucose

ANS: B Streptomycin can cause significant renal toxicity.

A patient who has completed the first phase of a three-drug regimen for tuberculosis has a positive sputum acid-bacilli test. The nurse will tell the patient that a. drug resistance has probably occurred. b. it may be another month before this test is negative. c. the provider will change the pyrazinamide to ethambutol. d. there may be a need to remain in the first phase of therapy for several weeks.

ANS: B The goal is for the patients sputum test to be negative 2 to 3 months after the therapy. The positive test does not indicate drug resistance. The provider will not change the drugs or keep the patient in the first phase longer than planned.

The nurse is counseling a patient who will begin taking a sulfonamide drug to treat a urinary tract infection. What information will the nurse include in teaching? a. "Drink several quarts of water daily."b. "If stomach upset occurs, take an antacid."c. "Limit sun exposure to no more than 1 hour each day."d. "Sore throat is a common, harmless side effect."

ANSWER IS A A A a. "Drink several quarts of water daily"

A patient taking trimethoprim-sulfamethoxazole (TMP-SMX) to treat a urinary tract infection complains of a sore throat. The nurse will contact the provider to request an order for which laboratory test(s)? a. Complete blood count with differentialb. Throat culturec. Urinalysisd. Coagulation studies

ANSWER IS A A A a. Complete blood count with differential

The nurse is preparing to give trimethoprim-sulfamethoxazole (TMP-SMX) to a patient and notes a petechial rash on the patient's extremities. The nurse will perform which action? a. Hold the dose and notify the provider.b. Request an order for a blood glucose level.c. Request an order for a BUN and creatinine level.d. Request an order for diphenhydramine, Benadryl.

ANSWER IS A A A a. Hold the dose and notify the provider

The nurse is caring for a patient who is receiving sulfadiazine. The nurse knows that this patient's daily fluid intake should be at least which amount? a. 1000 mL/dayb. 1200 mL/dayc. 2000 mL/dayd. 2400 mL/day

ANSWER IS C C C c. 2000 mL/day

The nurse is preparing to administer trimethoprim-sulfamethoxazole (TMP-SMX) to a patient who is being treated for a urinary tract infection. The nurse learns that the patient has type 2 diabetes mellitus and takes a sulfonylurea oral antidiabetic drug. The nurse will monitor this patient closely for which effect? a. Headachesb. Hypertensionc. Hypoglycemiad. Superinfection

ANSWER IS C C C c. Hypoglycemia

A female patient who is taking trimethoprim-sulfamethoxazole TMP-SMZ Bactrim, Septra to treat a urinary tract infection reports vaginal itching and discharge. The nurse will perform which action? a. Ask the patient if she might be pregnant.b. Reassure the patient that this is a normal side effect.c. Report a possible super infection to the provider.d. Suspect that the patient is having a hematologic reaction.

ANSWER IS C C C c. Report a possible super infection to the provider.

A patient who is taking trimethoprim-sulfamethoxazole (TMP-SMX) calls to report developing an all-over rash. The nurse will instruct the patient to perform which action? a. Increase fluid intake.b. Take diphenhydramine.c. Stop taking TMP-SMX immediately.d. Continue taking the medication

ANSWER IS C C C c. Stop taking TMP-SMX immediately

The nurse is preparing to give a dose of trimethoprim-sulfamethoxazole (TMP-SMX) and learns that the patient takes warfarin (Coumadin). The nurse will request an order for a. a decreased dose of TMP-SMX.b. a different antibiotic.c. an increased dose of warfarin.d. coagulation studies.

ANSWER IS D D D d. coagulation studies

A patient is experiencing stomatitis after a round of chemotherapy. Which intervention by the nurse is correct?A. Clean the mouth with a soft-bristle toothbrush and warm saline solution.B. Rinse the mouth with commercial mouthwash twice a day.C. Use lemon-glycerin swabs to keep the mouth moist.D. Keep dentures in the mouth between meals.

A. Clean the mouth with a soft-bristle toothbrush and warm saline solution

The nurse is assessing a patient who has developed anemia after two rounds of chemotherapy. Which of these may be indications of anemia? (SELECT ALL THAT APPLY)A. HypoxiaB. FeverC. InfectionD. BleedingE. Fatigue

A. HypoxiaE. Fatigue

A patient develops flushing, rash, and pruritus during an IV infusion of vancomycin (Vancocin). Which action should a nurse take?A. Reduce the infusion rate.B. Administer diphenhydramine (Benadryl).C. Change the IV tubing.D. Check the patency of the IV.

A. Reduce the infusion rate.When vancomycin is infused too rapidly, histamine release may cause the patient to develop hypotension accompanied by flushing and warmth of the neck and face; this phenomenon is called red man syndrome. Diphenhydramine is not necessary if the infusion is administered slowly over at least 60 minutes. Changing the IV tubing would not help the symptoms. The patency of the IV needs to be checked before the administration is started.

A patient has been receiving an erythropoietin-stimulating agent (ESA) for 8 weeks. The nurse reviews the patients chart and notes no increase in hemoglobin levels from 8 g/dL on week 3 of therapy. The nurse will request an order fora. a complete blood count and serum iron levels.b. an increased dose of the erythropoietin-stimulating agent.c. more frequent dosing of the ESA.d. packed red blood cell infusions.

ANS: A If there is no response, ESAs should be discontinued after 8 weeks of therapy. If a patient does not respond, iron deficiency or underlying hematologic disease should be considered and evaluated.

Prior to administration of interferon alpha, the nurse will administer which medications?a. Acetaminophen and diphenhydramineb. Heparin and meperidinec. Lorazepam and furosemided. Narcotic analgesics and loratadine

ANS: A Patients receiving these drugs should be premedicated with acetaminophen to reduce chills and fever and with diphenhydramine to reduce nausea.

A patient is receiving interferon alpha (Roferon-A) subcutaneously. The patient experiences chills, fatigue, and malaise, and the nurse assesses a temperature of 102 F. The nurse will notify the provider of the temperature and will anticipate which order?a. Administer acetaminophen (Tylenol).b. Change to intravenous interferon alpha.c. Give diphenhydramine (Benadryl).d. Obtain a serum BUN and creatinine level.

ANS: A The major side effects of interferon are flulike symptoms with chills, fever, fatigue, malaise, and myalgia. Acetaminophen is given to treat this initially. Changing to an IV form does not alter the side effects. Diphenhydramine is given for nausea caused by interferon alpha. It is not necessary to obtain laboratory work when these symptoms initially occur.

The nurse is caring for a patient who is receiving vincristine (Oncovin), a plant alkaloid chemotherapeutic agent, to treat non-Hodgkins lymphoma. The nurse observes that the patient has difficulty walking. What action will the nurse take? a. Ask about numbness or tingling in the fingers and toes. b. Assess heart rate and blood pressure to evaluate for orthostatic hypotension. c. Assess the temperature to evaluate for infection. d. Request an order for a complete blood count and electrolytes.

ANS: A Peripheral neuropathy can occur with this drug and is manifested by difficulty walking and numbness and tingling in the fingers and toes. Orthostatic hypotension is not a side effect. Infection is always a concern, and regular evaluation of complete blood count and electrolytes is performed but not related to signs of peripheral neuropathy.

The nurse is teaching a nursing student about the antifungal drug amphotericin B. Which statement by the student indicates a need for further teaching? a. Amphotericin B may be given intravenously or by mouth. b. Patients who take this drug should have potassium and magnesium levels assessed. c. Patients with renal disease should not take amphotericin B. d. This drug is used for severe systemic infections.

ANS: A Amphotericin B is not absorbed from the gastrointestinal tract, so is not given by mouth. It can cause nephrotoxicity and electrolyte imbalance. It is highly toxic and is reserved for severe, systemic infections.

A patient who is about to begin chemotherapy asks the nurse when the risk of infection is highest. The nurse will tell the patient that infection risk is greatest at which point? a. A week to 10 days after each chemotherapy dose b. During the week immediately after chemotherapy c. Immediately prior to each dose of chemotherapy d. When the patients temperature is elevated by 1 F

ANS: A Following chemotherapy administration, the time at which the blood count, including white blood cells, is lowest is typically 7 to 10 days after treatment.

"The nurse is administering packed red blood cells (PRBCs) to a client. The nurse should first:"1. Discontinue the I.V. catheter if a blood transfusion reaction occurs.2. Administer the PRBCs through a percutaneously inserted centralcatheter line with a 20-gauge needle. 3. Flush PRBCs with 5% dextroseand 0.45% normal saline solution. 4. Stay with the client during thefirst 15 minutes of infusion.

Correct: 4 The most likely time for a blood transfusion reaction to occur is during the first 15 minutes or first 50 mL of the infusion. If a blood transfusion reaction does occur, it is imperative to keep an established I.V. line so that medication can be administered to prevent or treat cardiovascular collapse in case of anaphylaxis. PRBCs should be administered through a 19-gauge or larger needle; a peripherally inserted central catheter line is not recommended, in order to avoid a slow flow. RBCs will hemolyze in dextrose or lactated Ringer's solution and should be infused with only normal saline solution.

The nurse is caring for a patient who is receiving an intravenous antibiotic. The patient has a serum drug trough of 1.5 mcg/mL. The normal trough for this drug is 1.7 to 2.2 mcg/mL. What will the nurse expect the patient to experience?a. Inadequate drug effectsb. Increased risk for superinfectionc. Minimal adverse effectsd. Slowed onset of action

A Inadequate drug effects Low peak levels may indicate that the medication is below the therapeutic level. They do not indicate altered risk for superinfection, a decrease in adverse effects, or a slowed onset of action.

Which of these descriptions best matches the term colony stimulating factor?A) adhere to collagen beneath endotheliumB) helper cells are one typeC) hormone that regulates blood cell formationD) kill bacteria using hydrogen peroxideE) often elevated in allergic individuals

C) hormone that regulates blood cell formation

the nurse is providing teaching after an adult receives a booster immunization. Which adverse reaction will the nurse immediately report to the health care provider? (select all that apply) A. swelling and redness at injection site B. Fever of 100f C. joint pain D. Heat over injection site E. Rash over the arms, back and chest F. Shortness of breath

C, E, F

A patient with a history of lung transplantation is admitted for treatment for a respiratory infection. The patient has been taking cyclosporine (Sandimmune), prednisone, and azathioprine (Imuran) for 8 months. The provider has ordered azithromycin (Zithromax) to treat the infection and acetaminophen (Tylenol) as needed for fever. The nurse will contact the provider to: a. ask whether a different antibiotic can be used. b. ask that the prednisone be discontinued until the infection clears. c. suggest increasing the dose of cyclosporine. d. suggest using ibuprofen instead of acetaminophen

ANS: A Macrolide antibiotics, such as azithromycin, can inhibit cyclosporine metabolism, leading to increased levels of the drug. This patient needs either a reduced dose of cyclosporine or a different antibiotic. There is no indication for discontinuing the prednisone during treatment. The dose of cyclosporine would need to be reduced, because azithromycin leads to increased drug levels. There is no contraindication to using acetaminophen.

Which is an example of acquired passive immunity? a. Administration of IgG to an unimmunized person exposed to a disease b. Administration of an antigen via an immunization c. Inherent resistance to a disease antigen d. Immune response to an attenuated virus

ANS: A Passive immunity occurs without stimulation of an immune response. Acquired immunity requires administration of immune globulin. Inherent resistance to a disease antigen describes the state of natural immunity, not acquired passive immunity. The other answers involve stimulation of an immune response.

The nurse is teaching a patient about rifampin. Which statement by the patient indicates understanding of the teaching? a. I should not wear soft contact lenses while taking rifampin. b. I will need regular eye examinations while taking this drug. c. I will report orange urine to my provider immediately. d. I understand that renal toxicity is a common adverse effect.

ANS: A Patients taking rifampin should be warned that urine, feces, saliva, sputum, sweat, and tears may turn a harmless red-orange color. Patients should not wear soft contact lenses to avoid permanent staining. Regular eye exams are necessary for patients who receive isoniazid and ethambutol. Orange urine is a harmless side effect and does not need to be reported. Renal toxicity is not common with rifampin.

