P&P 1 chapters 33-38
The nurse completes a baseline assessment of a client prescribed antibiotics. For which reason should the nurse gather this information? (Select all that apply.)
-Several antibiotics are contraindicated in female clients who are or who might be pregnant. -Health history is important; many antibiotics are metabolized by the liver and excreted by the kidneys. -Certain classes of antibiotics share allergic properties; therefore, it is important to be aware of allergies. -Over-the-counter medications may interfere with the effectiveness of antibiotics. When conducting a baseline assessment before antibiotic therapy, the nurse should ask about any over-the-counter products the client is taking. Many herbal products can interfere with the effectiveness of antibiotics. Several antibiotics may cause harm to a developing fetus and should be avoided during pregnancy. Because most antibiotics are metabolized in the liver and excreted in the kidneys, any existing liver or renal disease can affect the effectiveness of the antibiotic. Several antibiotics share allergic properties (penicillins and cephalosporins). It is important to be aware of all drug allergies before administering antibiotics. Although clients may refuse drugs on the basis of cost, this is not a reason to complete a baseline assessment.
A client's nonsteroidal anti-inflammatory medication is changed from diclofenac (Cataflam, Voltaren) to celecoxib (Celebrex). Which conclusion should the nurse draw?
. Gastrointestinal (GI) irritation may decrease. The risk for GI irritation, GI bleeding, and ulcer formation is lower with celecoxib than diclofenac because celecoxib inhibits cyclooxygenase-2 (COX-2) but does not inhibit cyclooxygenase-1 (COX-1). Cardiovascular events and renal failure are potential risks of both medications. Neither medication cures RA.
A new client will be admitted in the same room as a client with a large pressure injury. Which client should the nurse identify as least appropriate to be placed in the room?
A client who is immunocompromised Enterococci are frequently found in pressure injuries in people admitted to the hospital. People who are immunocompromised are at highest risk for developing a vancomycin-resistant enterococci (VRE) infection. Someone who is immunocompromised should not be placed next to a potential source of VRE because of the risk of cross contamination. An elderly person, someone with pneumonia, or someone who is taking vancomycin are not at risk by being placed in a room with someone who is has a large pressure injury.
A client is diagnosed with giardiasis. Which symptom should the nurse associate with the infection?
Abdominal pain Giardiasis is associated with poor sanitation and is characterized by abdominal pain and malabsorption. The initial infection of a hookworm is characterized by an itchy rash at the site of penetration of the parasite. Fever and chills are associated with malaria. Skin and mouth ulceration is associated with cutaneous leishmaniasis.
A client is diagnosed with a fungal infection. Which characteristic should the nurse associate with fungi? (Select all that apply.)
Are not easily transmitted Grow slowly Progress for months Fungi are slow-growing infections that may progress for months. They are not easily transmitted through casual contact. Bacteria rapidly grow and produce toxins that overwhelm the host's defenses.
The nurse is preparing to administer amphotericin B (Fungizone) to a client with a severe systemic mycosis. Which laboratory value should the nurse validate before administering the medication?
Creatinine Before administering the medication, the client's creatinine level should be checked. Because amphotericin B is nephrotoxic, it should not be administered to a client with a creatinine level greater than 3 mg/dL. Complete blood count, amylase, and aspartate aminotransferase values are not relevant to the administration of amphotericin B.
The nurse is teaching a client who is prescribed pegIFN alfa-2b (Pegintron) about adverse effects to report to the healthcare provider. Which adverse effect should the nurse include? (Select all that apply.)
Fatigue Headache Injection site reactions Emotional lability The most frequently reported adverse effects with pegIFN alfa-2b are injection-site reactions, fatigue, headache, rigors, fever, nausea, myalgia, and emotional liability. Constipation is no a common adverse effect of this drug.
The nurse is assessing the therapeutic effects of trimethoprim-sulfamethoxazole (TMP-SMZ) 3 days after the client's initial dose. Which finding should cause the most concern?
Fever Fever may indicate hypersensitivity to the drug. Pruritus indicates a possible hypersensitivity to TMP-SMZ and is relatively common. Diarrhea is not an adverse effect associated with this medication. Nausea and vomiting are the most common adverse effects of TMP-SMZ.
The nurse is teaching a client about herbal preparations to avoid when taking ibuprofen (Advil, Motrin). Which herb should the nurse include in the discussion? (Select all that apply.)
Garlic Feverfew Ginger Herbal medications such as feverfew, ginger, garlic, and ginkgo increase the risk of bleeding when combined with ibuprofen. Saint John's wort and echinacea do not react with ibuprofen.
A client receiving cyclophosphamide (Cytoxan) for the treatment of breast cancer. Which finding should indicate that this medication is effective?
Immunosuppression Cyclophosphamide is an alkylating agent intentionally used to cause immunosuppression. Myelosuppression is not a therapeutic finding; it is an adverse effect in which the bone marrow activity is decreased. Aromatase is a classification of drug that reduces the level of estrogen in the blood. Cyclophosphamide does not increase testosterone levels.
A client is prescribed an alkylating agent. Which assessment finding should the nurse find most concerning?
Oral temperature of 101.3 degrees F (38.5degrees C) Significant myelosuppression may allow infections to occur and disseminate rapidly. An oral temperature of 101.3degrees F (38.5degrees C) should be concerning to the nurse. Rectal temperatures should be avoided due to the increased risk of trauma, bleeding, and infection. The oral route should be used, and axillary temperatures avoided because they are least accurate. Three temperatures higher than 100.5degrees F (38.1degrees C) taken over 4 hours are of concern and should be reported.
A client is experiencing a bleeding gastric ulcer. Which medication should the nurse question before administering? (Select all that apply.)
Oxaprozin (Daypro) Ibuprofen (Motrin) Diflunisal Etodolac Etodolac, diflunisal, ibuprofen, and oxaprozin are nonsteroidal anti-inflammatory drugs (NSAIDs) and will further increase the client's risk for GI ulcers. Misoprostol is a medication that may be prescribed to provide GI protection.
The nurse is reviewing the medical record of client prescribed cisplatin (Platinol). Which test should the nurse anticipate being integrated into the plan of care?
Periodic audiology testing Periodic audiology testing should be incorporated into the client's plan of care to monitor for ototoxicity when taking cyclophosphamide. Periodic eye examinations are suggested for a client who is prescribed hormones or hormone antagonists, due to the risk of ocular toxicity. An electrocardiogram is not necessary for this medication. An electroencephalogram is not necessary for this medication.
A client is prescribed fosamprenavir (Lexiva). Which additional retroviral drug should the nurse anticipate being prescribed?
Ritonavir (Norvir) Ritonavir is identified as a booster to increase the plasma concentration of the antiretroviral medication and allows for longer dosing intervals. Saquinavir, indinavir, and nelfinavir are not used as booster medication.
A client is suspected of having Lyme disease. Which type of organism should the nurse anticipate will be found in the blood specimen to confirm the diagnosis?
