Pharm Exam 1 ?s

Which approach should a nurse take to administer intravenous (IV) acyclovir (Zovirax) to an immunocompromised patient? A) Infuse IV fluids during administration of the dose and for 2 hours afterward. B) Administer IV acyclovir diluted in 20 mL normal saline (NS) over 10 minutes. C) Only infuse the drug if the white blood cell (WBC) count is above 2500/mm3. D) Ask the provider to change the route to subcutaneous (subQ) injection.

A Acyclovir can cause renal damage, and hydration of the patient during the infusion and for 2 hours afterward minimizes this risk. Acyclovir is not given by IV bolus or by intramuscular (IM) or subQ injection. It is used to treat infections in immunocompromised patients, but the dose is not changed or affected by the WBC count.

Before administering an aminoglycoside, it is most important for the nurse to assess the patient for a history of what? A) Myasthenia gravis B) Asthma C) Hypertension D) Diabetes mellitus

A Aminoglycosides can inhibit neuromuscular transmission, causing flaccid paralysis and potentially fatal respiratory depression. These drugs should be used with extreme caution in patients with myasthenia gravis.

A nurse should teach a patient to observe for which side effect when taking ampicillin (Polycillin)? A) Skin rash and loose stool B) Reddened tongue and gums C) Digit numbness and tingling D) Bruising and petechiae

A Ampicillin's most common side effects are rash and diarrhea; both reactions occur more frequently with ampicillin than with any other penicillin. Reddened tongue and gums, digit numbness and tingling, and bruising and petechiae are not associated side effects of ampicillin.

After completing a course of ciprofloxacin [Cipro] for a skin infection, the patient says, "I took the whole bottle of pills, but my infection hasn't gotten any better." Which additional information should the nurse recognize as most significant? A. The patient takes antacids on a daily basis. B. The medication was stored in a cool, dry area. C. The patient did not use sunscreen while taking the ciprofloxacin [Cipro]. D. The patient took two doses of diphenhydramine [Benadryl] while on ciprofloxacin [Cipro] therapy.

A Antacids interfere with the absorption of quinolone antibiotics, such as ciprofloxacin [Cipro], and many other drugs; therefore, this patient has not received the full dosing regimen, which is required if ciprofloxacin is to be effective against the infection. Storing the drug in a cool, dry area and using sunscreen or diphenhydramine would not disrupt the effectiveness of ciprofloxacin.

A patient is admitted to the hospital with a medical diagnosis of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). When taking the patient's history, a nurse recognizes which information as the most important? A) Plays a contact sport and is an athlete B) Currently resides in a long-term care facility C) Did not complete the last course of antibiotics D) Had gallbladder surgery in the previous month

A CA-MRSA is transmitted by skin-to-skin contact and by contact with contaminated objects, such as sports equipment and personal items. It is seen in young, healthy people without recent exposure to healthcare facilities, which is one of the biggest risk factors for CA-MRSA. Not completing an antibiotic course is unrelated.

A patient who has tuberculosis is treated with isoniazid. The nurse should monitor for which symptoms, which could indicate a vitamin B6 deficiency caused by the medication? A. Numbness and tingling in the fingers and toes B. Alopecia and flaking scalp C. Dry skin and brittle nails D. Oral ulcers and tongue fissures

A Dose-related peripheral neuropathy is the most common adverse effect of isoniazid. It results from a vitamin B6 deficiency, which is corrected by taking oral supplements. Symptoms include numbness and tingling in the fingers and toes. Alopecia and flaking scalp, oral ulcers and tongue fissures, and dry skin and brittle nails are not adverse effects of isoniazid-induced vitamin B6 deficiency.

A nurse should recognize that a patient who is infected with HIV is at the highest risk to develop opportunistic infections during which clinical phase of HIV? A) Late B) Intermediate C) Initial D) Prodromal

A During the late phase of HIV infection, CD4 T lymphocytes (CD4 T cells) are reduced below a critical level (200 cells/mL). This significantly increases the risk for opportunistic infections. During the initial phase of HIV infection, patients experience flulike symptoms of fever, pharyngitis, and myalgias. In the intermediate or middle phase of HIV infection, blood levels of HIV remain low and most patients are asymptomatic. There are no prodromal or premonitory clinical signs that indicate the onset of HIV infection.