The provider orders Zostavax for a 60-year-old patient. The patient reports having had chicken pox as a child. Which action will the nurse take? a. Administer the vaccine as ordered. b. Counsel the patient that the vaccine may cause a severe reaction because of previous exposure. c. Hold the vaccine and notify the provider of the patients history. d. Request an order for a Varivax booster instead of the Zostavax.

ANS: A Zostavax is given to boost the immunity to varicella-zoster virus among recipients. It is not likely to cause severe reaction secondary to prior exposure, since the immune response in most recipients has declined. Zostavax, not Varivax, is approved for this use.

A client is being treated for tuberculosis. Which medications are used to treat this condition? (Select all that apply.) a. Streptomycin sulfate b. Amoxicillin (Amoxil) c. Ethambutol (Myambutol) d. Gentamicin (Garamycin) e. Rifabutin (Mycobutin) f. Ethionamide (Trecator-SC) g. Pyrazinamide

ANS: A, C, E, F, G Streptomycin sulfate, ethambutol (Myambutol), rifabutin (Mycobutin), ethionamide (Trecator-SC), and pyrazinamide are used to treat tuberculosis. The other medications are not used

A patient with cancer is receiving pegfilgrastim (Neulasta). The patient reports bone pain, which the nurse recognizes as a. a sign of cancer metastasis.b. an indication of expansion of bone marrow.c. caused by osteomyelitis.d. worsening neutropenia

ANS: B Bone pain is common with these drugs and is caused by expansion of the bone marrow. It does not indicate metastasis. The bone pain is not due to osteomyelitis or neutropenia.

A patient who is receiving cancer chemotherapy has been ordered to receive epoetin alfa (Procrit) 150 units/kg 3 times weekly. The nurse reviews the patients chart and notes a hemoglobin level of 10.1 g/dL. The nurse will perform which action?a. Administer the medication as ordered.b. Hold the dose and notify the provider.c. Reduce the dose by 25%.d. Request an order for an increased dose.

ANS: B For patients receiving cancer chemotherapy, erythropoietin-stimulating agents should not be initiated at a hemoglobin level greater than or equal to 10 g/dL.

The nurse is discussing vaccines with the mother of a 4-year-old child who attends a day care center that requires the DTaP vaccine. The mother, who is pregnant, tells the nurse that she does not want her child to receive the pertussis vaccine because she has heard that the disease is not that serious in older children. What information will the nurse include when discussing this with the mother? a. If she gets the vaccine, both she and her 4 year-old child will be protected. b. If the 4-year-old child contracts pertussis, it can be passed on to her newborn. c. The vaccine will not be given to her child while she is pregnant. d. Vaccinating the 4-year-old will provide passive immunity for her unborn child.

ANS: B Even though pertussis is not as serious in older children, it is important to vaccinate children to prevent the spread of the disease to infants and others who are not immunized and who are at risk for significant morbidity and mortality from this disease. Vaccinating the mother will not protect the 4-year-old from getting pertussis. The DTaP vaccine may be given to children whose mothers are pregnant. Vaccinating the child does not confer passive immunity to the unborn child.

A patient with cancer is receiving pegfilgrastim (Neulasta). The patient reports bone pain, which the nurse recognizes as a. a sign of cancer metastasis. b. an indication of expansion of bone marrow. c. caused by osteomyelitis. d. worsening neutropenia.

ANS: B Bone pain is common with these drugs and is caused by expansion of the bone marrow. It does not indicate metastasis. The bone pain is not due to osteomyelitis or neutropenia.

A provider has ordered Gardasil to be given to a prepubertal 9-year-old female. The parent asks the nurse if this vaccine can be postponed until the child is in high school. The nurse will tell the parent that Gardasil a. is less effective in older adolescents. b. is more effective if given before sexual activity begins. c. is more effective if given prior to the hormonal changes of puberty. d. is not effective if given after the onset of menses

ANS: B Gardasil is most effective when the client is not yet sexually active.

The parent of a 12-month-old child who has received the MMR, Varivax, and hepatitis A vaccines calls the clinic to report redness and swelling at the vaccine injection sites and a temperature of 100.3 F. The nurse will perform which action? a. Recommend aspirin or an NSAID for pain and fever. b. Recommend acetaminophen and cold compresses. c. Report these adverse effects to the Vaccine Adverse Event Reporting System (VAERS). d. Schedule an appointment in clinic so the provider can evaluate the child.

ANS: B These are common, minor side effects of vaccines and can be treated with acetaminophen and cold compresses. Aspirin is contraindicated in children because of its association with Reyes syndrome. Since these are not serious adverse effects, they do not need to be reported to VAERS. It is not necessary to schedule a clinic visit.

The nurse is teaching a young adult patient who will begin receiving interferon. Which statement by the patient indicates understanding of the teaching?a. I may have a low-grade fever while taking this medication.b. I may have serious cardiovascular side effects because of this drug.c. I should take antiemetics prior to each dose of this medication.d. I may need to avoid people who are sick while Im taking this drug.

ANS: C Antiemetics should be given prior to treatment to prevent nausea from occurring. Fevers are common and are usually high. Cardiovascular side effects tend to occur in older patients. Neutropenia is rare with interferon and does not predispose patients to infection

A patient receiving interferon experiences confusion, somnolence, and aphasia. The nurse will perform which action?a. Discontinue the medication immediately.b. Inform the family that these symptoms may persist for years.c. Reassure the patient that these side effects are reversible.d. Request an order for lorazepam

ANS: C Neurologic side effects, such as confusion, somnolence, and aphasia, are reversible after the drug is stopped. It is not necessary to stop the medication unless the symptoms progress and become severe. Lorazepam is not indicated.

A patient is receiving the erythropoietin-stimulating agent epoietin alfa (Procrit). Which assessment finding would cause the nurse to notify the patients provider?a. Blood pressure of 90/65 mm Hgb. Headache and nauseac. Hemoglobin > 12 g/dLd. Infiltration of the IV

ANS: C There is an increased risk of death and serious cardiovascular events when the hemoglobin is greater than 12 g/dL. There is no need to notify the provider of the other findings.

A patient is receiving bone marrow transplantation for cancer and receives filgrastim (Neupogen). The patient reports abdominal pain in the left upper quadrant. The nurse will perform which action? a. Administer acetaminophen 650 mg. b. Administer an antiemetic medication. c. Report a potentially life-threatening event. d. Request an order for cardiac enzyme levels.

ANS: C Splenic rupture can occur with this drug and is manifested by pain in the left upper quadrant. The nurse should report the abdominal pain to the provider so the patient can be evaluated for splenic rupture.

The nurse is teaching a young adult patient who will begin receiving interferon. Which statement by the patient indicates understanding of the teaching? a. I may have a low-grade fever while taking this medication. b. I may have serious cardiovascular side effects because of this drug. c. I should take antiemetics prior to each dose of this medication. d. I may need to avoid people who are sick while Im taking this drug.

ANS: C Antiemetics should be given prior to treatment to prevent nausea from occurring. Fevers are common and are usually high. Cardiovascular side effects tend to occur in older patients. Neutropenia is rare with interferon and does not predispose patients to infection.

The nurse is caring for a patient who is receiving a high dose of intravenous azithromycin to treat an infection. The patient is also taking acetaminophen for pain. The nurse should expect to review which lab values when monitoring for this drugs side effects? a. Complete blood counts b. Electrolytes c. Liver enzymes d. Urinalysis

ANS: C High doses of macrolides, when taken with other, potentially hepatotoxic drugs such as acetaminophen may cause hepatotoxicity, so liver enzymes should be carefully monitored.

The nurse is preparing to administer clarithromycin to a patient. When performing a medication history, the nurse learns that the patient takes warfarin to treat atrial fibrillation. The nurse will perform which action? a. Ask the provider if azithromycin may be used instead of clarithromycin. b. Obtain an order for continuous cardiovascular monitoring. c. Request an order for periodic serum warfarin levels. d. Withhold the clarithromycin and notify the provider.

ANS: C Macrolides can increase serum levels of other drugs such as warfarin. If these drugs are used with macrolides, serum drug levels should be monitored. All macrolides have this drug interaction. Cardiovascular monitoring is not indicated. The drug may be given as long as serum drug levels are monitored.

A patient receiving interferon experiences confusion, somnolence, and aphasia. The nurse will perform which action? a. Discontinue the medication immediately. b. Inform the family that these symptoms may persist for years. c. Reassure the patient that these side effects are reversible. d. Request an order for lorazepam.

ANS: C Neurologic side effects, such as confusion, somnolence, and aphasia, are reversible after the drug is stopped. It is not necessary to stop the medication unless the symptoms progress and become severe. Lorazepam is not indicated.

A female patient who is allergic to penicillin will begin taking an antibiotic to treat a lower respiratory tract infection. The patient tells the nurse that she almost always develops a vaginal yeast infection when she takes antibiotics and that she will take fluconazole (Diflucan) with the antibiotic being prescribed. Which macrolide order would the nurse question for this patient? a. Azithromycin (Zithromax) b. Clarithromycin (Biaxin) c. Erythromycin (E-Mycin) d. Fidaxomicin (Dificid)

ANS: C When erythromycin is given concurrently with fluconazole, erythromycin blood concentration and the risk of sudden cardiac death increase.

A patient who has tuberculosis asks the nurse why three drugs are used to treat this disease. The nurse will explain that multi-drug therapy is used to reduce the likelihood of a. disease relapse. b. drug hypersensitivity reactions. c. drug resistance. d. drug adverse effects

ANS: C Without multi-drug therapy, patients easily develop resistance to antitubercular drugs. Using more than one antitubercular drug does not prevent relapse, hypersensitivity reactions, or adverse effects.

The nurse is preparing to administer interleukin-2 to a patient who has cancer. The patient reports shortness of breath. The nurse assesses clear breath sounds, a respiratory rate of 22 breaths per minute, a heart rate of 80 beats per minute, an oxygen saturation of 93% on room air, and a blood pressure of 92/68 mm Hg. The nurse will perform which action?a. Administer the dose as ordered.b. Administer oxygen while giving the dose.c. Discuss permanently discontinuing this treatment with the provider.d. Hold the dose and notify the provider.

ANS: D Because of pulmonary symptoms associated with interleukin-2, the drug should be held if the patient has an oxygen saturation <94% on room air. It may be given when the patients oxygen saturation improves. The drug does not need to be permanently discontinued.

A patient is receiving bleomycin (Blenoxane) as part of a chemotherapeutic regimen to treat leukemia. During intravenous administration of this drug, what will the nurse observe the patient closely for? a. Hypotension and visual disturbances b. Pain and blistering at the IV site c. Pink to red urine d. Shortness of breath and wheezing

ANS: D Bleomycin can cause anaphylaxis, so patients should be monitored for respiratory distress. Pain and blistering at the IV site is common to antitumor antibiotics except for bleomycin. Urine color changes occur with doxorubicin. Vincristine causes hypotension and visual disturbances.

16. The nurse is performing a health history on a patient who has multiple sclerosis. The patient reports episodes of muscle spasticity and recurrence of muscle weakness and diplopia. The nurse will expect this patient to be taking which medication? a. Adrenocorticotropic hormone (ACTH) b. Cyclophosphamide (Cytoxan) c. Cyclobenzaprine (Flexeril) d. Interferon-B (IFN-B)

ANS: D This patient is showing signs of remission and exacerbation of MS symptoms. Interferon is used to treat this phase. ACTH is used for acute attacks. Cyclophosphamide is used for chronic, progressive symptoms. Cyclobenzaprine is a centrally acting muscle relaxant that is used for muscle spasms to decrease pain and increase range of motion.