Spirillum Borrelia burgdorferi is a spirochete (spirillum), a spiral-shaped bacterium. It does not Gram stain and is neither gram-positive nor gram-negative. Cocci are spherical in shape and bacilli are rod-shaped.
The nurse is teaching a client with newly-diagnosed cancer about possible treatment modalities. Which should the nurse include? (Select all that apply.)
Surgery Radiation Chemotherapy Treatment modalities that are used to eradicate cancer include surgery, radiation, and chemotherapy. Palliative therapy is used to provide comfort and symptom relief in clients when a cure is not possible. Corticosteroids are used as antiemetics and to decrease inflammation related to cancer treatment.
A client is diagnosed with influenza. Which antiviral medication should the nurse prepare to administer via inhalation?
Zanamivir (Relenza) Zanamivir (Relenza) is a powdered formulation, administered by inhalation. Amantadine (Symmetrel) and oseltamivir (Tamiflu) are administered orally. Peramivir (Rapivab) is administered by a single intravenous infusion.
A client prescribed a sulfonamide antibiotic asks how the medication works. Which information about sulfonamides should the nurse provide?
"Fools" the bacteria into using them for growth, but they block it instead Sulfonamides resemble a precursor to folic acid, which is essential for bacterial growth. This "fools" the bacteria into using it for growth, but protein synthesis is blocked instead. Penicillins and cephalosporins block cell wall synthesis. Fluoroquinolones block the DNA and nucleic acid synthesis. Azoles and polyenes change the bacterial cell membrane to allow its contents to leak out.
A client is taking pyrantel (Antiminth) for enterobiasis. Which client statement should indicate an adverse reaction to the drug?
"I constantly feel like I need to have a bowel movement." An adverse reaction to pyrantel includes tenesmus or a continuous urge to have a bowel movement that is accompanied by pain. Hemoptysis, or coughing up blood, is a symptom associated with hookworms as they travel down the throat and into the lungs. Hookworms and tapeworms produce symptoms of abdominal pain. Enuresis, or uncontrollable urination, is a symptom of enterobiasis.
A client is diagnosed with severe salicylate poisoning. Which treatment prescription should the nurse expect?
N-acetylcysteine Urine alkalization is used for severe salicylate poisoning. Naloxone is the treatment for opioid overdose. Flumazenil is the treatment for benzodiazepine overdose. N-acetylcysteine is the treatment for acetaminophen overdose.
A client develops mucositis secondary to chemotherapy administration. Which intervention should the nurse include in this client's plan of care? (Select all that apply.)
Offer popsicles. Provide a bland diet. Use a soft toothbrush. Methods to alleviate pain are essential for the client with mucositis. These include offering popsicles, using a soft toothbrush, and providing a bland diet. Antiemetics alleviate nausea and vomiting. Antiseptic mouthwashes would cause further pain and are contraindicated.
Laboratory results show that a client's red blood cell (RBC) count has decreased in the 10 days after a chemotherapy treatment. Which should the nurse assess? (Select all that apply.)
Oxygen saturation Level of fatigue RBCs carry oxygen to tissues and carry away metabolic wastes. If the RBCs are decreased, the client will be fatigued and have a lower oxygen saturation. The oral cavity is assessed in the client with stomatitis. The body temperature will increase if the client has an infection or sepsis. Nausea and vomiting are gastrointestinal adverse effects from chemotherapy.
A client receiving chemotherapy reports severe nausea and vomiting. Which medication should the nurse administer to alleviate this complication?
Prochlorperazine (Compazine) Prochlorperazine (Compazine), ondansetron (Zofran), and lorazepam (Ativan) are common antiemetics that are used for nausea and vomiting related to chemotherapy drugs. Sodium bicarbonate is an antidote for carmustine (Gliadel) extravasation. Filgrastim is used to treat neutropenia. Dexrazoxane is used with cardiotoxic chemotherapeutic medications to prevent heart damage.
A client asks why hormones are prescribed to treat prostate cancer. Which response should the nurse make?
"Your tumor is hormone sensitive." Endocrine, or hormonal, therapy is limited to treating hormone-sensitive tumors of the breast or prostate. In general, the hormone and hormone antagonists act by blocking the substances essential for tumor growth. The hormones do not increase the activity of the immune system; they have an antitumor activity effect. It is unknown whether the hormones directly target and kill the cancer cells or interfere with the replication of the cancer cells.
A client is prescribed mebendazole (Vermox) for ascariasis. Which client statement should indicate that teaching about the medication was effective?
"I will take this medication for the next 3 days." Pharmacotherapy for ascariasis is generally successful in eliminating the helminth from the body, without causing significant adverse effects. Oral mebendazole for 3 days is the standard treatment. It is unnecessary to treat all family members. The client does not need to continue taking the medication until testing negative; stools are rechecked 2 weeks after therapy is completed to confirm elimination of the roundworms. The medication is taken as prescribed and not until symptoms are gone.
A client is receiving interferon therapy. Which client statement should cause the nurse concern? (Select all that apply.)
"I've been feeling too sad to get out of bad." "I've been experiencing hallucinations." "Sometimes I feel like I should just end my life." Adverse effects to the neurologic system and mental status can occur in clients receiving interferon therapy. Psychoses, depression, and suicidal ideations are signs of adverse effects. Headaches, nausea, and diarrhea are not typical adverse effects in interferon therapy.
The nurse is teaching about nonsteroidal anti-inflammatory drugs (NSAIDs). Which statement should the nurse include?
"Most NSAIDs exhibit the same inhibitory actions." Most NSAIDs exhibit the same inhibitory actions, meaning they perform the same action in the body (inhibiting prostaglandins) whether the inflammation is caused by an injury, autoimmune disease, or allergy. Since NSAIDs perform the same action, they do not work differently in the body. NSAIDs, except for first-generation salicylates, increase cardiovascular risk. Corticosteroids are most effective at treating severe, disabling, painful inflammation.
The nurse has administered a vaccine to a client. Which outcome should the nurse use to evaluate if the vaccine successfully produced immunity?
A positive titer A titer measures the amount of antibodies produced in response to a vaccine. A positive titer verifies the effectiveness of the vaccine and indicates that immunity has been achieved. A normal WBC and normal temperature indicate that the client is free from infection. An elevated platelet count indicates the presence of thrombocytosis.
The nurse is discussing why mycobacteria are difficult to destroy. Which statement should the nurse include?
A waxy coating covers the mycobacterium, protecting it from disinfectants. Mycolic acid, a waxy coating that covers the surface of mycobacterium, makes it resistant to many disinfectants, including chlorinated water. Mycobacteria are not hydrophobic or constantly mutating. Although they do invade the macrophage to survive, the bacteria do not destroy macrophages.
A client is prescribed aspirin (acetylsalicylic acid). Which factor should the nurse recognize increases the risk of gastrointestinal (GI) bleeding with this medication? (Select all that apply.)