A nurse is preparing to administer ganciclovir (Cytovene) to a patient for treatment of Cytomegalovirus (CMV) pneumonitis. Which laboratory result should the nurse recognize as a contraindication to use of this drug? A) Neutrophil count below 500/mm3 B) Platelet count of 350,000/mm3 C) Serum calcium level of 9.5 mg/dL D) Reduced forced vital capacity (FVC)

A Ganciclovir is used to treat and prevent CMV infection in immunocompromised patients. Bone marrow suppression is a dose-limiting toxicity of ganciclovir; therefore, the drug is contraindicated in patients with neutrophil counts below 500/mm3 or platelet counts below 25,000/mm3. It does not affect the serum calcium level or FVC, a measure of lung function in patients who have airflow-restrictive disorders.

Which approach should a nurse take when administering an oral dose of levofloxacin [Levaquin]? A. Give the medication with or without food. B. Administer the drug with an oral dose of a magnesium-based antacid. C. Premedicate the patient with diphenhydramine [Benadryl]. D. Administer the drug with milk products.

A Levofloxacin should not be administered with milk products or antacids containing magnesium or aluminum, because this reduces absorption from the gastrointestinal (GI) tract. However, this does not happen with most foods. Premedicating with diphenhydramine is unnecessary.

A patient who has a vancomycin-resistant enterococci (VRE) infection is receiving linezolid (Zyvox). Which laboratory result indicates that the patient is having an adverse effect? A) White blood cell (WBC) count of 1200 units/L B) Hemoglobin (Hgb) level of 18 g/dL C) Potassium level of 3.0 mEq/dL D) Glucose level of 200 mg/dL

A Linezolid can cause reversible myelosuppression, manifesting as anemia, leukopenia, or even pancytopenia. The potassium and blood glucose levels are not affected by linezolid.

A nurse is administering an oral dose of itraconazole [Sporanox] to a patient at 10:00 AM. The nurse should administer a prescribed dose of famotidine [Pepcid] at which time? A. 9:00 AM B. 10:00 AM C. 10:30 AM D. 11:00 AM

A Medications that lower gastric acidity, such as famotidine [Pepcid], can reduce absorption of oral itraconazole [Sporanox]. Those agents should be given at least 1 hour before itraconazole or 2 hours after. The other time administrations would interfere with absorption of itraconazole.

When ceftriaxone is administered intravenously, it is most important for the nurse to avoid mixing it with what? A) Ringer's lactate B) Normal saline C) Sterile water D) D5 0.45% NS

A Mixing ceftriaxone with calcium causes precipitates to form. Ringer's lactate contains calcium; therefore it should not be mixed with ceftriaxone. It is safe to mix normal saline, sterile water, and D5 0.45% NS with ceftriaxone.

A nurse should teach a patient who has Pneumocystis pneumonia (PCP) about the dosing and therapeutic effects of which medication? A) Trimethoprim/sulfamethoxazole (Bactrim) B) Azithromycin (Zithromax) C) Acyclovir (Zovirax) D) Ganciclovir (Cytovene)

A PCP is a potentially fatal infection caused by Pneumocystis jiroveci. Among people with advanced HIV infection, it is the most common opportunistic infection. The preferred regimen for treatment and prophylaxis of PCP is trimethoprim/sulfamethoxazole. Azithromycin is used in the treatment of Mycobacterium avium infection. Cytomegalovirus (CMV) retinitis is treated with ganciclovir. Acyclovir is the preferred treatment of varicella-zoster virus, which causes chickenpox and herpes zoster.

A patient is receiving penicillin G (Bicillin C-R). Which assessment should the nurse monitor as an indicator of an undesired effect? A) Cardiac rhythm B) Serum sodium level C) Lung sounds D) Red blood cell (RBC) count

A Penicillin G in high IV doses may cause hyperkalemia, which can result in dysrhythmias or cardiac arrest. Hypernatremia occurs with high IV doses of ticarcillin. Lung sounds and the RBC count are unrelated to the administration of penicillin G.

Which statement should the nurse include when teaching a patient about rifampin [Rifadin]? A. "A harmless side effect will be a red-orange discoloration of body fluids." B. "Oral contraception is the preferred method of birth control when using rifampin." C. "Take vitamin B6 to relieve numbness and tingling in the fingers and toes." D. "Treatment length for the medication is 3 times per day for an 8-week period."

A Red-orange discoloration of body fluids is a common side effect of rifampin, but it is not harmful. Rifampin does not cause peripheral neuropathy. It does reduce the effectiveness of oral contraceptives, so a nonhormonal form of birth control should be considered. All antitubercular agents need to be taken at least 6 to 24 months to eradicate the slow-growing mycobacterium.