The nurse is preparing to administer interleukin-2 to a patient who has cancer. The patient reports shortness of breath. The nurse assesses clear breath sounds, a respiratory rate of 22 breaths per minute, a heart rate of 80 beats per minute, an oxygen saturation of 93% on room air, and a blood pressure of 92/68 mm Hg. The nurse will perform which action? a. Administer the dose as ordered. b. Administer oxygen while giving the dose. c. Discuss permanently discontinuing this treatment with the provider. d. Hold the dose and notify the provider.

ANS: D Because of pulmonary symptoms associated with interleukin-2, the drug should be held if the patient has an oxygen saturation <94% on room air. It may be given when the patients oxygen saturation improves. The drug does not need to be permanently discontinued.

A 48-month-old child is scheduled to receive the following vaccines: MMR, Varivax, IPV, and DTaP. The childs parents want the child to receive two vaccines today and the other two in 1 week. To accommodate the parents wishes, the nurse will administer a. the DTaP and Varivax today and the MMR and IPV in 1 week. b. the IPV and MMR today and the Varivax and DTaP in 1 week. c. the MMR and DTaP today and the Varivax and IPV in 1 week. d. the MMR and Varivax today and the DTaP and IPV in 1 week.

ANS: D If the MMR or other live virus vaccine is not given the same day as the varicella vaccine, administration of the two vaccines should be separated by at least 4 weeks. In the incorrect answers, the two live virus vaccines are given only one week apart.

An oncology home care nurse is preparing to administer a chemotherapeutic agent to a patient at the patients home. What precautions will the nurse take while administering the IV chemotherapeutic agent? a. Clear a counter space for preparation of the solution. b. Don a surgical mask while administering the drug. c. Take surgical scrubs to wear during the infusion. d. Wear an impermeable, disposable gown when hanging the drug.

ANS: D Nurses should take precautions when handling cytotoxic drugs if inhalation, ingestion, or contact with skin and mucous membranes is possible. When hanging an IV solution, it is possible to splash solution onto the skin, so the nurse should wear a disposable, impermeable gown. If the nurse has to prepare a solution at home, a plastic-backed pad should be used as a surface. When there is a risk of aerosol exposure, a National Institute for Occupational Safety and Healthapproved respirator is necessary. Surgical masks do not provide adequate respiratory protection. Surgical scrubs are permeable.

A patient who has oral candidiasis will begin using nystatin suspension to treat the infection. What information will the nurse include when teaching this patient? a. Coat the buccal mucosa with the drug and then rinse your mouth. b. Gargle with the nystatin and then spit it out without swallowing. c. Mix the suspension with 4 ounces of water and then drink it. d. Swish the liquid in your mouth and then swallow after a few minutes.

ANS: D Patients should be taught to swish the suspension in the mouth to coat the tongue and buccal mucosa and then swallow the medication. It should not be spit out, diluted with water, or swallowed with water.

A patient who is taking isoniazid (INH) as part of a two-drug tuberculosis treatment regimen reports tingling of the fingers and toes. The nurse will recommend discussing which treatment with the provider? a. Adding pyrazinamide b. Changing to ethambutol c. Increasing oral fluid intake d. Taking pyridoxine (B6)

ANS: D Peripheral neuropathy is an adverse reaction to INH, so pyridoxine is usually given to prevent this. It is not necessary to change medications. Increasing fluids will not help with this.

A young adult patient is in the clinic to receive a tetanus vaccine after sustaining a laceration injury. The nurse learns that the patient, who works in a day care center, has not had any vaccines for more than 10 years. Which vaccine will the nurse expect to administer? a. DT b. DTaP c. Td d. Tdap

ANS: D Persons who work with children should receive acellular pertussis vaccine. The Tdap

The nurse is preparing to give a dose of gentamicin to a patient and notes that the most recent serum gentamicin trough level was 2 mcg/mL. What will the nurse do next? a. Administer the drug as ordered. b. Administer the drug and monitor for adverse effects. c. Notify the provider to discuss decreasing the dose. d. Notify the provider to report a toxic drug level.

ANS: D The trough drug level for gentamicin should be less than 2 mcg/mL. The nurse should not administer the drug and should notify the provider of the toxic level.

A nurse collects a culture sample of infected tissue. What does the result of testing the culture contribute to the patients care? A) Identifies the specific organism causing the infection B) Pinpoints the exact site of the infection C) Identifies individualized patient factors contributing to infection D) Describes the length of time the patient has experienced infection

Ans: A Feedback: A culture is collected to identify the causative organism of an infection. It can help with determining the site of infection in some cases if the infection is limited only to the site where the culture is collected. It does not individualize patient factors contributing to infection. These must be determined through assessment. It cannot indicate how long the patient has had the infection, which is often determined by the white blood cell count and differential.

The nurse is caring for a 62-year-old patient who is receiving IV gentamicin (Garamycin). The patient complains of difficulty hearing. What should the nurse do? A) Hold the dose and notify the physician immediately. B) Administer the dose and speak in a louder voice when talking to the patient. C) Administer the dose and report this information to the oncoming nurse. D) Administer the dose and document the finding in the nurses notes.

Ans: A Feedback: Aminoglycosides are contraindicated in the following conditions: known allergy to any of the aminoglycosides; renal or hepatic disease that could be exacerbated by toxic aminoglycoside effects and that could interfere with drug metabolism and excretion, leading to higher toxicity; preexisting hearing loss, which could be intensified by toxic drug-related adverse effects on the auditory nerve. Ototoxicity should be reported and the drug should be stopped. You would not administer the dose and then call the physician, administer the dose and report information to oncoming nurse, or administer the dose and document the finding in the nurses notes because each additional dose administered could potentially worsen hearing loss.

The nurse is caring for a patient who is receiving an aminoglycoside. What would be a priority assessment on this patient? A) Respiratory function B) Vision C) Cardiac function D) Liver function

Ans: A Feedback: Aminoglycosides come with a black box warning alerting health care professionals to the serious risk of ototoxicity and nephrotoxicity. Central nervous system effects include ototoxicity, possibly leading to irreversible deafness; vestibular paralysis resulting from drug effects on the auditory nerve; confusion; depression; disorientation; and numbness, tingling, and weakness related to drug-related adverse effects on other nerves. Visual alterations are not usually reported in relation to this drug. Respiratory function and liver function are not usually impacted by this drug.

The patient is admitted to the acute care facility with acute septicemia and has orders to receive gentamicin and ampicillin IV. The nurse is performing an admission assessment that includes a complete nursing history. What information provided by the patient would indicate the need to consult the health care provider before administering the ordered medication? A) Takes furosemide (Lasix), a potent diuretic, daily B) Had prostate surgery 3 months ago C) History of hypothyroidism D) Allergic to peanuts and peanut products

Ans: A Feedback: Aminoglycosides should be avoided if the patient takes a potent diuretic because of the increased risk of ototoxicity, nephrotoxicity, and neurotoxicity. Learning the patient takes a potent diuretic would indicate the need to consult with the health care provider before administering gentamicin. Prostate surgery, hypothyroidism, and an allergy to peanuts would not preclude administration of these medications and would not indicate a need to consult with the provider.

The clinic nurse is administering vaccines at well-baby checkups. Before administering a diphtheria, tetanus, and pertussis (DTP) vaccine, what vital sign is most important for the nurse to check? A) Temperature B) Pulse C) Blood pressure D) Respirations

Ans: A Feedback: Caution should be used whenever a vaccine is given to a child with a history of febrile convulsions or cerebral injury, or in any condition in which a potential fever would be dangerous. Caution also should be used in the presence of any acute infection. As a result, checking the childs temperature is most important because this would be an indicator of potential infection. The nurse should ask the mother about history of febrile seizures or any condition that would make a fever dangerous.

A patient with AIDS is taking an antiviral agent. What comment by the patient would indicate that the teaching plan was effective? A) I feel like I do when I have the flu. B) I will continue to take the over-the-counter medication for my allergies. C) Excessive fatigue and a severe headache are common adverse effects of my medication. D) This drug will cure AIDS.

Ans: A Feedback: Common adverse effects of antiviral agents are flu-like symptoms, which may be related to the underlying disease. Excessive fatigue and a severe headache can indicate a serious complication and should be reported immediately. Antiviral agents do not cure the disease. HIV causes loss of helper T-cell function. This causes the immune system to be depressed and allows opportunistic infections to occur. Antiviral agents reduce the number of mutant viruses that are formed and spread to noninfected cells.

What measure protects the nurse when preparing cytotoxic drugs? A) Wearing protective equipment such as gloves, mask, and gown B) Washing hands before preparation C) Mixing medication in a 1-L bag D) Administering medication IM

Ans: A Feedback: Cytotoxic drugs are toxic chemicals and the nurse who administers them must take adequate precautions to avoid self-exposure. These precautions include protective equipment. Hand hygiene should be performed before administering any medication but this measure does not protect the nurse. Whether mixing the medication in a 1-L bag or administering it IM, the nurse must wear protective equipment.

After administering an antibiotic, the nurse assesses the patient for what common, potentially serious, adverse effect? A) Rash B) Pain C) Constipation D) Hypopnea

Ans: A Feedback: Examine skin for any rash or lesions, examine injection sites for abscess formation, and note respiratory statusincluding rate, depth, and adventitious sounds to provide a baseline for indications of an allergic or adverse response to the drug. Report nausea, vomiting, diarrhea, rash, recurrence of symptoms for which the antibiotic drug was prescribed, or signs of new infection (e.g., fever, cough, sore mouth, drainage). These problems may indicate adverse effects of the drug, lack of therapeutic response to the drug, or another infection. Pain, constipation, and hypopnea are not common adverse effects of antibiotic drugs.

The nurse is planning care for an AIDS patient admitted with chronic severe diarrhea secondary to adverse effects of the antiviral drugs prescribed. What would be the most appropriate goal for this patient? A) Patient will show improved nutritional status evidenced by weight gain. B) Alleviation or reduction of signs and symptoms of AIDS. C) Patient will be able to demonstrate the effectiveness of the teaching plan. D) Patient will state that comfort and safety measures are effective and show compliance with the regimen.

Ans: A Feedback: Severe chronic diarrhea is likely to result in malnutrition and weight loss along with potential alterations in fluid and electrolyte balance. The best indicator of improvement would be an improvement in nutritional status as indicated by weight gain. Although the other outcomes might be applicable to a patient with AIDS, weight gain is the priority concern for a patient with severe chronic diarrhea.

The nurse is caring for a female patient whose tests confirm she is 10 weeks pregnant and has contracted tuberculosis. The health care provider orders a combination of antimycobacterials. What combination of drugs would the nurse identify as safest for this pregnant patient? A) Isoniazid, ethambutol, and rifampin B) Rifabutin, streptomycin, and rifampin C) Capreomycin, cycloserine, and ethionamide D) Dapsone, ethambutol, and cycloserine

Ans: A Feedback: The antituberculosis drugs are always used in combination to affect the bacteria at various cellular stages and first-line drugs are always the first choice, using second-line drugs only when the patient is unable to take the first-line medications. Because this patient is pregnant, the safest choices would be isoniazid, ethambutol, and rifampin but no drug is administered during pregnancy unless the benefit outweighs the risk. The other drug choices would be less safe and would not be used unless the safer drugs were contraindicated.

A 69-year-old patient comes to the clinic to talk to the nurse. The patient asks the nurse about when he should get the pneumonia vaccine. The patients medical record reveals that he received the vaccine at age 55. What should the nurse tell the patient? A) This vaccine is only given once and you have already had it. B) This vaccine is given every 10 years and you will be due next year. C) This vaccine is only repeated if the first dose was given before age 65. You should have another vaccine. D) This vaccine is no longer recommended. Dont worry about getting pneumonia.

Ans: A Feedback: The pneumonia vaccine contains 23 strains and is believed to offer lifetime protection. The tetanus vaccine is given every 10 years. The vaccine is recommended for anyone at risk, especially those over age 65. Options C and D are distracters.

When the nurse cares for a patient receiving an antibiotic, what instructions will the nurse provide no matter what medication is prescribed? (Select all that apply.) A) Drink plenty of fluids to avoid kidney damage. B) Take all medications as prescribed until all of the medication is gone. C) Report difficulty breathing, severe headache, or changes in urine output. D) Take antibiotic with food to avoid gastrointestinal (GI) upset. E) Take safety precautions such as changing position slowly.