Alcohol use Smoking Helicobacter pylori infection Smoking, alcohol use, and Helicobacter pylori infection increase the risk for aspirin-induced GI bleeding. Age greater than 60, not 40, is a risk factor. The risk for GI bleeding is not increased when acetaminophen (Tylenol) is taken with aspirin (acetylsalicylic acid), because acetaminophen does not affect platelets.
A client taking antiviral medication is expressing suicidal ideations. Which antiviral medication should the nurse expect the client to be taking?
Amantadine (Symmetrel) Amantadine (Symmetrel) has an adverse effect of suicidal ideations, especially in those with previous central nervous system disorders. Psychiatric disorders have not been demonstrated with docosanol (Abreva), tenofovir (Vemlidy), or acyclovir (Zovirax).
A client asks what can cause cancer cells to spread to other areas of the body. Which should the nurse identify?
Angiogenesis is the formation of new blood vessels, allowing cancer cells a way to spread. Solid tumors need a way of obtaining oxygen and nutrients to grow. Cancer cells have the ability to form new blood vessels that not only provide nutrition but also allow cancer cells to escape and metastasize to other areas of the body. Chemotherapy drugs do not cause metastasis by rupturing tumors. Carcinogens do cause cancer but do not lead to metastasis. Secondary cancer prevention practices screen for cancers and do not lead to metastasis.
A client is receiving cyclosporine therapy. Which instruction should the nurse provide this client to prevent toxicity?
Avoid grapefruit and grapefruit juice Mixing grapefruit with cyclosporine can cause a significant increase in the drug levels and could result in toxicity. Clients can mix their medication with milk if desired. Returning for follow-up laboratory visits is important for neutropenia and leukopenia monitoring but not for toxicity. Taking the medication at the same time each day will not prevent toxicity.
The nurse is preparing a client for surgery. Which antibiotic should the nurse expect to administer preoperatively?
Cefazolin Cefazolin is a first-generation cephalosporin used for prophylactic treatment of bacterial infections. It is the most often administered parenteral antibiotic and is used for infection prophylaxis in clients having surgery. Ampicillin and penicillin G are two drugs in the penicillin class; many bacteria have developed resistance against these antibiotics. Vancomycin is a miscellaneous cell wall inhibitor and is considered the antibiotic of last resort.
A client is prescribed antiviral medication. Which information should the nurse provide to explain how antiviral drugs inhibit viral infection?
Change the shape of proteins that can prevent attachment to host Antiviral drugs target a specific structure of the virus or a part of the replication cycle. Some antiviral drugs inhibit specific viral enzymes or change the shape of proteins that can prevent attachment to the host cell. The drug cannot kill all of the infected cells without killing the host.
A client is receiving amphotericin B (Fungizone) for cryptococcosis. Which should the nurse monitor to assess for infusion-related symptoms? (Select all that apply.)
Chills Headache Vomiting With acute administration of amphotericin B, infusion-related signs and symptoms, such as fever, chills, vomiting, anorexia, and headache, can develop. Symptoms and signs usually stop as therapy progresses. Tremors and rash are not infusion-related signs.
A client is taking isoniazid for tuberculosis. Which food should the nurse advise the client to avoid, reducing adverse effects? (Select all that apply.)
Chocolate Aged cheese Bananas The client should avoid foods containing tyramine, such as bananas, chocolate, aged cheese, red wine, and smoked and pickled fish, because of the possibility of adverse effects of palpitations, flushing, and hypertension. Avocados are not high in tyramine. Red wine should be avoided.
A client who is hospitalized for pneumonia develops severe diarrhea. Which organism should the nurse suspect as causing the diarrhea?
Clostridium difficile C. difficile is a common healthcare-acquired infection of the colon that causes severe diarrhea. Symptoms of VRE, CRE, and MRSA depend on the location of the infection, but they rarely affect the colon and cause diarrhea.
A client is receiving methotrexate (MTX, Rheumatrex, Trexall). Which assessment finding should the nurse find most concerning?
Diarrhea Methotrexate is an antimetabolite that is primarily used in combination therapy to maintain induced remission in those individuals who have had a surgical resection or amputation for a primary tumor. Diarrhea and ulcerative stomatitis require the suspension of the therapy because it may lead to hemorrhagic enteritis and death from intestinal perforation. A headache is an adverse effect of the drug but is not the most concerning assessment finding. Weight loss may occur due to the nausea and vomiting associated with the treatment and should be monitored but is not the most concerning finding. Immunosuppression is expected with the use of an antineoplastic drug.
An older client is prescribed a high dose of erythromycin (Erythrocin). For which adverse effect should the nurse closely monitor this client? (Select all that apply.)
Dizziness Vertigo Hearing loss Older clients, especially those with impaired hepatic or renal excretion, are prone to experience hearing loss, vertigo, and dizziness when using high doses of erythromycin. Nausea and vomiting are not adverse effects specifically seen in older clients.
The nurse is discussing recombinant technology vaccines. Which information should the nurse include?
Do not contain viral DNA so they cannot cause infection Recombinant technology produces vaccines that contain viral subunits or proteins created in a laboratory. The vaccines do not contain viral DNA, so the viruses cannot replicate or become infectious. Inactivated (killed) vaccines contain organisms killed by heat or chemicals. Attenuated (live) vaccines are created with organisms rendered less likely to cause disease. Toxoid vaccines are developed from bacterial toxins, not the bacteria itself.
A client is diagnosed with a solid tumor of the bone. Which medication should the nurse anticipate being prescribed for this client?
Doxorubicin (Adriamycin) Doxorubicin is a cytotoxic antibiotic that has a wide spectrum of antitumor activity and is considered one of the most effective drugs against a solid tumor. Cladribine is a purine analog that is used to treat leukemia. Anastrozole is an aromatase inhibitor that is used to treat hormone-sensitive tumors. Procarbazine is an alkylating agent that is used to treat Hodgkin's disease.
A client is taking isoniazid for tuberculosis. For which sign of neurotoxicity should the nurse monitor? (Select all that apply.)
Drowsiness Dizziness Headache Signs of neurotoxicity include dizziness, drowsiness, headache, changes in visual acuity, blurred vision, loss of color sense, or paresthesia of the hands and feet. Photosensitivity and hypersensitivity in the extremities are not adverse effects or typical signs of neurotoxicity with the use of antimycobacterial drugs.
The nurse is teaching about the cell kill hypothesis with chemotherapy. Which should the nurse identify as a goal of this concept?
Eliminate most of the cancer with each treatment, leaving the immune system to remove any leftover cancer cells. Chemotherapy cell kill hypothesis is aimed to eradicate most of the cancer cells with each treatment. After several treatments, the goal is to have the client's immune system eliminate the few remaining cancer cells. Biological therapy enhances the immune system to eradicate cancerous cells. Adjuvant chemotherapy is designed to remove any remaining cancer cells after surgery. Cancer treatment with chemotherapy is not designed to remove all the cancerous cells with one treatment.
A client with an infection is prescribed penicillin G. For which reason should the nurse realize this is an appropriate medication choice? (Select all that apply.)