A patient is taking rifampin [Rifadin] for active tuberculosis. Which assessment does the nurse identify as an adverse effect of the drug? A. Jaundice B. Blood glucose level of 60 mg/dL C. Absent deep tendon reflexes D. Moon face

A Rifampin is toxic to the liver, which increases the patient's risk of hepatitis. Jaundice is a sign of liver dysfunction and should be monitored. Rifampin has no effect on the blood glucose level or deep tendon reflexes, nor does it cause a moon face.

The nurse identifies which drug as a short-acting tetracycline? A) Sumycin B) Declomycin C) Vibramycin D) Minocin

A Sumycin is a short-acting tetracycline. Declomycin is an intermediate-acting tetracycline, and Vibramycin and Minocin are long-acting tetracyclines.

A patient is receiving an aminoglycoside (tobramycin) antibiotic. A nurse asks the patient to choose daily meal selections, to which the patient responds, "Oh, dear, I don't want another IV." The nurse makes which assessment about the patient's response? A) Some hearing loss may have occurred. B) The confusion is due to the hospital stay. C) A nutrition consult most likely is needed. D) The patient has a family history of dementia.

A The patient's comment suggests that the person did not hear the instructions. Aminoglycoside antibiotics can cause ototoxicity. The first sign may be tinnitus (ringing in the ears), progressing to loss of high-frequency sounds. Audiometric testing is needed to detect it. Nutrition, confusion, and a family history of dementia do not address the problem of possible hearing loss associated with aminoglycosides.

Which administration instruction should the nurse give a patient scheduled to start receiving the HIV fusion inhibitor enfuvirtide (Fuzeon)? A) "Rotate injection sites in the arm, thigh, and abdomen." B) "Take only when you consume low-fat meals." C) "Dosing is optimal 30 minutes before meals." D) "Injection-site reactions are usually uncommon."

A The primary action of enfuvirtide is to block the entry of HIV into CD4 T cells. It is administered through subcutaneous injection, and the injections should be rotated in the upper arm, thigh, and abdominal areas of the body. Injection-site reactions of pain, tenderness, erythema, and induration occur in almost every patient. Enfuvirtide is not an oral medication; dosing before meals or with low-fat meals is not a relevant instruction.

A patient is receiving local applications of mafenide (Sulfamylon) to burn areas. Before application, it is most important for the nurse to do what? A) Administer a pain medication. B) Obtain a set of vital signs. C) Auscultate the lung fields. D) Obtain a signed consent form.

A The sulfonamide mafenide (Sulfamylon) is used to suppress bacterial colonization in patients with burns. Local application frequently is painful. It is important to administer a pain medication before applying mafenide (Sulfamylon). Obtaining vital signs and a signed informed consent form and auscultating lung fields are not essential actions for mafenide application.

Both IV ampicillin/sulbactam (Unasyn) and gentamicin (Garamycin) are ordered for a patient. When administering these medications, the nurse will do what? A) Ensure that separate IV solutions are used. B) Use two different peripheral IV sites. C) Administer the gentamicin first. D) There are no necessary precautions

A When penicillins are present in high concentrations, they interact chemically with aminoglycosides, causing inactivation of the aminoglycoside. Therefore, penicillins and aminoglycosides should not be mixed in the same IV solution. Rather, these drugs should be administered separately. Two different peripheral IV sites are not necessary. Administering the gentamicin first does not ensure separation of the two medications.

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 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.

Why is it important for drugs to have ease of administration? A) Fewer medication errors B) Less risk of side effects C) Greater chemical stability D) Greater likelihood of reversibility

A) Fewer Medication Errors Ease of administration increases convenience and adherence and can reduce administration errors. Ease of administration is not related to side effects, chemical stability, or reversibility.

What is the ultimate concern for the nurse when administering a drug? A) Intensity of the response B) Dosage C) Route of administration D) Timing of administration

A) Intensity of the response The ultimate concern for the nurse when administering a drug is the intensity of the response, which is determined by the dosage size, route of administration, and timing of administration.

Which statements will the nurse include when teaching a patient about isoniazid therapy for the treatment of tuberculosis? (Select all that apply.) A. "Take the isoniazid on an empty stomach." B. "Notify your healthcare provider if your skin starts to turn yellow." C. "Numbness or tingling in your extremities is a normal response when taking this drug." D. "You urine will turn reddish orange because of the effects of this drug." E. "Use of this drug is associated with vision problems."