Ans: A, B, C Feedback: The patient taking any antibiotic needs to drink plenty of fluids to avoid kidney damage and improve excretion of the metabolized drug; take all medications as prescribed until all of the medication is gone to avoid developing a resistant strain of bacteria; and report any difficulty breathing, severe headache, or changes in urine output because these are primary manifestations of serious adverse effects. Although some antibiotics need to be taken with food, others may be best taken on an empty stomach so this does not apply to all antibiotics. Not all antibiotics are associated with central nervous system (CNS) toxicity so taking safety precautions need only be included in patient teaching if they are taking a drug associated with CNS adverse effects.

A nursing student asks the pharmacology instructor for ways to minimize the emergence of drug-resistant microbial agents. What would be an appropriate response by the instructor? (Select all that apply.) A) Avoid the use of broad-spectrum antibacterial drugs when treating trivial or viral infections. B) Use narrow-spectrum agents if they are thought to be effective. C) Do not use vancomycin unnecessarily. D) Prescribe antibiotics when the patient believes they are warranted. E) Start the antibiotics, do culture and sensitivity tests, and provide patient education.

Ans: A, B, C Feedback: To prevent or contain the growing threat of drug-resistant strains of bacteria, it is very important to use antibiotics cautiously, to complete the full course of an antibiotic prescription, and to avoid saving antibiotics for self-medication in the future. You would not give antibiotics every time the patient wants them, nor would you do a culture and sensitivity test after starting antibiotics. Therefore, Options D and E are incorrect.

The nurse is caring for a child who weighs 30 kg. The physician orders gentamicin (Garamycin) tid. The recommended dosage range is 6 to 7.5 mg/kg/day. Why is it important to give a dosage within this recommended range? (Select all that apply.) A) To avoid toxic effects B) To protect other patients C) To reduce the risk of drug-resistant organisms D) To eradicate the bacteria E) To promote lactic acid removal

Ans: A, B, C, D Feedback: By administering the correct dosage, you avoid overdosage and reduce the risk of toxic effects. The correct dosage reduces the risk of creating drug-resistant organisms; it also protects both the patient and the other patients who might be susceptible to the drug-resistant organisms as well. The proper dosage is needed to eradicate the bacteria. Lactic acid removal is not related to the proper dosage and is a distracter for this question.

The nurse administers polymyxin B to a patient with a gram-negative bacterial infection. What symptoms would cause the nurse to suspect drug fever, hold the medication, and call the health care provider immediately? (Select all that apply.) A) Fever B) Dizziness C) Ataxia D) Increased activity E) Reduced urine output

Ans: A, B, C, E Feedback: The actions of polymyxin B on cell membranes means it can be toxic to the human host, leading to nephrotoxicity, neurotoxicity (e.g., facial flushing, dizziness, ataxia, paresthesias, drowsiness), and drug-related fever and rash. This drug is reserved for infections that do not respond to less toxic drugs; the nurse needs to be alert for serious reactions and hold the drug until notifying the provider.

The nurse is providing discharge teaching for a patient going home on the medication entecavir (Baraclude). What is the priority teaching point for this patient? A) Take the whole course of the medication as prescribed. B) Take this medication with grapefruit juice. C) Do not stop taking this medication or allow the prescription to run out. D) The patient will take this medication for the rest of his life.

Ans: C Feedback: A potential risk for hepatitis B exacerbation could occur when the drugs are stopped. Therefore, teach patient the importance of not running out of the drugs and using extreme caution when discontinuing these drugs. Options A, B, and D are incorrect responses.

The nurse is conducting a class for nurses hired to work on the oncology unit. What statement, if made by the nurse, would be correct regarding chemotherapy for older adults? (Select all that apply.) A) Older adults may be more susceptible to the central nervous system (CNS) and GI effects of these drugs. B) Older patients are at risk for dehydration and diminished nutritional status. C) Safety precautions should be instituted as soon as any drug is initiated. D) Dosage will need to be adjusted based on the age of the older adult. E) Older adults are already somewhat immunosuppressed, so further suppression is a concern.

Ans: A, B, E Feedback: Older adults may be more susceptible to the CNS and GI effects of some of these drugs. Older patients should be monitored for hydration and nutritional status regularly. Safety precautions should be instituted if CNS effects occur but are not needed for every drug as soon as it is initiated. Dosage is adjusted based on hepatic and renal function, not the patients age. Protecting these patients from exposure to infection and injury is a very important aspect of their nursing care because older patients are naturally somewhat immunosuppressed because of age.

A patient is admitted to the unit and the nurse assesses whether he or she is at increased risk for infection when what factors are determined? (Select all that apply.) A) Malnutrition B) Hypertension C) Suppression of immune system D) Advanced age E) Decreased amylase levels

Ans: A, C, D Feedback: Factors that suppress the host defense mechanisms include malnutrition, suppression of immune system, and advanced age. Hypertension does not predispose a person to infection neither does a decreased amylase level.

The nurse is assigned to perform telephone triage for the clinic and receives a call from a young mother whose 6-month-old baby received her third diphtheriapertussistetanus immunization that morning. The mother reports the babys temperature is 99.8 axillary, the site of injection is a little red, and the baby is irritable. After checking the standing orders provided by the pediatrician, what teaching would the nurse provide this mother? (Select all that apply.) A) These are common adverse effects reported after immunizations. B) Bring the baby back to the clinic for an examination. C) Apply a warm moist compress to the babys leg. D) Aspirin can be given to manage fever symptoms. E) Symptoms should subside within 2 to 3 days.

Ans: A, C, E Feedback: The symptoms reported by this mother are all common adverse effects following immunization that will subside within 2 to 3 days. In the meantime, the mother can make the baby more comfortable by administering a weight appropriate dosage of acetaminophen, applying warm compresses to the injection site, and providing a quiet environment. If the symptoms do not subside within 2 to 3 days, the baby should be seen for follow-up care. Aspirin should not be given due to risk of Reyes syndrome.

The nurse collects the past medical history of a patient new to the clinic. The patient states he or she is allergic to penicillin. What would the nurse question next? (Select all that apply.) A) What signs and symptoms were displayed with the reaction? B) What treatment was required to control the allergic reaction? C) How was the medication administered? D) How many dosages were administered before the reaction occurred? E) Had the medication ever been prescribed before the time when the reaction occurred?

Ans: A, D, E Feedback: It is important to determine what the allergic reaction was and when the patient experienced it (e.g., after first use of drug, after years of use). If she had been prescribed this medication before with no reaction and then had a reaction the next time it was prescribed, this would be important information to know. Some patients report having a drug allergy, but closer investigation indicates that their reaction actually constituted an anticipated effect or a known adverse effect to the drug. It would not necessarily be important to find out what was done to stop the reaction or who the caregiver was at the time of the reaction or what type of allergic reaction it was.

The nurse is preparing to contact the physician for an antibiotic order for the patients infection. What information will the nurse be prepared to provide for the physician to choose the proper antibiotic? A) First day of infection symptoms B) Culture and sensitivity test results C) The patients intake and output for past 2 days D) Results of complete blood count with differential

Ans: B Feedback: Antibiotics are best selected based on culture results that identify the type of organism causing the infection and sensitivity testing that shows what antibiotics are most effective in eliminating the bacteria. First day of symptoms of infection is likely already known if culture and sensitivity testing has been performed. Although measurement of intake and output is one indicator of renal function, a bloodureanitrogen test and assessment of creatinine levels would be better ways of assessing renal function, which will be used to determine dose of medication but not for selection of the correct antibiotic. The white blood cell count and differential would indicate the possibility of an infection but are not needed in choosing the proper antibiotic.

The nurse is administering an anti-infective to a pediatric patient. What will the nurse assess for related to adverse effects in this patient? A) Cardiovascular function and perfusion B) Hydration and nutritional status C) Liver and pancreatic function D) Rest and sleep status

Ans: B Feedback: Because children can have increased susceptibility to the gastrointestinal and nervous system effects of anti-infectives, monitor hydration and nutritional status carefully. Patients should be encouraged to drink fluids. Cardiovascular, hepatic, and pancreatic function are not at greater risk in children. Rest and sleep status are important but are not impacted by anti-infectives.

A male patient, aged 78 presents in the emergency department after stepping on a nail. The patient tells the nurse that he had his last tetanus shot 12 years ago and asks whether he will need another shot today. The nurse explains that tetanus boosters are required how often? A) Yearly B) Every 10 years C) Every 2 years D) Every 5 years

Ans: B Feedback: Having a tetanus booster shot every 10 years will help to protect older adults from exposure to that illness. Ask the patient about any adverse reaction to previous tetanus boosters, and weigh that risk against the possible exposure to tetanus. Options A, C, and D are incorrect information to give the patient.

When administering anti-infectives to patients, the nurse is aware of the risk for what potentially fatal adverse effect? A) Gastrointestinal toxicity B) Eighth cranial nerve damage C) Anaphylaxis D) Toxic effects on the kidney

Ans: C Feedback: Anaphylaxis is an acute, systemic allergic response to a substance that can be fatal if medical intervention does not occur almost immediately because the airway closes due to tissue edema making it impossible to breathe. Gastrointestinal toxicity, hearing loss due to eighth cranial nerve damage and, toxic effects to the kidney are all adverse effects that may be seen with some anti-infectives. Although these adverse effects can be serious, they are not usually fatal.

A 14-year-old boy is brought to the clinic by his mother. The patient has a note from his basketball coach explaining that a member of the team has been diagnosed with hepatitis A infection. The nurse notes that the patient has an extensive list of allergies. What is the nurses priority action when administering the immune globulin? A) Perform a hepatitis A antibody check. B) Monitor the patient carefully and have emergency equipment ready if needed. C) Apply ice to the injection site to slow the absorption of the serum. D) Give the patient aspirin and a corticosteroid before the injection to modulate reaction

Ans: B Feedback: If a patient has known allergies, it is important to monitor the patient carefully and have emergency equipment ready if needed after injection of proteins such as immune globulin. Severe allergic reactions, including anaphylaxis, could occur. Ice would slow absorption of the immune globulin, delaying the reaction and delivery of the immune globulin to the bloodstream where it can act on the hepatitis A virus. If a person had hepatitis A antibodies, the immune globulin would not be needed. The delay in getting that information could be problematic if the patient had been exposed to hepatitis A. Aspirin should be avoided in children due to risk of Reyes syndrome. Corticosteroids can reduce immune response and so would be contraindicated.

The nurse works in a geriatric clinic and promotes administration of influenza immunizations to patients over age 65 how frequently? A) Once at age 65 B) Yearly C) Every 5 years D) As a one-time dose

Ans: B Feedback: In addition, adults with chronic diseases are advised to be immunized yearly with an influenza vaccine, and also once with a pneumococcal pneumonia vaccine. Options A, C, and D are incorrect.

The nurse is providing patient teaching before discharging a patient home. The patient is taking ciprofloxacin (Cipro). What would the nurse teach this patient is the best way to prevent crystalluria caused by ciprofloxacin (Cipro)? A) Eliminate red meat and seafood from the diet. B) Encourage at least 2 liters of fluid per day. C) Avoid caffeine and alcohol. D) Spend time in the sun each day to optimize vitamin D levels.

Ans: B Feedback: Provide the following patient teaching: Avoid driving or operating dangerous machinery because dizziness, lethargy, and ataxia may occur; try to drink a lot of fluids and maintain nutrition (very important), even though nausea, vomiting, and diarrhea may occur. There is no need to eliminate red meat, seafood, caffeine, or alcohol from the diet, although alcohol may increase the risk of GI irritation. Patients should be taught to avoid the sun due to possible photosensitivity.