Few adverse effects Preferred treatment of organisms shown to be susceptible by culture and sensitivity Inexpensive Penicillin G is the preferred drug for treatment of infections shown to be susceptible by culture and sensitivity testing. It is inexpensive and has few adverse effects. However, penicillin G has a narrow spectrum of activity, targeting most gram-positive bacteria. Cephalosporins have a more stable structure of the beta-lactam ring, which makes them a bit more resistant to enzyme destruction.
A client is being treated with vincristine (Marqibo, Oncovin). Which adverse effect should the nurse find most concerning?
Hoarseness Hoarseness can be an indication of cranial nerve palsy associated with neurotoxicity. The dose-limiting toxicity of vincristine is neurotoxicity. Abdominal distention may be a result of severe constipation, which may occur in a client taking vincristine, but is not the most concerning adverse effect. Gastrointestinal-related adverse effects include vomiting and stomatitis, but these are not the most concerning.
The nurse notes a client is prescribed the hepatitis B (HBV) vaccine (Recombivax HB). For which health problem should the nurse realize this vaccination is indicated? (Select all that apply.)
Injectable drug use End-stage renal disease Healthcare employment High-risk sexual practices HBV is transmitted through blood and body fluid exposure. Clients who are healthcare workers, inject drugs, engage in high-risk sexual practices, or have end-stage renal diseases are at risk for blood exposure and contracting the virus. Gallbladder disease is not a risk factor for contracting HBV.
A client asks about ways to prevent cancer. Which should the nurse provide about primary cancer prevention? (Select all that apply.)
Maintain a healthy diet. Stop using tobacco. Receive the human papillomavirus (HPV) vaccination. Avoid prolonged sun exposure. Primary cancer prevention includes interventions that keep cancer from developing. These include stopping the use of all tobacco products, maintaining a healthy diet, receiving the HPV vaccination, and avoiding prolonged sun exposure. Obtaining cancer-screening tests is secondary cancer prevention.
A client is taking aldesleukin (Proleukin). Which action should the nurse expect to occur?
Promotes proliferation of B and T cells, macrophages, and natural killer (NK) cells Interleukins such as aldesleukin initiate activation of interferons, tumor necrosis factor, and other interleukins to promote proliferation of B cells and T cells, macrophages, and NK cells. Interferons inhibit viral replication and increase phagocytic activity. Cyclosporines inhibit DNA synthesis, which causes DNA destruction and breakage of chromosomes.
The nurse is reviewing classes of antiretroviral drugs. Which drug class should the nurse identify? (Select all that apply.)
Protease inhibitors Integrase strand transfer inhibitors Entry inhibitors Nonnucleoside reverse transcriptase inhibitors (NNRTIs) Antiretroviral drugs fall into five classes: nucleoside and nucleotide reverse transcriptase inhibitors, NNRTIs, protease inhibitors, entry inhibitors, and integrase strand transfer inhibitors. T4 inhibitors are not a class of antiretroviral drugs.
A client is receiving cyclophosphamide (Cytoxan). Which intervention should the nurse include to prevent urinary complications? (Select all that apply.)
Provide intravenous and oral fluids Perform urine dipstick for red blood cells Monitor intake and output Cyclophosphamide is a chemotherapy drug that can cause urinary damage. Because of this, intake and output should be assessed to ensure renal function, intravenous and oral fluids should be provided to maintain hydration, and urine should be assessed for hemorrhagic cystitis. Dexrazoxane (Zinecard) is used to prevent cardiac toxicity with certain chemotherapy drugs. Numbness and tingling in the extremities are neurological complications.
A client is taking antiretroviral medications. Which laboratory test should the nurse anticipate monitoring? (Select all that apply.)
Serum amylase HIV viral load CD4 counts The client's hepatic and renal function, complete blood count, CD4 counts, HIV viral load, lipid levels, serum amylase, and blood glucose should be monitored while taking antiretroviral medications. Thyroid uptake and electrolyte panel are not necessary to monitor when a client is prescribed antiretroviral medications.
The nurse is preparing a lecture on immunity for high school students. Which organ should the nurse describe as being part of the lymphatic system? (Select all that apply.)
Spleen Tonsils Thymus The tonsils, spleen, and thymus are the main organs in the lymphatic system. The jugular vein and abdominal aorta are structures within the arterial system.
A client taking zidovudine (AZT, Retrovir) uses nutritional supplements. Which supplement should cause the nurse the most concern?
St. John's wort St. John's wort should be used with caution with zidovudine. The supplement may cause a decrease in antiretroviral activity. Multivitamins or vitamins C or D3 are not contraindicated with zidovudine.
A client is diagnosed with histoplasmosis. Which factor should the nurse identify with this infection? (Select all that apply.)
Starts in the lungs Occurs in clients with healthy immune systems Is community acquired Histoplasmosis is a community-acquired fungal infection. It usually starts in the lungs of a client with a healthy immune system. Fungal infections acquired in the hospital are opportunistic and occur in the immunocompromised client.
A female client taking a broad-spectrum antibiotic for a urinary tract infection reports vaginal itching and discharge. Which health problem should the nurse suspect?
Superinfection of the vagina A superinfection develops while a client is taking an antibiotic for a different infection. Vaginal Clostridium albicans infections are common superinfections. The client's symptoms do not indicate an allergy or adverse effect. The new infection does not indicate that the client is having an initial drug-resistant infection.
A client with malaria is prescribed chloroquine (Aralen). Which should the nurse use to describe the primary purpose of this medication?
Treatment for the acute stage of the disease Chloroquine is the preferred drug for the treatment of the acute stage of malaria. High doses of other parenteral antimalarial drugs are used to treat complicated malaria. Drugs used to treat malaria eliminate the merozoites, not sporozoites, from the red blood cells. Primaquine is used to eliminate hepatic cysts and is initiated near the conclusion of the acute therapy.
A client works in a textile plant with exposure to industrial chemicals. Which should the nurse include as part of a focused assessment?
Urine color and clarity Because inhalation and exposure to industrial chemicals can predispose a person to bladder cancer, urine color and clarity should be assessed. Lung sounds would be assessed if the client has risk for lung cancer or lung disease. Signs of fluid overload are assessed for heart, liver, or kidney disease. Peripheral pulses should be assessed for peripheral vascular disease.
The nurse is teaching about adverse effects that are common to most chemotherapy medications. Which adverse effect should the nurse include? (Select all that apply.)
Vomiting Nausea Stomatitis Fatigue Chemotherapy kills all rapidly dividing cells, including red blood cells and those in the gastrointestinal tract. This leads to fatigue, nausea, vomiting, and stomatitis. Pneumonitis is not a common adverse effect.
A client is prescribed doxorubicin (Adriamycin). Which client statement should indicate that teaching about this medication was effective?