A,B Numbness and tingling in the extremities is associated with the development of peripheral neuropathy and should be reported to the healthcare provider. Rifampin, not isoniazid, causes discoloration of body fluids. Ethambutol, not isoniazid, is associated with optic neuritis. The other two statements are true and can be included in patient teaching.

When teaching a patient about tuberculosis, the nurse will include which statements? (Select all that apply.) A. "Most people infected with M. tuberculosis are asymptomatic." B. "Most people infected with M. tuberculosis harbor dormant bacteria for life if they do not receive drug therapy." C. "Treatment of tuberculosis lasts 3 months." D. "Isoniazid can cause peripheral neuropathy by depleting vitamin B12." E. "Rifampin can cause optic neuritis."

A,B Treatment for tuberculosis usually lasts 6 months to 2 years. Isoniazid can cause peripheral neuropathy by depleting vitamin B6. Ethambutol, not rifampin, can cause optic neuritis. The other two statements are true and can be included in patient teaching.

Which statements about serum drug levels does the nurse identify as true? (Select all that apply.) A) With once-daily dosing, only trough levels need to be drawn. B) Peak levels for intramuscular (IM) injections should be drawn 30 minutes after administration of the medication. C) The trough level ideally should be close to zero. D) For patients receiving once-daily doses, the sample should be drawn 2 hours before the next dose. E) For patients receiving divided doses, trough levels should be drawn 1 hour before the next dose.

A,B,C For patients receiving once-daily doses, the sample should be drawn 1 hour before the next dose. For patients receiving divided doses, trough levels should be drawn immediately before the next dose. The other three statements are true.

The nurse should include which instructions when teaching a patient about tigecycline therapy? (Select all that apply.) A) "Use sunscreen when you are outside." B) "If you have diarrhea more than five times a day, notify your healthcare provider." C) "Avoid using this drug if you are pregnant." D) "Stop taking the drug if you experience nausea." E) "Stop taking the drug if you experience vomiting."

A,B,C Nausea and vomiting may occur. The patient should not stop taking the medication; rather, the healthcare provider should be notified so that an alternative plan can be discussed. The other three instructions should be included in the patient teaching.

Which statements about vancomycin (Vancocin) does the nurse identify as true? (Select all that apply.) A) Vancomycin is the most widely used antibiotic in U.S. hospitals. B) Vancomycin is effective in the treatment of Clostridium difficile infection. C) Vancomycin is effective in the treatment of MRSA infections. D) Patients who are allergic to penicillin are also allergic to vancomycin. E) The major toxicity of vancomycin therapy is liver failure.

A,B,C Patients who are allergic to penicillin are able to take vancomycin. The major toxicity of vancomycin therapy is kidney failure. The other three statements are true.

A patient is receiving the protease inhibitor (PI) amprenavir (Agenerase). Which laboratory results would the nurse evaluate as indicators of adverse effects of this medication? (Select all that apply.) A) Plasma cholesterol level B) Serum transaminases C) Cardiac enzymes D) Blood glucose level E) Creatinine level

A,B,D All PIs cause hyperglycemia and diabetes, and patients should be instructed to report symptoms of polydipsia, polyphagia, and polyuria. In addition, PIs can increase serum levels of transaminases and should be used with caution in patients with chronic liver disease. Cholesterol should be measured for elevation caused by the use of PIs that results in a risk of cardiovascular events. Altered cardiac enzymes and serum creatinine levels are not associated with adverse effects of PIs.

The nurse identifies which statements about penicillins as true? (Select all that apply.) A) Penicillins are the safest antibiotics available. B) The principal adverse effect of penicillins is allergic reaction. C) A patient who is allergic to penicillin always has a cross-allergy to cephalosporins. D) A patient who is allergic to penicillin is also allergic to vancomycin, erythromycin, and clindamycin. E) Penicillins are normally eliminated rapidly by the kidneys but can accumulate to harmful levels if renal function is severely impaired.

A,B,E A patient who is allergic to penicillin has a 1% chance of also being allergic to cephalosporins. Patients who are allergic to penicillin are safely able to take vancomycin, erythromycin, and clindamycin. The other three statements are true.

A patient who is receiving vancomycin (Vancocin) IV for a methicillin-resistant Staphylococcus aureus (MRSA) infection asks a nurse, "Why can't I take this medicine in a pill?" Which response should the nurse make? A) "The prescription could be changed, because vancomycin comes in two forms." B) "You're allergic to penicillin, and this is the only way this medication can be given." C) "It will cause too much loss of appetite and nausea if given in the oral form." D) "It is more effective by IV, because the pill form will stay in the digestive tract."