A patient comes to the clinic to talk with the nurse about planned overseas travel. The patient tells the nurse that he or she is planning a trip to an area of the world where malaria is common. He wants to know how to prevent contracting the disease. What should the nurse respond? A) We can ask the physician to give you some anti-infectives in case you get malaria. B) We can ask the physician for some anti-infectives for you to take prophylactically. C) Dont worry, if you get malaria they have some good doctors where you are going. D) If you get malaria, you can always be treated on the way home.

Ans: B Feedback: Some anti-infectives are used as a means of prophylaxis when patients expect to be in situations that will expose them to a known pathogen, such as travel to an area where malaria is endemic, or undergoing oral or invasive gastrointestinal surgery in a person who is susceptible to subacute bacterial endocarditis. After the patient contracts malaria, it is much harder to treat so he would not start the medication or obtain treatment after being infected.

What severe reaction would the nurse assess for if it were necessary to administer trimethoprim/sulfamethoxazole (TMP/SMX) to an older adult? A) Diarrhea B) Bone marrow depression C) Vomiting D) Decreased gastrointestinal (GI) motility

Ans: B Feedback: TMP/SMX is associated with an increased risk of severe adverse effects in patients with reduced liver and kidney function. Because kidney function is known to decline as a natural part of aging, older adults would be at more increased risk of severe reactions and would require more careful monitoring. Severe skin reactions and bone marrow depression are the most frequently reported severe reactions. Diarrhea and vomiting are possible adverse effects of most medications but are not examples of severe reactions, although they would require proper intervention to prevent dehydration. GI motility is more likely to increase than to decrease.

A patient calls the clinic to talk to the nurse. The patient states that he or she saw the physician last week and was prescribed penicillin for a strep throat. The patient goes on to say that they feel so much better they stopped taking the drug today, even though there are a few pills left. What is the nurses best response? A) Okay, thank you for letting me know. I will document in your medical record that the treatment was effective. B) It is important that you take all the medication so all the germs are killed. Otherwise they could come right back and be even stronger. C) What you have described is the halo effect of the drug, making you feel better when you are still infected. Youll feel sick again when the drug is out of your system. D) You will need to come to the clinic and be evaluated by your physician to make sure the infection is really gone.

Ans: B Feedback: The duration of drug use is critical to ensure that the microbes are completely, not partially, eliminated and are not given the chance to grow and develop resistant strains. The nurse must explain the importance of taking all of the prescribed medication and should not agree with the patient. This is not related to a halo effect and the patient may feel well until drug levels decrease rather than being completely eliminated from the body. The patient does not need to be seen if the infection is responding to treatment, but they must take the rest of the antibiotic.

The nurse, writing a care plan for a patient on an aminoglycoside, includes what intervention to reduce the accumulation of the drug in the kidney? A) Avoid caffeine intake. B) Increase fluids. C) Decrease activity. D) Increase consumption of fruits and vegetables.

Ans: B Feedback: To prevent the accumulation of anti-infective drugs in the kidneys, which can damage the kidney, patients taking anti-infective drugs should be well hydrated. Decreasing the dosage will likely reduce the therapeutic action and increase risk of resistance. There is no evidence of association between caffeine intake and drug accumulation in the kidney. Decreasing activity and increasing fruits and vegetables in the diet would not be effective in decreasing drug accumulation.

What is the priority nursing assessment to monitor when administering vaccinations?A. MyalgiasB. AnaphylaxisC. Symptoms of infectionD. Pain at the injection site

B. Anaphylaxis Anaphylaxis is a potential life-threatening adverse reaction to vaccines. Pain and myalgias can occur but are not life threatening.

A hospitalized patient is receiving an antiviral drug to treat cytomegalovirus. What is the nurses priority action after administering the antiviral drug? A) Monitor vital signs every hour. B) Decrease fluid intake. C) Keep side rails up. D) Encourage the patient to ambulate 10 minutes after each dose.

Ans: C Feedback: Antiviral drugs for herpes and cytomegalovirus can cause confusion, dizziness, and other central nervous system (CNS) effects. Side rails should be up after administration to protect the patient from injury until risk for these adverse effects is lowered because not every patient will experience these effects. The patient should not be encouraged to walk after each dose because of the risk of falls if adverse effects occur. Fluid intake should be slightly increased to help decrease risk of nephrotoxicity. Vital signs should be monitored, but it would not be necessary to take them every hour unless serious adverse effects occur.

A 25-year-old female patient presents at the clinic with fever, chills, and achy joints. The patient is diagnosed with influenza A, and ribavirin is prescribed. What should the nurse include in patient teaching about this medication? A) Advise women of childbearing age to remain on oral contraceptives for at least 1 month after finishing this medication. B) Advise women of childbearing age that this drug is also an abortifacient. C) Advise women of childbearing age to use barrier contraceptives. D) Advise women of childbearing age that this drug is safe for the fetus.

Ans: C Feedback: For ribavirin, advise women of childbearing age to use barrier contraceptives if they are taking this drug. The drug has been associated with serious fetal effects, but it has not been associated with spontaneous abortions. Oral contraceptives should not be stopped and barrier contraceptives should be used in addition.

A patient is told that he or she will have to undergo extensive dental surgery. The dentist prescribes a course of antibiotic therapy before beginning the procedures and continuing for 5 days after the procedure. What is this is an example of? A) Chemotherapy B) Curative treatment C) Prophylaxis D) Synergism

Ans: C Feedback: In a situation where an infection is likely to occur, antibiotics can be used to prevent it. This is called prophylaxis. Synergism is using two antibiotics at the same time to improve their effectiveness. Chemotherapy is the use of drugs to destroy abnormal cells, usually cancer cells. Curative treatment involves treating an actual infection to promote a cure.

he nurse is caring for a patient who is receiving a broad-spectrum anti-infective agents. The nurse would assess the patient for what common adverse effect of broad spectrum anti-infective agents? A) Destruction of pathogens B) Decrease in infection C) Destruction of the normal flora D) Decrease in inflammation

Ans: C Feedback: One offshoot of the use of anti-infectives, especially broad-spectrum anti-infectives, is destruction of the normal flora resulting in superinfections. Destruction of pathogens is the therapeutic effect and not an adverse effect resulting in a decrease in infection. Inflammation is reduced by resolution of infection.

A patient with a gram-negative infection is being treated with an aminoglycoside. What system should the nurse expect to monitor closely while the patient is taking this medication? A) Respiratory system B) Ophthalmic system C) Renal system D) Musculoskeletal system

Ans: C Feedback: Renal function should be tested daily because aminoglycosides depend on the kidney for excretion and if the glomerular filtration rate (GFR) is abnormal it may be toxic to the kidney. The results of the renal function testing could change the daily dosage. Aminoglycosides do not usually adversely affect respiratory, hepatic, or musculoskeletal function, although baseline data concerning these systems is always needed.

A nurse is caring for a patient with HIV. What lab tests would the nurse monitor when a protease inhibitor has been ordered for this patient? A) A fasting blood sugar and 2-hour postprandial blood sugar B) Urine specific gravity and urine pH C) Serum alanine aminotransferase and bilirubin D) Arterial blood gases and O2 saturation

Ans: C Feedback: Serum alanine aminotransferase and bilirubin are monitored when a protease inhibitor is used due to the risk of liver damage and the need to monitor liver function. Cholesterol and triglycerides may also be elevated by the drug and should be monitored. Protease inhibitors are metabolized in the liver and partially by the cytochrome P450 oxidase system. Although some cases of kidney stones have been related to protease inhibitors use, the greatest risk is to the liver and therefore urine specific gravity and urine pH, which indicate renal function, would be less critical to assess. Lab tests for blood sugar and arterial blood gases would not be directly affected by hepatic function.

The nurse is providing discharge teaching to a patient who is being sent home on oral tetracycline (Sumycin). What instructions should the nurse include? A) Take the medication only once a day. B) Check pulse rate and hold the drug if lower than 60 beats per minute (bpm). C) Take the drug on an empty stomach. D) Take the medication with 2 ounces of water.

Ans: C Feedback: Tetracycline should be taken on an empty stomach 1 hour before or 2 hours after meals with a full 8 ounces of water to ensure full absorption. Tetracycline is usually taken at least once every 12 hours. Checking the pulse and holding the dose if below 60 bpm is an action specific to the use of cardiac glycosides.

The mother of a newborn is learning about immunization schedules. The nurse tells this mother her child will ideally receive the immunization for measles, mumps, and rubella (MMR) on what schedule? A) 2 months, 4 months, between 6 and 18 months, and between 4 and 6 years B) 2 months, 4 months, 6 months, and between 12 and 15 months C) Between 12 and 15 months and between 4 and 6 years D) Between 24 months and 18 years of age

Ans: C Feedback: The recommended schedule for the MMR is the first dose between 12 and 15 months and the second dose between 4 and 6 years. The schedule for inactivated poliovirus is 2 and 4 months, between 6 and 18 months, and between 4 and 6 years. Immunization for Haemophilus influenzae is 2, 4, and 6 months and between 12 and 15 months. The schedule for hepatitis A is between 24 months and 18 years of age.

A patient comes to the clinic with a herpes outbreak. The nurse notes from the patients chart that the patient is just beginning a course of antibiotics prescribed by another physician in the clinic. What classification of antibiotic should not be taken with an antiviral medication used to treat herpes? A) Penicillin B) Beta-Lactam C) Aminoglycoside D) Macrolide

Ans: C Feedback: The risk of nephrotoxicity increases when agents indicated for the treatment of herpes and cytomegalovirus are used in combination with other nephrotoxic drugs, such as the aminoglycoside antibiotics. No contraindication exists for penicillins, beta-lactams, or macrolide antibiotics.

What is the priority reason for the nurse to consider questioning an order for tetracycline in a child younger than 8 years of age? A) Children younger than 8 years of age cannot take tetracyclines. B) Weight-bearing joints have been impaired in young animals given the drugs. C) Tetracyclines can damage developing teeth and bone in children younger than 8 years of age. D) Liver and kidney function may be damaged when it is given to children under 8 years of age.

Ans: C Feedback: Use tetracyclines with caution in children younger than 8 years of age because they can potentially damage developing bones and teeth. Although the drug does not cause damage to liver and kidneys, it may be contraindicated in patients with hepatic or renal dysfunction because it is concentrated in the bile and excreted in the urine. Fluoroquinolones, not tetracyclines, are generally contraindicated for use in children (i.e., those younger than 18 years of age) because weight-bearing joints have been impaired in young animals given the drugs. Clindamycin (Dalacin C) warrants monitoring hepatic and renal function when it is given to neonates and infants. Trimethoprimsulfamethoxazole (Nu-Cotrimox) is used in children, although children younger than 2 months of age have not been evaluated. Children under 8 years of age can take tetracycline, but it should be used with caution.

A patient newly diagnosed with HIV is receiving patient teaching from the clinic nurse about antiviral medications. What would the nurse tell the patient needs to be reported to a health care provider? A) Dizziness B) Constipation C) Vomiting D) Rash

Ans: D Feedback: All options provided have the potential to be an adverse effect of antiviral medications prescribed to treat HIV. Most can be managed through diet or over-the-counter medications but a rash needs to be reported immediately because it could indicate a potentially serious reaction and requires immediate intervention.

Overuse of anti-infective agents is known to contribute to the onset of superinfections in the body. What is a causative agent of a superinfection? A) Escherichia coli B) Probenecid C) Protozoans D) Pseudomonas

Ans: D Feedback: Common superinfections include vaginal or gastrointestinal yeast infections, which are associated with antibiotic therapy, and infections caused by Proteus and Pseudomonas throughout the body, which are a result of broad-spectrum antibiotic use. Probenicid is a medication, not a causative organism. Protozoa and E. coli do not usually cause superinfections.

The nurse has provided patient teaching for a patient who will be discharged to home on an anti-infective. What statement made by the patient indicates the nurse needs to provide additional teaching concerning the use of anti-infectives? A) Antibiotics will not help me when I have a viral infection. B) A bacterial culture will be done before antibiotics are prescribed for me. C) I could develop diarrhea as a result of taking an antibiotic. D) I will stop taking the antibiotic as soon as I feel better.