"I should report if my heart feels like it is beating faster." Doxorubicin can cause cardiac adverse effects which can be life-threatening and include sinus tachycardia. Nonsteroidal anti-inflammatory drugs such as Advil should be avoided because they place the client at risk for bleeding. Doxorubicin causes temporary decreased fertility that may not result in permanent infertility. Pain is an abnormal finding during the administration of the drug. The drug is given intravenously and can cause major damage to the skin, subcutaneous tissues, and nerves if extravasation occurs.
A client prescribed dexrazoxane (Zinecard) before doxorubicin (Adriamycin) asks why two medications are needed. Which explanation should the nurse provide to the client?
"The first drug will protect your heart from the side effects of the antitumor treatment." Dexrazoxane is a cardioprotective drug that is used to treat and help prevent doxorubicin cardiotoxicity. Started by slow intravenous infusion 30 minutes before doxorubicin, dexrazoxane reduces the incidence and severity of cardiomyopathy from the antitumor antibiotic doxorubicin. Dexrazoxane is not intended to enhance the effect of the antitumor antibiotic. Dexrazoxane does not protect the client's immune system, but helps prevent cardiotoxicity. Dexrazoxane does not prevent myelosuppression in the client.
A client is prescribed cyclophosphamide (Cytoxan). Which statement should the nurse include when teaching about this medication?
"This drug may result in sterility." Cyclophosphamide may result in sterility. Hematuria, blood in the urine, is not a common finding and may indicate that the client has hemorrhagic cystitis, which can be severe and even fatal. Alopecia occurs more frequently with clients taking cyclophosphamide. The goal of treatment is not to stop the production of white blood cells, but to slow down or eradicate the synthesis of cancer cells.
The nurse is reviewing viruses. Which organism should the nurse understand a virus can infect? (Select all that apply.)
Animals Plants Bacteria Viruses are intracellular parasites that infect bacteria, plants, and animals by entering a host cell and using it to replicate. Viruses do not have the organelles necessary for self-survival. Fungi feed on organic matter and are not host to viruses. Extracellular parasites live outside of cells.
A client is taking tetracycline (Sumycin). At which time should the nurse expect the onset of action to occur?
1 to 2 hours The onset of action for tetracycline (Sumycin) is 1 to 2 hours. It may take longer for the client to feel improvement of the condition being treated.
A client is taking antiviral medication. Which finding should the nurse recognize as a therapeutic benefit? (Select all that apply.)
Adequate fluid intake Diminishing signs of infection Normal appetite Evidence of medication effectiveness includes diminishing signs of the original infection, exhibiting normal appetite, and taking in adequate fluid. Drowsiness and decreasing energy level may be signs of adverse effects from the medication.
A client takes acetaminophen (Tylenol) for arthritic pain. Which laboratory value should the nurse monitor for this client? (Select all that apply.)
Alanine aminotransferase (ALT) Hematocrit Aspartate aminotransferase (AST) Hemoglobin Ibuprofen may increase bleeding time as well as aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels. It may decrease hemoglobin and hematocrit. C-reactive protein measures the amount of inflammation. It is not affected by acetaminophen use.
A client taking tinidazole (Tindamax) for giardiasis is demonstrating signs of psychosis. Which should the nurse identify as contributing to the client's clinical condition?
Alcohol use Tinidazole and alcohol produce a disulfiram-like reaction that can result in psychosis. Giardiasis is an infection in the intestine and is not associated with sepsis. The psychosis is not related to drug toxicity. Adverse effects are mild and include a bitter or metallic taste and gastrointestinal distress.
The nurse is discussing the pathophysiology of inflammation. Which information should the nurse include?
Antigen exposure causes permeability of vessels and allows phagocytic cells to reach the antigen. When the body is exposed to a foreign substance (antigen), nearby blood vessels become permeable to allow phagocytic cells to reach and neutralize the antigen. The increased permeability of blood vessels causes increased tissue edema. There is a correlation between the amount of tissue damage from the antigen and the amount of inflammation: the greater the tissue damage, the greater the degree of inflammation. Massive release of chemical mediators throughout the entire body occurs with anaphylaxis, a life-threatening allergic response that can cause cardiovascular shock and death.
The nurse is discussing the structure of a virus. Which substance should the nurse identify that helps a virus attach to the cell membrane?
Capsid The virus is surrounded by a protein coat called the capsid. Structural proteins (RNA and DNA) or glycoproteins are arranged in repeating subunits, helping the virus attach to the cell membrane of the host.
The nurse manager is creating a plan to limit hospital-acquired infections (HAIs). For which source of HAIs should the nurse consider possible interventions? (Select all that apply.)
Client flora Invasive devices Medical personnel Medical environment General sources of HAIs, including client flora, invasive devices, medical personnel, and the medical environment. The client's personal belongings are not a potential source of HAIs.
A client is prescribed a new antibiotic. Which information should the nurse provide to reduce the risk for antibiotic resistance?
Continue taking the entire prescription even if symptoms disappear. A client taking an antibiotic should be advised to take the entire prescription, and not just until feeling better. The client should not renew the prescription for future use because of the risk of using it unnecessarily or inappropriately. Proper hand hygiene is essential but is not relevant to reducing the risk for antibiotic resistance.
A client has an elevated interleukin level. Which type of chemical mediator should the nurse recognize is elevated?
Cytokine Interleukins are an example of cytokines, which are chemical mediators produced by macrophages, leukocytes, and dendritic cells in order to regulate immune and inflammatory reactions. Leukotrienes, prostaglandins, and C-reactive proteins are other chemical mediators of inflammation but do not include interleukins.
A client is prescribed high doses of acyclovir (Zovirax). For which infection should the nurse recognize this dose is required?
Cytomegalovirus Acyclovir (Zovirax) is a preferred drug for all of the conditions, but only effective at high doses for cytomegalovirus. Acyclovir is not identified as treatment for herpes zoster. Herpes simplex 1 and 2 can be treated effectively with the traditional dosing of acyclovir.
A client's medication is switched from celecoxib (Celebrex) to ibuprofen (Advil, Motrin). Which change should the nurse expect? (Select all that apply.)
Increased platelet aggregation New onset gastrointestinal (GI) irritation Ibuprofen is a cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) inhibitor, but celecoxib only blocks COX-2. Unlike celecoxib (Celebrex), ibuprofen (Advil, Motrin) can cause platelet aggregation and GI irritation. Since both medications have analgesic, anti-inflammatory, and antipyretic effects, no change would be expected with respect to those outcomes.
A client is prescribed aspirin (acetylsalicylic acid). Which therapeutic response should the nurse anticipate?
Decrease in body temperature A therapeutic response of aspirin is a lower body temperature. Aspirin does not decrease bacterial growth rate. Aspirin is indicated for the relief of mild to moderate inflammation, and it may increase the effect of anticoagulants.
A client is prescribed acetaminophen (Tylenol). For which therapeutic response should the nurse monitor?
Decrease in moderate pain Acetaminophen will decrease moderate pain. Acetaminophen does not decrease inflammation. Since acetaminophen is an antipyretic, the medication decreases body temperature. Acetaminophen does not affect platelet aggregation.