D Because of its chemical size and weight, vancomycin is absorbed poorly in the gastrointestinal (GI) tract and is given parenterally for most infections. It is used for serious infections caused by organisms such as MRSA and in patients with susceptible organisms allergic to penicillins. Oral administration is used only for infections of the intestine. It is not associated with loss of appetite or nausea.

Which laboratory result should a nurse monitor more frequently when a patient is receiving clarithromycin (Biaxin) and warfarin (Coumadin)? A) Activated partial thromboplastin time (aPTT) B) Platelet count C) Erythrocyte sedimentation rate (ESR) D) International normalized ratio (INR)

D Clarithromycin is a macrolide similar to erythromycin and can inhibit hepatic metabolism of medications such as warfarin and theophylline. The INR is the blood test used to evaluate warfarin ranges. The aPTT is the blood test used in monitoring heparin. The platelet count and ESR are not affected by clarithromycin.

A patient who is receiving an aminoglycoside develops flaccid paralysis and impaired breathing. Which medication does the nurse anticipate administering? A) Magnesium sulfate (Epsom salt) B) Potassium chloride (K-Dur) C) Sodium bicarbonate (Citrocarbonate) D) Calcium gluconate (Kalcinate)

D Flaccid paralysis and impaired breathing are signs of impaired neuromuscular transmission, which may occur with aminoglycosides, especially if they are administered concurrently with a neuromuscular blocking agent. Impaired transmission can be reversed with intravenous infusion of a calcium salt (calcium gluconate). Magnesium sulfate, potassium chloride, and sodium bicarbonate do not reverse impaired neuromuscular transmission caused by aminoglycosides.

Which antifungal agent is used as a one-time oral dose to treat vaginal yeast infections? A. Nystatin [Mycostatin] B. Caspofungin [Cancidas] C. Voriconazole [Vfend] D. Fluconazole [Diflucan]

D Fluconazole [Diflucan] has almost 100% bioavailability and therefore is often sufficient as a single dose to treat vaginal yeast infections. Caspofungin [Cancidas] cannot be administered orally. It is used in patients unresponsive to amphotericin B. Nystatin [Mycostatin] is administered as an oral or topical application for candidiasis. Voriconazole [Vfend] is used in the treatment of aspergillosis.

A patient who takes ciprofloxacin [Cipro] and runs 6 miles daily tells a nurse about heel and calf tenderness. The nurse anticipates the healthcare provider to take which action? A. No action is needed, because this is a temporary but expected side effect. B. Continue the antibiotic with an anti-inflammatory medication. C. Slow the running pace and walk more. D. Discontinue the medication, because severe damage can result.

D Fluoroquinolones may result in tendinitis and rupture by disrupting the extracellular matrix of cartilage. Because tendon injury is reversible if diagnosed early, fluoroquinolones should be discontinued at the first sign of tendon pain or inflammation.

The cephalosporins are beta-lactam antibiotics similar in structure and actions to the penicillins. They are contraindicated in patients with a history of severe allergic reactions to penicillins. The use of soy products, peanuts, and opioids is unrelated to cephalosporins. A) High blood pressure B) Cardiotoxicity C) Red man syndrome D) Seizures

D Imipenem can reduce blood levels of valproate, a drug used to control seizures, and breakthrough seizures have occurred. If possible, combined use of imipenem and valproate should be avoided. If no other antibiotic will suffice, supplemental antiseizure therapy should be considered. The other responses are not associated with use of imipenem and valproate.

Which enteral aminoglycoside would the nurse expect to be ordered preoperatively for a patient having intestinal surgery? A) Gentamicin B) Tobramycin C) Amikacin D) Neomycin

D In general, aminoglycosides are poorly absorbed in the gastrointestinal (GI) tract. Neomycin is given orally to suppress bowel flora before surgery of the intestine and is not used parenterally because of its high nephrotoxicity and ototoxicity. Gentamicin, tobramycin, and amikacin are administered parenterally only.