Ans: D Feedback: Compliance with anti-infective therapy is a concern. Patients tend to stop taking the drugs when they begin to feel better. A nurse should instruct the patient to take the entire course of prescribed drug to ensure a sufficient period to rid the body of pathogens and to help prevent the development of resistance. Antibiotics are not prescribed for viral infections. It is important that cultures be performed before antibiotics are prescribed to determine what organism is causing the infection so that the correct drug is prescribed. Diarrhea is the most common adverse effect from anti-infectives.

What medication would the nurse question if ordered for a pediatric patient? A) Amikacin B) Cefazolin C) Streptomycin D) Levofloxacin

Ans: D Feedback: Fluoroquinolones are contraindicated in patients who are younger than 18 years of age. Levofloxacin is the only fluoroquinolone among the answer options and is contraindicated for pediatric patients under age 18.

The nurse is describing the schedule for vaccinations to the parents of a new baby. The nurse explains the measlesmumpsrubella (MMR) vaccine is first administered at what age? A) 1 month B) 3 months C) 6 months D) 15 months

Ans: D Feedback: MMR is administered initially as a combined vaccine at 15 months. Therefore, options A, B, and C are incorrect.

A nurse is providing patient education to the mother of a child receiving a first immunization. The nurse tells the mother that after the injection, it is normal for the child to exhibit what signs and symptoms? A) Vomiting and diarrhea B) High fever and sweating C) Lethargy, drowsiness, and irritability D) Pain, redness, and swelling at site of injection

Ans: D Feedback: Normal reactions to immunizations include pain, redness, and swelling at the site of the injection. Vomiting, diarrhea, high fever, sweating, lethargy, or drowsiness would not be expected and should be reported. The child could also be slightly irritable due to the pain at the injection site

The patient in the clinic receives a prescription for an anti-infective to treat a urinary tract infection. The patient asks the nurse, Would you ask the doctor to give me refills on this prescription? I get a urinary tract infection almost once a year it seems and Id like to have a refill I can store for the next time so I dont have to come back to the clinic. What is the nurses priority response? A) Sure, Id be glad to ask. How many refills would you like to have? B) Most medications, if not used, should be discarded after a year so it is better to get a new prescription next year when you need it. C) This antibiotic doesnt destroy every pathogen that could cause a urinary tract infection so it is better to get the right antibiotic next time. D) Saving antibiotics for another time and self-diagnosing when antibiotics are needed lead to resistant organisms that no longer respond to drugs.

Ans: D Feedback: Option A is incorrect because the patient should not be given refills to use indiscriminately. The remaining options are all important teaching points for this patient, but the priority is teaching this patient about drug-resistant organisms and how they can be prevented, as well as what happens if an infection results from a resistant organism.

A patient has been prescribed ribavirin for influenza A. The patient is experiencing nausea, vomiting, and diarrhea. What would the nurse be sure to include in the patient teaching about this medication? A) Do not take with anticholinergic medications. B) Do not take with acetaminophen or aspirin. C) Do not take with antiarrhythmics. D) Do not take with antacids.

Ans: D Feedback: Ribavirin levels may be reduced if given with antacids. Patients who receive amantadine or rimantadine may experience increased atropine-like effects if either of these drugs is given with an anticholinergic drug. Patients taking rimantadine may also experience a loss of effectiveness of aspirin and acetaminophen if these are also being used. Rifampin is known to decrease the effectiveness of many drugs, including antiarrhythmics

A 22-year-old female is diagnosed with mycobacterial tuberculosis. The physician orders rifampin (Rifadin) 600 mg PO daily. What should the nurse question the patient about? A) Her diet B) Sun exposure C) Type of exercise she does D) Use of contact lenses

Ans: D Feedback: Some antimycobacterial drugs can cause discoloration of body fluids. The orange tinged discoloration can cause permanent stain to contact lenses. The patient should avoid wearing them while on the antimycobacterial therapy. With antimycobacterial drugs there is not a concern is warranted about photosensitivity or exercise. However, due to the GI adverse effects, the nurse may want to discuss an appropriate diet if the patient experiences GI upset after beginning treatment.

When conducting patient teaching about using antibiotic medications, what is it critical for the nurse to include to help stop the development of resistant strains of microorganisms? A) Antibiotics should be used quickly to treat colds and other viral infections before the invading organism has a chance to multiply. B) Antibiotic dosage should be reduced and used for shorter periods of time to reduce unnecessary exposure to the drug. C) Prescriptions for antibiotics should be readily available so they can be filled as soon as patients suspect they have an infection. D) It is very important to take the full course of an antibiotic as prescribed and not save remaining drugs for future infections.

Ans: D Feedback: Teaching patients to take the full course of their antibiotic as prescribed can help to decrease the number of drug-resistant strains. Antibiotics should only be used to treat bacterial infections that have been cultured to identify the antibiotic sensitivity and then patients should be instructed to use the antibiotic for the prescribed course, which will help to eliminate drug-resistant strains. Reducing dosage and time intervals increases the chance for drug resistance because anti-infectives are most effective when taken exactly as indicated.

A mother brings her 18-month-old son into the clinic for his diphtheria, tetanus, and pertussis vaccine. The child has a runny nose, a fever of 102.4F and is coughing. What should the nurse do? A) Administer the vaccine but monitor the child afterward for an extended time period. B) Give an antipyretic and administer vaccine when temperature is within normal range. C) Administer a reduced dose of the vaccine today and a normal dose when child is healthy. D) Hold the immunization until the child is free of allergic or cold-like symptoms.

Ans: D Feedback: The nurse should not administer the immunization if the child exhibits signs of acute infection because the vaccine can cause mild infection and can exacerbate acute infections. The child should be free of infection for several days before the immunization is given. Treating the fever, extended monitoring, or smaller doses will not overcome this risk and the only option is to hold the immunization until the child is healthy.

An intensive care unit nurse is caring for a patient taking kanamycin. What is the nurses priority action? A) Giving the drug for no longer than 7 days B) Assessing liver function daily C) Contacting the ordering physician D) Monitoring renal function daily

Ans: D Feedback: The potential for nephrotoxicity and ototoxicity with amikacin is very high, so the drug is used only as long as absolutely necessary and should not be administered for longer than 7 to 10 days because of its potentially toxic adverse effects, which include renal damage, bone marrow depression, and gastrointestinal (GI) complications. The nurse cannot stop administering the drug after 7 days if the doctor orders it to be given longer but the nurse could question the order and promote change to another antibiotic if necessary. Monitoring renal function is the priority action when this drug is administered and the provider should be notified if signs of renal failure occur. Liver function is not usually impacted by this drug, although a patient with preexisting liver alterations may require a change in dosage to prevent toxicity. There is no indication of a need to contact the health care provider.

A student asks the pharmacology instructor if there is a way to increase the benefits and decrease the risks of antibiotic therapy. What would be an appropriate response by the instructor? A) Taking drugs not prescribed for the particular illness tends to maximize risks and minimize benefits. B) Never use antibiotics in combination with other prescriptions or in combination with other antibiotics. C) Maximize antibiotic drug therapy by administering the full dose when the patient has a fever. D) Use antibiotics cautiously and teach patients to complete the full course of an antibiotic prescription.

Ans: D Feedback: To prevent or contain the growing threat of drug-resistant strains of bacteria, it is very important to use antibiotics cautiously, to complete the full course of an antibiotic prescription, and to avoid saving antibiotics for self-medication in the future. A patient and family teaching program should address these issues, as well as the proper dosing procedure for the drug (even if the patient feels better) and the importance of keeping a record of any reactions to antibiotics. Thus, taking drugs not prescribed for the particular illness tends to maximize risks and minimize benefits. Also, if the infection is viral, antibacterial drugs are ineffective and should not be used.

The nursing instructor is discussing immunity with her clinical group. What statement would the instructor make that would be accurate about immunity? A) Active immunity occurs with injected antibodies that react with specific antigens. B) Serum sickness results when the body fights antibodies injected as a form of active immunity. C) Passive immunity occurs when foreign proteins are recognized and the body produces antibodies. D) Passive immunity is limited, lasting only as long as the antibodies circulate.

Ans: D Feedback: Unlike active immunity, passive immunity is limited. It lasts only as long as the circulating antibodies last because the body does not produce its own antibodies as found in active immunity. People are born with active immunity in which the body recognizes a foreign protein and begins producing antibodies to react with specific proteins or antigens. Serum sickness is a massive immune reaction against the injected antibodies that occur with passive immunity.

The nurse is caring for a patient receiving IV aminoglycosides for an intractable infection in his or her leg. What would it be important for the nurse to monitor this patient for? A) Visual disturbances B) Liver dysfunction C) Serum glucose levels D) Renal dysfunction

Ans: D Feedback: When patients are taking aminoglycosides, it is important they be monitored closely for any sign of renal dysfunction. Aminoglycosides do not generally cause visual disturbances, liver dysfunction, or altered serum glucose levels.

The nurse is assessing a patient who has experienced severe neutropenia after chemotherapy and will monitor for which possible signs of infection? (SELECT ALL THAT APPLY)A. Elevated WBC countB. FeverC. NauseaD. Sore throatE. Chills

B. FeverD. Sore throatE. Chills

during anti tb therapy with isoniazid a patient received another prescription for pyridoxine. which statement by the nurse best explains the rationale for this second med?A. this vitamins will help to improve your energy levelsB. this vitamins helps to prevent neurologic adverse effectsC. this vitamin works to protect her heart from toxiceffectsD. this vitamins helps to reduce gastrointestinal adverse effects

B this vitamin helps to prevent neurologic adverse effects

During a blood transfusion a client develops chills and a headache, what is the priority nursing actionA) cover the client B) stop the transfusion at once C) notify the physician immediately D) decrease the rate of blood infusion

B) stop the transfusion because chills, headache, and nausea are all signs of transfusion reaction

During a routine checkup a 72 year old patient is advised to receive a influenza vaccine injection. He questions this saying "I had one last year. Why do I need another one?" What is the nurses best response?A. "The effectiveness of the vaccine wears off after 6 months."B. "Each year a new vaccine is developed based on the flu strains that are likely to be in circulation."C. "When you reach 65 years old, you need booster shots on an annual basis."D. "Taking the flu vaccine each year allows you to build your immunity to a higher level each time."

B. "Each year a new vaccine is developed based on the flu strains that are likely to be in circulation."

The current immunization for tetanus and diphtheria toxoids and pertussis, Tdap, is administered to people in which age range?A. Younger than 6 years of ageB. 11 years of age and olderC. Any age rangeD. In the first 2 years of life

B. 11 years of age and older Currently, DTaP is the preferred preparation for primary and booster immunization against these diseases in children from 6 weeks to 6 years of age unless use of the pertussis component is contraindicated. Tdap is the recommended vaccine for adolescents and adults, those over the age of 11 years.

Which vaccination is marketed and recommended in the prevention of a virus that is known to cause cervical cancer?A. Herpes zoster vaccine (Zostavax)B. Papillomavirus vaccine (Gardasil)C. Pneumococcal vaccine (Prevnar 13)D. Hepatitis B virus vaccine (Recombivax HB)

B. Papillomavirus Vaccine Human papillomavirus virus (HPV) is a common cause of genital warts and cervical cancer. The HPV vaccine (Gardasil, Cervarix) is the first and only vaccine known to prevent cancer.

when assessing a patient who will be receiving a measles vaccine, the nurse will consider which condition to be a potable contraindication?A. AnemiaB. PregnancyC. Ear infectionD. Common Cold

B. Pregnancy

The is caring for a patient who becomes severely nauseated during chemotherapy. Which intervention is most appropriate?A. Encourage light activity during chemotherapy as a distraction.B. Provide antiemetic medications 30 to 60 minutes before chemotherapy begins.C. Provide antiemetic medications only upon the request of the patient.D. Hold fluids during chemotherapy to avoid vomiting.