A client with tuberculosis develops a rash, fever, and numbness in the hands and feet. Which finding should indicate that the client's symptoms are caused by isoniazid? (Select all that apply.)
Dizziness Optic neuritis Hallucinations Memory loss Although there are few adverse effects of isoniazid, dizziness, memory loss, optic neuritis, and other psychoses may be seen. Dysrhythmia is not a typical adverse effect of isoniazid.
A client is experiencing inflammation. Which statement should the nurse include when teaching the client about this health problem?
Inflammation is a natural process for ridding the body of antigens. Inflammation is a self-limiting, natural process for ridding the body of antigens. Inflammation is a symptom of an underlying disorder; it is not a disease. When applicable, topical medications should be used instead of oral medications because they have fewer adverse effects. Ice packs and rest are nonpharmacologic, useful treatments for inflammation.
The parent of an infant asks how many doses are recommended in the initial series of the diphtheria, tetanus, and pertussis (DTaP) vaccines. Which response should the nurse provide?
Five Five doses during the first 6 years of a child's life are recommended as part of the initial series of the DTaP vaccine. The measles, mumps, rubella, hepatitis A, human papillomavirus, and varicella vaccines are given in two doses. The hepatitis B vaccination is given in three doses.
The nurse is reviewing the report of a client's lymphatic tissue biopsies. In which body system should the nurse expect to see large concentrations of lymphoid tissue? (Select all that apply.)
Gastrointestinal Genitourinary Respiratory Large collections of lymphoid tissue are found in the gastrointestinal, genitourinary, and respiratory systems, which are portals of entry to the body. Lymphocytes patrol these regions to look for possible foreign pathogens or material. The cardiovascular and musculoskeletal systems do not contain large amounts of this type of tissue.
A client asks about the uses of ciprofloxacin (Cipro). Which should the nurse list in response? (Select all that apply.)
Gastrointestinal infection Sinus infection Urinary tract infection Fluoroquinolones are used effectively in the treatment of uncomplicated urinary tract infections, sinus and other respiratory infections, and gastrointestinal infections. Varicella and influenza are viral infections, and fluoroquinolones are not effective in treating these infections.
A client is prescribed aspirin (acetylsalicylic acid) for fever control. Which client risk factor should the nurse address before administering the medication?
Gastrointestinal (GI) bleeding A potential adverse effect of aspirin is GI bleeding, and this risk increases with higher doses. The risk versus benefit of the medication should be considered. Aspirin is often used as prophylaxis for clients at risk for stroke, MI, and arterial thromboembolism.
The nurse is reviewing a pathology report and notes that the bacterium is spiral shaped and violet after Gram staining. Which type of bacteria should the nurse note in the documentation?
Gram-positive spirilla Bacteria that retain the Gram stain will stay violet after staining and are considered gram-positive. Bacteria that do not retain the Gram stain will not stay violet and are considered gram-negative. Spiral-shaped bacteria are known as spirilla. Cocci are round or spherical.
The nurse is starting a first nursing job. Which vaccine should the nurse expect to receive?
Hepatitis B The hepatitis B virus (HBV) is transmitted via blood and body fluids. Healthcare workers have a 10-fold increased risk of HBV. The HBV vaccine is therefore recommended for all healthcare workers. The meningococcal vaccine is recommended for children age 11 and 12 with a booster at age 16. The pneumococcal disease vaccine is recommended for people over the age of 65. The HPV vaccine is recommended for teens age 14 to 19.
An older client is taking antiretroviral medications. For which age-related adverse effect should the nurse monitor? (Select all that apply.)
Hepatotoxicity Nephrotoxicity Although all clients are at risk for neurotoxicity, blood dyscrasias, and dermatologic effects when taking antiviral medications, older adult clients are more at risk for hepatotoxicity and nephrotoxicity than other age groups due to age-related changes in the body.
A client with tuberculosis (TB) will be receiving combination therapy. For which reason should the nurse expect isoniazid to be prescribed?
Inhibits the synthesis of mycolic acid Isoniazid acts by inhibiting the synthesis of mycolic acid, the waxy coating that protects mycobacteria. Because mycolic acids are unique to mycobacteria, isoniazid has no activity for other microbial species. Ethambutol has a bacteriostatic effect and is effective against atypical mycobacteria. Dapsone inhibits folic acid metabolism.
A client with HIV infection also has cardiac disease. Which entry inhibitor should be used with caution in this client?
Maraviroc (Selzentry) Maraviroc must be used with caution in clients with cardiac disease because the medication may increase the risk of myocardial ischemia or infarction. There is no reason to be cautious when providing enfuvirtide, saquinavir, and raltegravir to clients with cardiac disease.
The nurse is teaching about the pathogenesis of HIV. Which mode of transmission should the nurse include? (Select all that apply.)
Needlesticks Sexual activity Mother to newborn HIV is transmitted through blood or other contaminated body fluids such as semen. Transmission can occur through sexual activity, needlesticks, from a mother to a newborn, or infected fluids through broken skin. HIV cannot be contracted by using the same bathroom or sharing dishes with the client.
A client prescribed a sulfonamide antibiotic has a glucose-6-phosphate dehydrogenase deficiency. Which action should the nurse take first?
Notify the healthcare provider because of the risk of erythrocyte rupture. Clients with a glucose-6-phosphate dehydrogenase deficiency should not take sulfonamides because of the risk of erythrocyte rupture. The nurse should immediately notify the provider and withhold the medication. Excessive bleeding is not a risk of administering sulfonamide antibiotics to someone with glucose-6-phosphate dehydrogenase deficiency. It is not appropriate for the nurse to administer a full or decreased dose of the medication.
The nurse notes gram-negative cocci in a cervical culture of a client suspected of having pelvic inflammatory disease. Which bacteria should the nurse suspect as causing the infection?
Neisseria gonorrhoeae Neisseria gonorrhoeae are gram-negative cocci that can cause gonorrhea or pelvic inflammatory disease. Haemophilus influenza is a gram-negative bacillus that can cause pneumonia, meningitis in children, otitis media, and sinusitis. Pseudomonas aeruginosa is also a gram-negative bacillus that can cause urinary tract infections, skin infections, and septicemia. Mycobacterium tuberculosis is another type of organism that causes tuberculosis.
A preschool age client is experiencing a high fever. Which type of immune response should the nurse recognize is characterized by fever?
Nonspecific defenses Fever, complement, phagocytes, and inflammation are all examples of process barriers in the nonspecific immune system. Inflammation is also a type of nonspecific immune response, but fever is not associated with inflammation. Humoral immunity is mediated by antibodies/immunoglobulins. Cell-mediated immunity contains the T cell line.
A client is prescribed an immunosuppressant. Which instruction should the nurse provide this client to reduce the risk of developing an opportunistic infection? (Select all that apply.)
Practice proper oral hygiene Wash hands frequently Avoid large crowds, especially indoors Avoid people with a known infection Clients who are taking immunosuppressants are at a higher risk of acquiring opportunistic infections. Actions to reduce the risk of an infection include frequent hand washing, practicing proper oral hygiene, avoiding others with a known infection, and avoiding large crowds indoors. Taking the medication at the same time will not reduce the risk of developing an infection.
The nurse is teaching a newly-diagnosed client about HIV. Which goal of treatment should the nurse include? (Select all that apply.)
Prevent transmission Improve immune function Suppress HIV viral load Prolong survival The goals of pharmacologic treatment of HIV are to reduce HIV-related morbidity and prolong survival, improve quality of life, restore and preserve immune function, suppress the HIV viral load, and prevent HIV transmission.
The nurse is discussing the development of an HIV vaccine. Which challenge to the development of this vaccine should the nurse identify? (Select all that apply.)
Rapid replication rate of virus Need to reach inside latent T cells Determining the most effective type Design to prevent virus from entering cells There are currently no vaccines for HIV. Issues for creating an HIV vaccine include the rapid replication rate of the virus, high mutation rate of infected cells, and the need to determine the best type of vaccine. The virus would best be prevented if the vaccine were designed to reach into the latent T cells, which has proven difficult because the virus lives throughout the body.
A client with malaria has taken chloroquine (Aralen) for the past 72 hours. Which assessment finding should indicate that the drug is effective?
Reduced fever Chloroquine can reduce a fever within 48 hours for a client in the acute stage of malaria. Diarrhea, dermatitis, and abdominal pain are not symptoms of malaria.
A client is taking tacrolimus (Prograf) to prevent transplant rejection. For which reason should the nurse recognize this medication is the treatment choice?
Reduces the dose for corticosteroids Although newer medications have been developed, the calcineurin inhibitors remain the preferred drug for use in transplants because they allow for reduced dosage of corticosteroids, which results in a reduced incidence of post-transplant opportunistic infections. Calcineurin inhibitors do not particularly have fewer adverse effects. They promote both B cell and T cell proliferation, along with macrophages and natural killer cells.
A client is taking antiviral medication. Which laboratory value should the nurse monitor for an adverse effect?
Renal function test Complete blood count, hepatic and renal function tests, and viral cultures should be monitored in the client taking antiviral medication. The results of blood glucose, electrolytes, and WBC count are not used to identify adverse effects of antiviral medication.
An older client has been prescribed a nonsteroidal anti-inflammatory drug (NSAID) for acute shoulder pain. Which assessment should the nurse include before administering the medication? (Select all that apply.)
Renal function Cardiovascular risk Bleeding risk Hearing acuity Ibuprofen-like NSAIDs inhibit platelet aggregation and increase the risk for bleeding, nephrotoxicity, ototoxicity, and myocardial infarction. Cardiac enzymes do not specifically require measuring before starting NSAID therapy.
A client is taking a fluoroquinolone for an infection. Which finding in the client's history should be of greatest concern to the nurse?
Renal insufficiency Renal insufficiency can contribute to a buildup of a toxic level of fluoroquinolone as a result of inadequate excretion of the drug. Allergy to penicillin is not associated with fluoroquinolone use. Peptic ulcer disease is not a contraindication to the use of fluoroquinolones. Noncompliance is a concern, but it is not as critical as the possibility of toxicity.
A client is prescribed amphotericin B (Fungizone) for a systemic mycosis. Which information should the nurse include in the teaching?
Report any ringing or humming in the ears. Amphotericin B is associated with ototoxicity, and clients should be instructed to report any ringing or humming in the ears. The infected site should not be scrubbed vigorously. If gastrointestinal upset occurs, the medication can be taken with food or milk. Topical medication should not be covered with an occlusive dressing.
A client is prescribed interferon alfa-2b (Intron A). Which statement should the nurse use to explain the naming convention for this drug?
Represents specific interferon structures Biological response modifiers (natural cytokines) are represented by the alpha and beta lettering and numbering distinguishing interferon structures and their specific function in the immune system. They are not representations of the drug class or mechanism of action, nor are they chemical compound names.
A client is taking a nonnucleoside reverse transcriptase inhibitor (NNRTI) with another antiretroviral drug. For which reason should the nurse recognize that NNRTIs are always used in combination with other antiretroviral medications?
Resistance to NNRTIs occurs rapidly Since resistance to NNRTIs develops rapidly, they are always used in combination with other antiretrovirals. There is no evidence that the drug is more therapeutic in combination with another antiretroviral drug. NNRTIs have very few adverse effects on their own. It is possible that the use of more than one antiretroviral drug may approach the infection from more than one direction, but that is not the purpose of the combination therapy.
A client with HIV is taking a medication that blocks the synthesis of viral DNA. For which class of antiretroviral medication should the nurse prepare teaching for this client?
Reverse transcriptase inhibitors Reverse transcriptase inhibitors block the synthesis of viral DNA. Protease inhibitors prevent the final step of HIV maturation. Entry inhibitors block the entry of viral nucleic acid into the T4 lymphocyte. Integrase strand transfer inhibitors prevent HIV from inserting its DNA into the human chromosome.
A female client is taking oral metronidazole (Flagyl) for giardiasis. Which assessment finding should concern the nurse the most?
Right upper quadrant pain Metronidazole is extensively metabolized in the liver. Right upper quadrant pain may indicate hepatic impairment. The injectable form of metronidazole contains a significant amount of sodium, which can lead to edema in clients with heart failure. A metallic taste may be experienced by the client taking metronidazole but is not harmful. Vaginal candidiasis occurs with the use of the vaginal gel.
An older client is prescribed an antifungal medication for blastomycosis. Which information should the nurse include in the instructions?
Rise from lying to sitting or standing slowly. The older client is at increased risk for hypotension and falls and should be taught to rise slowly from lying to sitting or standing. Clients taking an antifungal medication should be encouraged to increase fluid intake. Blastomycosis begins in the lungs, so scrubbing the infected site vigorously is not applicable. If gastrointestinal upset occurs, it is acceptable to take medication with food or milk.
A client taking rifampin (Rifadin) and isoniazid for tuberculosis develops a resistance to rifampin. Which intervention should the nurse expect at this time?
Stop rifampin (Rifadin) and add ciprofloxacin (Cipro). If a client develops multidrug-resistant strains of Mycobacterium tuberculosis during the course of therapy, second-line antibiotics such as ciprofloxacin are added to the regimen. The provider will stop the drug showing resistance to rifampin and add the second-line drug ciprofloxacin, possibly in addition to another first-line drug. Simply stopping or replacing the rifampin is not enough to treat multidrug resistance. It is not prudent to continue the resistant drug and add a second-line drug such as cycloserine.
The nurse prepares to administer pegIFN alfa-2a (Pegasys). Through which route of administration should the nurse give this medication?
Subcutaneous PegIFN alfa-2a (Pegasys) comes in single-use prefilled syringes to be administered subcutaneously. This medication is not given intradermally, intravenously, or intramuscularly.