B. Provide antiemetic medications 30 to 60 minutes before chemotherapy begins.

What teaching would the nurse provide to a client receiving tetanus toxoid?A. "You will have lifetime immunity from this injection."B. "Soreness at the injection site is a common reaction."C. "This medication must be repeated weekly for 4 weeks."D. "Increase fluid and fiber in your diet to prevent constipation."

B. Soreness at the injection site is a common reactionSoreness at the injection site is a common adverse effect of tetanus toxoid.

An allergy to which substance is a contraindication to the administration of an immunizing drug?A. SoyB. EggC. CornD. Wheat

B.Egg Contraindications to the administration of immunizing drugs include allergy to the immunization itself or allergy to any of its components, such as eggs or yeast.

the nurse is teaching a patient who is starting antitb therapy with rifampin. which adverse effects would the nurse expect to seeA. headache and neck painB. gynecomastiaC. Reddish brown urineD. numbness or tingling of extremities

C reddish brown urine

A patient is receiving vancomycin (Vancocin). The nurse identifies what as the most common toxic effect of vancomycin therapy?A. OtotoxicityB. HepatotoxicityC. Renal toxicityD. Cardiac toxicity

C. Renal toxicityThe most common toxic effect of vancomycin (Vancocin) therapy is renal toxicity. Although ototoxicity may occur, it is rare. The liver and heart are not affected when vancomycin is used.

When giving a vaccine to an infant, the nurse will tell the mother to expect which adverse effect?A. Fever over 101FB. RashC. Soreness at the injection siteD. Chills

C. Soreness at the injection site

A 28 year old patient is in the urgent care center after stepping on a rusty tent nail. The nurse evaluates the patient's immunity status and notes that the patient thinks she had her tetanus booster about 10 years ago, just before starting college. Which immunization would be most appropriate at this time?A. Immunoglobulin IntravenousB. DTapC. TdapD. No immunizations necessary

C. Tdap

The client receives interferon alfa-2b (Intron-A) for treatment of Kaposis sarcoma. Which question by the client would alert the nurse that additional assessment is necessary? 1. I really feel sad; do I need to see a psychiatrist? 2. Is it safe to drink grapefruit juice with this medication? 3. Do I need to limit my fluids while on this medication? 4. Is it okay to use aspirin or ibuprofen products while on this medication?

Correct Answer: 1 Rationale 1: Use of immunostimulant drugs can lead to the development of encephalopathy. Assess mental status and be especially vigilant for signs and symptoms of depression and suicidal ideation. Rationale 2: There is no relationship between interferon alfa-2b (Intron-A) and grapefruit juice. Rationale 3: There is no relationship between limiting fluids and interferon alfa-2b (Intron-A). Rationale 4: There is no relationship between interferon alfa-2b (Intron-A) and aspirin or ibuprofen products.

A client is receiving amphotericin B. The nurse will reinforce teaching by telling the client that he should report which symptoms? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Feeling hot 2. Hearing loss 3. Dizziness 4. Constipation 5. Heartburn

Correct Answer: 1,2,3 Rationale 1: Many clients develop fever and chills at the beginning of therapy. Rationale 2: Amphotericin B can cause ototoxicity. Rationale 3: Vertigo can occur due to ototoxicity which may occur with amphotericin B. Rationale 4: Constipation is not associated with amphotericin B. Rationale 5: Heartburn is not associated with amphotericin B.

A new mother expresses concern about immunizing her infant saying, I am breastfeeding, so I know that will pass my immunity to my baby. I dont see why anything else is necessary. How should the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. You are correct that your baby will receive some passive immunity from you. 2. That immunity is called adapted immunity and it only lasts for a few days. 3. There are some diseases for which immunity is not passed from mother to child. 4. Your baby will need the extra protection provided by standard immunizations. 5. Vaccines are not indicated until you stop breastfeeding.

Correct Answer: 1,3,4 Rationale 1: The mother is correct that passive immunity to some diseases is provided through the placenta and through breast milk. Rationale 2: This is called passive immunity and it lasts longer than a few days. Rationale 3: The passive immunity passed from mother to child does not protect the child from all the diseases that acquired immunity does. Rationale 4: In order to be protected from many diseases the child will need acquired immunity from vaccine. Rationale 5: The vaccine schedule for a breastfed infant is the same as for an infant who is not breastfed.

A child has leukemia and is immunosuppressed due to chemotherapy. The mother frantically calls the clinic to say that her child was exposed to varicella (chicken pox). What does the best plan by the nurse include? 1. The child should come to the clinic as soon as possible to receive an injection of varicella immune globulin if he develops chicken pox. 2. The child should come to the clinic as soon as possible to receive an injection of varicella immune globulin. 3. The child should be brought to the clinic immediately to receive a vaccination for chicken pox. 4. The child should be kept away from other children to avoid further exposure to varicella.

Correct Answer: 2 Rationale 1: Immune globulin is not given after the disease develops. Rationale 2: Immune globulin must be given before the disease develops. Rationale 3: The child is immunosuppressed; administering a vaccination for chicken pox could result in developing the disease. Rationale 4: Keeping the child away from others will not help; the child has already been exposed.

A mother comes to the clinic and tells the nurse, I dont want my child to have any vaccinations. I have heard they cause autism. What is the best response by the nurse? 1. Vaccinations are safe; there is no reason to worry. 2. Vaccinations have some risks, but the benefits outweigh the risks. 3. I understand what you are saying; this is really your choice. 4. Vaccinations are required by law; you really dont have a choice.

Correct Answer: 2 Rationale 1: It is very non-therapeutic to tell a client not to worry. Rationale 2: Vaccines have some risks, but many more deaths and serious illnesses occur from the diseases than from the vaccinations. Rationale 3: Telling the client the nurse understands her is incomplete because it does not answer the clients question. Rationale 4: Telling a client she does not have a choice with vaccinations is also non-therapeutic; many states do allow a parent to decline vaccinations.

A mother brings her child to the clinic for his last diphtheria-pertussis-tetanus (DPT) immunization. The mother tells the nurse that the child developed a red rash after the previous diphtheria-pertussis-tetanus (DPT) immunization. What does the best action by the nurse include? 1. Administer only a pertussis-tetanus immunization. 2. Withhold this immunization and contact the physician. 3. Tell the mother to give the child acetaminophen (Tylenol) if another rash develops. 4. Administer diphenhydramine (Benadryl) prior to the diphtheria-pertussis-tetanus (DPT) immunization.

Correct Answer: 2 Rationale 1: There is no such immunization as pertussis-tetanus. Rationale 2: This red rash is unexpected and could indicate a potential adverse reaction to the vaccine such as anaphylaxis, so the nurse should withhold the immunization and contact the physician. Rationale 3: The nurse should not tell the mother to administer acetaminophen (Tylenol); this will not prevent anaphylaxis. Rationale 4: The nurse cannot administer diphenhydramine (Benadryl) without a physicians order.

The nurse is teaching a class on immunizations for women with newborn infants. The nurse evaluates that learning has occurred when the women make which statements? Note: Credit will be given only if all correct choices and no incorrect choices are selected Standard Text: Select all that apply. 1. The immunizations are more effective if they are given closer together. 2. Our babies might have a mild fever and be fussy for a few days. 3. If our babies develop a fever, we must call the doctor immediately. 4. We can give acetaminophen (Tylenol) if our babies have a mild fever. 5. If our babies develop a mild fever, it means an allergic reaction.

Correct Answer: 2,4 Rationale 1: The recommended immunization schedule should be followed. There is no benefit to giving the immunizations closer together. Rationale 2: A mild fever is a typical reaction to immunizations. Rationale 3: The physician does not need to be called unless the fever is high. Rationale 4: Acetaminophen (Tylenol) is indicted for relief of mild symptoms. Rationale 5: A mild fever does not indicate an allergic reaction to the immunization.

The nurse is reviewing the Centers for Disease Control recommendations for vaccines. The pneumococcal vaccine (Pneumovax 23) is recommend for which groupA. Newborn infantsB. Patients who are immunosuppressedC. Patients who are transplant candidatesD. Smokers between 19 and 64 years old

D. Smokers between the age of 19 and 64

A key part of the nursing process when caring for a client who is receiving immunosuppressant therapy should be to 1. assess nutritional status. 2. monitor vital signs. 3. assess renal function. 4. monitor liver function studies.

Correct Answer: 3 Rationale 1: Nutritional status is not a key priority for the client. Rationale 2: Vital signs are important but not the key priority. Rationale 3: Renal function is key because these drugs can cause nephrotoxicity because of physiological changes in the kidneys. Rationale 4: Liver function studies are important, but toxicity problems would occur over time.

The client receives oral nystatin (Mycostatin) suspension for an oral candidiasis infection. She tells the nurse she cannot continue to swish and swallow because her nausea is too great. What is the best response by the nurse? 1. I will ask your doctor if a pill form can be substituted. 2. Try drinking a 7-Up after you swallow the medication. 3. It is all right to swish the medication and then spit it out. 4. You can take a phenergan suppository before the nystatin (Mycostatin).

Correct Answer: 3 Rationale : If GI side effects are disturbing, the client may swish the medication and then spit it out. A phenergan suppository is not necessary. Drinking a 7-Up is not necessary. Substituting a tablet form is not necessary

The client receives amphotericin B (Fungizone) for histoplasmosis. What does the best assessment by the nurse include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Serum amylase 2. Serum sodium 3. Blood urea nitrogen 4. Serum glucose 5. Serum creatinine

Correct Answer: 3,5 Rationale 1: Amphotericin B (Fungizone) does not affect serum amylase. Rationale 2: Amphotericin B (Fungizone) does not affect serum sodium. Rationale 3: Amphotericin B (Fungizone) is nephrotoxic, so serum creatinine and blood urea nitrogen should be monitored. Rationale 4: Amphotericin B (Fungizone) does not affect serum glucose. Rationale 5: Amphotericin B (Fungizone) is nephrotoxic, so serum creatinine and blood urea nitrogen should be monitored.

A mother tells the nurse, I am so concerned about my child. He may not have adequate immunity to chicken pox. What is the best response by the nurse? 1. You dont have to worry as long as your child has received all of his vaccinations. 2. We can give your child another booster if you would like. 3. There really is no way to know if your child will develop chicken pox. 4. We can draw a titer to determine if there is adequate immunity.

Correct Answer: 4 Rationale 1: Telling the mother not to worry is non-therapeutic; she is worried. Rationale 2: Giving another booster may be unnecessary. Rationale 3: Drawing a titer will help determine if the child will develop chicken pox. Rationale 4: Drawing a titer is a valid way to determine the immune level to chicken pox.

A nurse is presenting community education regarding vaccines for influenza. Which information should the nurse plan to include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Everyone should receive an injection of influenza vaccine every year. 2. Children should not receive influenza immunizations until age 10. 3. Intranasal vaccine is available for infants. 4. Many adults have a choice between injectable and intranasal forms of immunization. 5. A childs first immunization will consist of two injections given 1 month apart.

Correct Answer: 4,5 Rationale 1: Injection is not the only form of influenza immunization. Rationale 2: Influenza immunizations are started earlier than age 10. Rationale 3: There is no intranasal vaccine for infants. Rationale 4: An intranasal influenza vaccine is available for many adults. Rationale 5: A childs first immunization consists of an injection followed by a second injection in 1 month. After this initial immunization the schedule changes to 1 immunization per year.

"Before starting a transfusion of packed red blood cells for an anemic patient, the nurse would arrange for a peer to monitor his or her other assigned patients for how many minutes when the nurse begins the transfusion?A. 5 minutesB. 15 minutesC. 60 minutesD. 30 minutes"

Correct B Patients who are likely to have a transfusion reaction will more often exhibit signs within the first 15 minutes that the blood is infusing

The nurse is preparing to administer a blood transfusion of PRBCs. The correct solution to use to flush the tubing when administering a blood transfusion is:A. 5% dextrose in water (D5W). B. Lactated Ringer's solution (LR). C. 0.9% NaCl (normal saline) solution D. Plasmalyte-A

Correct C The correct answer is normal saline. Normal saline is the only solution used to flush the tubing during a blood transfusion. The other solutions listed aren't indicated and may hemolyze the RBCs.