A client has an allergy to salicylates. Which medication prescription should the nurse question? (Select all that apply.)
Salsalate (Mono-Gesic, Salsitab) Meloxicam (Mobic) Ketorolac (Sprix, Toradol) Choline magnesium trisalicylate (Trilisate) Clients with a hypersensitivity to aspirin (acetylsalicylic acid) will also likely be hypersensitive to other nonsteroidal anti-inflammatory drugs (NSAIDs). Meloxicam, ketorolac, salsalate, and choline magnesium trisalicylate are NSAIDs. Acetaminophen is not an NSAID and would be safe to prescribe.
A client is prescribed an antibiotic. Which instruction should the nurse provide about this medication? (Select all that apply.)
Take all the prescription. Do not share the prescription with others. Return to the healthcare provider if the symptoms persist after the full therapy. The client should be instructed to complete the full course of the medication, not to share it with others, and to return to the healthcare provider if the symptoms persist after the therapy is completed. Although certain antibiotics do have food and fluid restrictions, in general this would not be included in the teaching.
The nurse teaches an infant's parents about vaccine recommendations. Which schedule should the nurse describe for the measles, mumps, and rubella (MMR) vaccine?
Two doses, one at 12 to 15 months and the other at 4 to 6 years of age. The recommended schedule for infants to receive the MMR vaccine is two subcutaneous doses, one at 12 to 15 months and the other at 4 to 6 years of age. The recommended schedule for the hepatitis B vaccine is three doses in a series, one each at 0, 1, and 6 to 18 months of age. The recommended schedule for the polio vaccine is four doses, one each at 2, 4, and 6 to 18 months, the last at 4 to 6 years of age. The schedule for the diphtheria, tetanus, and pertussis vaccine is five doses, one each at 2, 4, 6 and 15 to 18 months and the last at 4 to 6 years of age.
A client is prescribed an immunosuppressant drug. Which instruction should the nurse include to minimize adverse effects of this medication? (Select all that apply.)
Wash hands frequently Actions to take if dizziness occurs Report temperature over 101 degrees F Monitor blood pressure To minimize adverse effects, the client should be instructed on blood pressure measurement and when to report adverse effects to the healthcare provider. Monitoring temperature assesses for an infection, and dizziness is an adverse effect that could cause a fall. Washing hands frequently helps minimize the risk of infection. A fluid restriction is not required for this medication.
The nurse is caring for clients with inflammatory health problems. Which client statement should concern the nurse?
"I have been taking a corticosteroid for the past 3 months." Corticosteroids may have serious long-term adverse effects and are usually prescribed for only 1 to 3 weeks. The nurse should be concerned if a client has been taking a corticosteroid for the past 3 months. Ankylosing spondylitis and Hashimoto's thyroiditis are health problems that may benefit from anti-inflammatory medications. If a corticosteroid were prescribed to bring severe inflammation under control, a nonsteroidal anti-inflammatory medication such as ibuprofen (Motrin) may be prescribed after the corticosteroid is finished.
A client is prescribed acetaminophen (Tylenol) for a headache. Which client statement should indicate that teaching about this medication was effective?
"I should report any skin rash or itching." Acetaminophen may cause serious allergic reactions with symptoms of angioedema, difficulty breathing, itching, or rash. Skin blistering should be immediately reported to the healthcare provider because Stevens-Johnson syndrome is a rare but serious adverse effect of the medication. Caffeine is not identified to be avoided when taking acetaminophen. The client should not take extra doses because risk of adverse effects due to acetaminophen poisoning is dose related; hepatic failure and death could occur.
A client is prescribed a nonsteroidal anti-inflammatory drug (NSAID) for ophthalmic inflammation. Which client statement should indicate to the nurse that teaching was effective?
"My feet should not swell while taking the medication." Edema is not expected or a desired response of NSAID therapy. Edema and dark-colored urine indicates the NSAID is affecting the client's renal system. Vomiting and blurred vision are not expected responses of the medication; they are both adverse effects that should be reported to the healthcare provider.
A client is taking a nonsteroidal anti-inflammatory drug (NSAID) for osteoarthritis. Which instruction should the nurse provide?
"Take the medication with food or milk." NSAIDs should be taken with food or milk to prevent gastrointestinal (GI) upset. Taking ginkgo with an NSAID increases the risk for bleeding. Black stools indicate GI bleeding. Decreased urine output indicates possible nephrotoxicity.
A client is prescribed a nonsteroidal anti-inflammatory drug (NSAID) for rheumatoid arthritis. For which client statement should the nurse provide follow-up teaching?
"Taking two NSAIDs together will provide greater pain relief." Taking two NSAIDs together should be avoided as this may cause serious adverse gastrointestinal (GI) effects. Since NSAIDs are pregnancy category C or D (depending on the trimester and specific NSAID) they are not safe for use during pregnancy. Certain medications (e.g., digoxin, lithium, beta blockers, anticoagulants) can interact with NSAIDs. Taking an NSAID with a corticosteroid may cause serious adverse GI effects.
The nurse is teaching about the immune system. Which statement should indicate that teaching was effective? (Select all that apply.)
"The cell-mediated immune response is mediated by T lymphocytes and includes the secretion of cytokines." "The humoral immune response is mediated by B lymphocytes and includes the secretion of antibodies." "Both the humoral and cell-mediated immune response utilize memory cells to prevent reinfection with the same pathogen." The humoral immune system is mediated by B lymphocytes and includes the secretion of antibodies. The cell-mediated immune response is mediated by T lymphocytes and involves the secretion of cytokines. Both the humoral and cell-mediated immune responses involve the use of memory cells to prevent reinfection with the same pathogen.
A pregnant client with the herpesvirus asks if it is safe to take antiviral medication. Which response should the nurse make?
"The safety of these drugs has not been clearly established." Because of the seriousness of neonatal herpes infections, pregnant clients are sometimes treated with antiviral medication. Most research has focused on the use of acyclovir (Zovirax). The safety of these drugs has not been clearly established for use during pregnancy. The nurse is the key to helping the client understand more about medication as prescribed.
A client with cryptosporidiosis asks about how the infection was acquired. Which response should the nurse provide?
"This can be contracted from contaminated food or water." Cryptosporidiosis is a protozoan infection that is transmitted from fecally contaminated food, drinking water, or recreational water. Cryptosporidiosis is not transmitted by an insect or through the consumption of raw fish or undercooked meat. Malaria and African trypanosomiasis are diseases caused by insects. Tapeworms are one of many infectious organisms that can be acquired from eating raw fish. Toxoplasmosis is a disease that can occur from eating undercooked meat.
The nurse is asked why it is important to know whether an organism is gram-positive or gram-negative. Which response should the nurse provide?
"To help guide antibiotic selection." Gram staining helps provide general guidance toward antibiotic selection and understanding of the behavior of a microorganism. Gram staining can be used for documentation purposes, but this is not the best answer. Gram staining is not the best way to track local outbreaks of infection. Gram staining provides information about bacterial species, and not viruses.