A 58-year-old man is receiving vancomycin as part of the treatment for a severe bone infection. After the infusion, he begins to experience some itching and flushing of the neck, face, and upper body. He reports no chills or difficulty breathing. The nurse should suspect an allergic reaction has occurred. an anaphylactic reaction is about to occur the medication will not be effective for the bone infection. the IV dose may have infused too quickly.

Correct answer: D Rationale: These symptoms are know as red man syndrome and may occur during or after an infusion of vancomycin. This syndrome is characterized by flushing or itching of the head, face, neck, and upper trunk area. Symptoms can usually be alleviated by slowing the rate of infusion to at least 1 hour. Red man syndrome is bothersome but usually not harmful. Rapid infusions may also cause hypotension.

A nurse has received a prescription to transfuse a client with a unit of packed red blood cells. Before explaining the procedure to the client, the nurse asks which initial questions?1. Have you ever had a transfusion before? 2. Why do you think that you need the transfusion? 3. Have you ever gone into shock for any reason in the past? 4. Do you know the complications and risks of a transfusion?

Correct: 1 Asking the client about personal experience with tranfusion therapy provides a good starting point for client teaching about this procedure. Options 3 & 4 are not helpful because they may elicit a fearful response from the client. Although determining whether the client knows the reason for the transfusion is important, option 2 is not an appropriate statement in terms of eliciting information from the client regarding an understanding of the need for the transfusion.

The client has a hematocrit of 22.3% and a hemoglobin of 7.7 mg/dL. The HCP hasordered two (2) units of packed red blood cells to be transfused. Which interventionsshould the nurse implement? Select all that apply1. Obtain a signed consent.2.Initiate a 22-gauge IV.3.Assess the client's lungs.4.Check for allergies.5.Hang a keep-open IV of D5W

Correct: 1, 3, 4

The nurse enters a client's room to assess the client, who began receiving a blood transfusion 45 minutes earlier, and notes that the client is flushed and dyspneic. On assessment, the nurse auscultates the presence of crackles in the lung bases. The nurse determines that this client most likely is experiencing which complication of blood transfusion therapy?1) Bacteriemia. 2) Hypovolemia. 3) Fluid overload 4) Transfusion reaction

Correct: 3 With fluid overload, the client has the presence of crackles in addition to dyspnea. An allergic reation, a type of blood transfusion reaction, would produce symptoms such as flushing, dyspnea, itching, and a generalized rash. Hypovolemia is not complication of blood transfusions. With bacteriemia, the client would have fever, a symptom not presented.

A 52-year-old woman is admitted with a new diagnosis of gastrointestinal (GI) bleed. The physician has ordered the client to receive 2 units of packed red blood cells (PRBCs) for a hemoglobin (Hgb) of 6.8g/dL. The nurse begins the infusion of the first unit at 100mL/hr. Firfteen minutes after the start of the infusion, the client complains that she is feeling chilled, is short of breath, and is experiencing lumbar pain rated 8 on a 1-10 scale. Whic of the following should be the nurse's FIRST action."1. Obtain vital signs and notify the physician of potential reaction2. Slow the infusion to 75mL/hr and reassess in 15 minutes3. Stop the infusion and run normal saline (NS) to keep the vein open (KVO)4. Administer PRN pain medication as ordered, apply oxygen at 2 L/min, and provide an additional blanket"

Correct: 3"1. ""Obtain vital signs..."" - vital sings should be obtained, and the physician notified after treatment is discontinue. The unit in quesiton should not be restarted, and any other units that were issued should not be implemented.2. ""Slow the infusion..."" - just slowing the infusino will not resolve the issue of an allergic reaction to the treatment3. ""Stop the infusion..."" - (CORRECT): The symptoms of feeling chilllded, being short of breath, and having back pain coudl indicate an acute hemolytic reaction. This medical emergency requires swift action on the part of the nurse, including immediately discontinuing the infusion, flushing the IV site, and saving the unit of blood in question for testing.4. ""Administer PRN pain medication..."" - Treating the symptoms of the reaction will not resolve the issue of an allergic reactio to the treatment"

A nurse check a unit of blood received from the blood bank and notes the presence of gas bubbles in the bag. Which should the nurse implement?A. Return the bag to the blood bank. B. Infuse the blood using the filter tubing. C. Add 10ml of NS to the bag. D. Agitate the bag to mix contents gently.

Correct: AThe nurse should return the blood to the blood bank because the gas bubbles in the bag indicate possible contamination. If the nurse were going to administer the blood, the nurse would use filter tubing to trap the particulate matter. Although normal saline can be infused concurrently with the blood, NS or any other substance should never be added to the blood in a blood bag. The blood should not be agitated this can harm the RBCs.

"The nurse is caring for a patient who is to receive a transfusion of two units of packed red blood cells. After obtaining the first unit from the blood bank, the nurse would ask which of the following health team members in the nurses' station to assist in checking the unit before adiminstration?A: Unit SecretaryB: A PhlebotomistC: A Physician's AssistantD: Another Registered Nurse

Correct: D Before hanging a transfusion, the registered nurse must check the unit with ANOTHER RN or with a licensed practical (vocational) nurse, depending on agency policy. Checking blood products is not in the unit secretary's or phlebotimist's scope of practice. The physician assistant is not another RN or licensed practical nurse.

A client prescribed azithromycin (Zithromax) expresses concern regarding GI upset that was experienced when previously prescribed an erythromycin antibiotic. What is the nurse's best response?A. "Take an over-the-counter antiemetic to lessen the nausea."B. "Stop taking the drug if you experience heartburn and diarrhea."C. "I will call the health care provider and request a different antibiotic."D. "This drug is like erythromycin with less gastrointestinal adverse effects."

D. "This drug is like erythromycin with less gastrointestinal adverse effects."

Administration of which substance provides passive immunity?A. VaccinesB. ToxoidsC. AntitoxinsD. Immunoglobulins

D. Immunoglobulins Vaccines, antitoxins, and toxoids provide active immunity by stimulating the humoral immune system. Immunoglobulins provide passive immunity by giving the patient substances to fight specific antigens.

An animal control officer was bitten by a stray dog that showed signs of rabies. Which statement by the nurse is correct regarding the treatment for rabies prophylaxis?A. "you will receive treatment if you begin to show symptoms of rabies."B. "you will receive one oral dose of medication today, and one more in 1 week."C. "you will need to receive 3 subcutaneous injections over the next week."D. "you will need to receive 5 intramuscular injections over the next 28 days."

D. You will need to receive 5 intramuscular injections over the next 28 days

during patient education regarding own oral macrolide such as erythromycin the nurse will include which information?A. If GI upsets occur the drug will have to be stoppedB. the drug needs to be taken with an antacid to avoid GI problemsC. the patient needs to take each dose with a sip of waterD. the patient may take the drug with a small snack to reduce GI irritation

D. the patient may take the drug with a small snack to reduce GI irritation

What type of vaccine is contraindicated in clients who have active malignant disease?

Live vaccines

About ten minutes after the nurse begins an infusion of packed RBCs, the patient complains of chills, chest and back pain, and nausea. His face is flushed, and he's anxious. Which is the priority nursing action?1. Administering antihistamines STAT for an allergic reaction.2. Notifying the physician of a possible transfusion reaction.3. Obtaining a urine and serum specimen to send to the lab immediately.4. Stopping hte transfusion and maintaining a patent IV catheter."

The correct answer is 4. The patietn is experiencing a transfusion reaction. The immediate nursing action is to stop the transfusion and maintain a patent IV line. The other options may be indicated but aren't the priority in this case.

A hearing test is ordered for the pt after 1 week of Vancomycin therapy. Which of the following statements best describes the reason for this test?a) Vancomycin can cause damage to the auditory nerveb) Hearing loss is a side effect of taking acetaminophenc) Everyone 60 years or older should have a hearing test.d) MRSA has been known to spread to the inner ear.

a) Vancomycin can cause damage to the auditory nerve

The nursing care plan for a client receiving epoetin alfa (Epogen, Procrit) should include careful monitoring for which symptom?a. Chest painb. Severe hypotensionc. Impaired liver functiond. Severe diarrhea

a. Chest pain Rationale: Epoetin alfa increases the risk of thromboembolic disease. The client should be monitored for early signs of stroke or heart attack

The nurse teaches the client to immediately report to the healthcare provider which adverse reaction to oprelvekin (Neumega)?a. Difficulty breathingb. Nauseac. Muscle paind. Thirst

a. Difficulty breathingRationale: Fluid retention is a common side effect of oprelvekin therapy. The client should be assessed for the symptoms of pleural effusion, which include difficulty breathing, cough, and dyspnea.

A nurse is caring for a client with chronic renal failure who is receiving epoetin alfa. Which health-promotion strategy should the nurse include in the client's plan of care?a. Encourage adequate dietary intake of iron and folic acid.b. Encourage frequent exercise or aerobic activity.c. Monitor for signs of cardiac adverse effects.d. Assess for symptoms of peripheral thrombosis.

a. Encourage adequate dietary intake of iron and folic acid.Rationale: The response to erythropoiesis-stimulating therapy may be decreased if blood levels of iron, folic acid, and vitamin B12 are deficient. Therefore, the nurse should encourage the client to maintain adequate dietary intake of iron, folic acid, and vitamin B12 (found in meats, dairy, eggs, fortified cereals and breads, leafy green vegetables, citrus fruits, dried beans, and peas). Provide dietary consult as needed and consider nutritional supplements of these nutrients if the diet is inadequate.

What are the adverse effects of tetracycline?a. rash, diarrhea, pain at injection siteb. superinfections of the flora; photosensitivity; discoloring of teethc. rash, fever, numbness in hands and feetd. nausea, vomiting, abdominal cramping

b

A client with a diagnosis of cancer is receiving epoetin alfa (Epogen, Procrit) as part of the treatment regimen. Which nursing action is most appropriate for determining the effectiveness of this drug?a. Assessing the client's energy levelb. Monitoring the hematocrit and hemoglobin levelsc. Monitoring the client's blood pressured. Assessing the client's level of consciousness

b. Monitoring the hematocrit and hemoglobin levelsRationale: This medication does not cure the primary disease condition; however, it helps reduce the anemia that dramatically affects the client's ability to function. The hematocrit and hemoglobin levels will provide a reference for evaluating the drug's effectiveness.

What is an antibacterial used for patients who cannot tolerate penicillin?a. tetracyclineb. Bactrimc. erythromycind. Cipro

c

The pt reports itching on his chest. Assessment findings include the presence of pale pink, raised bumps on the chest and neck. Based on these findings, which of the following interventions should the nurse implement first?a) Administer an IV antihistamineb) Notify the healthcare providerc) Stop the Vancomycin infusiond) Apply cool compresses to chest.

c) Stop the Vancomycin infusion

A patient receiving vancomycin by rapid infusion complains of itching. Assessment findings include the presence of red rash covered by elevated bumps on the face, neck, trunk, and arms. Vitals are temp 100.8 F (38.5 C), HR 88/min, RR 20/min, BP 80/50 mm Hg. Based on these findings, which of the following interventions should the nurse implement first?a) Apply cool compresses to chest.b) Notify the healthcare providerc) Stop the vancomycin infusiond) Administer an IV antihistamine

c) Stop the vancomycin infusion

What should the nurse anticipate as the rationale for administering filgrastim (Neupogen) to a client?a. Bone marrow transplant immunosuppressantb. Diagnosis of acute lymphoblastic leukemiac. Treatment for non-Hodgkin's lymphomad. Neutropenia secondary to chemotherapy

d. Neutropenia secondary to chemotherapyRationale: Filgrastim is a colony-stimulating factor used primarily for chronic neutropenia or neutropenia secondary to chemotherapy. Administration of filgrastim will shorten the length of time of neutropenia in patients with cancer whose bone marrow has been suppressed by antineoplastic drugs or in patients following bone marrow or stem cell transplants