Thirty minutes after receiving an intramuscular (IM) injection of penicillin G (Pfizerpen), a patient reports itching and redness at the injection site. Which action should the nurse take first? A) Elevate the lower legs. B) Place an ice pack on the site. C) Make sure the patient stays calm. D) Administer subcutaneous epinephrine

D Itching and redness at the IM injection site indicate an allergy to penicillin. The primary treatment is epinephrine (subcutaneous, IM, or IV) plus respiratory support. Elevation, ice packs, and calming the patient are done once epinephrine has been administered

A nurse is teaching a patient who is scheduled to start taking itraconazole [Sporanox]. Which statement by the patient would indicate understanding of the teaching? A. "I'll take diphenhydramine [Benadryl] before this medication so I don't have a reaction." B. "It's important to remember to wear sunscreen while taking this medicine." C. "I'll avoid citrus foods, such as oranges and grapefruits, while taking this medication." D. "If I notice my skin turning yellow or feel any nausea, I'll notify my healthcare provider."

D Itraconazole may cause liver injury, and although a causal link has not been identified, patients need to be informed about symptoms to report. These include jaundice, nausea, and right upper abdominal pain. It is not necessary to take diphenhydramine, wear sunscreen, or avoid citrus products while taking itraconazole.

A patient who has HIV and is taking the nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) zidovudine (Retrovir) reports vomiting, abdominal pain, fatigue, and hyperventilation. Which laboratory result is the priority for the nurse to evaluate? A) Megakaryocytes B) Red blood cell (RBC) counts C) CD4 T-lymphocyte counts D) Arterial blood lactate

D Potentially fatal lactic acidosis and hepatic steatosis (fatty liver) can occur with all NRTIs. Measuring arterial blood lactate is a priority for the diagnosis of lactic acidosis. Associated symptoms of nausea, vomiting, abdominal pain, fever, and hyperventilation may occur. Megakaryocytes, RBC counts, and CD4 T-lymphocyte counts also may be measured with NRTI therapy, but alterations in these values are not associated with the complication of lactic acidosis.

A patient who has active TB is to start a medication regimen that includes pyrazinamide. The nurse identifies a risk for complications if the patient also has which medical condition? A. Parkinson's disease B. Rheumatoid arthritis C. Glaucoma D. Alcoholism

D Pyrazinamide is contraindicated in patients with both liver dysfunction and gout. It should be used with caution in patients who abuse alcohol, and liver function studies should be done every 2 weeks. It is not known to cause complications in patients who have Parkinson's disease, rheumatoid arthritis, or glaucoma.

A patient is receiving amphotericin B. The nurse identifies which medication as useful in preventing adverse effects of amphotericin B? A. Furosemide [Lasix] B. Insulin C. Vitamin K D. Potassium

D Renal injury from amphotericin B may cause severe hypokalemia. Serum potassium levels should be monitored more frequently and potassium supplements given to correct low plasma levels. Furosemide, insulin, and vitamin K do not prevent any adverse effects of amphotericin B.

A patient who has an infection with Mycobacterium leprae (leprosy) has been prescribed rifampin [Rifadin]. The nurse identifies which dosing schedule as most effective for this drug? A. Two times per day B. Every other day C. Once every 2 weeks D. Once per month

D Rifampin is the most effective agent for treating leprosy. A single dose kills more than 99.9% of viable M. leprae. Monthly administration is effective, and this dosing schedule minimizes adverse effects.

A nurse should recognize that which sulfonamide, applied topically, has the greatest therapeutic benefit for burns? A) Sulfadiazine B) Trimethoprim (Trimpex) C) Sulfacetamide (Isopto Cetamide) D) Silver sulfadiazine (Silvadene)

D Silver sulfadiazine is a topical anti-infective agent used to treat and prevent infection in second- and third-degree burns. Its effects are due primarily to the release of free silver and not to the sulfonamide portion of the molecule. Sulfadiazine and trimethoprim are sulfonamides used systemically, not topically. Sulfacetamide is used for superficial infections of the eye.

A nurse assessing a patient who is 12 years old should associate which complication with the patient's receiving tetracycline (Sumycin) as a younger child? A) Delay in long bone growth B) Early onset of puberty C) Severe face and body acne D) Discoloration of the teeth

D Tetracycline is contraindicated in children younger than 8 years of age, because it binds to calcium in developing teeth, resulting in permanent discoloration of the teeth. Delay in long bone growth, early onset of puberty, and severe face and body acne are not adverse effects associated with tetracyclines.

A patient taking gemifloxacin develops a rash. The nurse anticipates the healthcare provider to take which action? A. No action is needed, because this is a temporary but expected side effect. B. Continue the antibiotic with an anti-inflammatory medication. C. Cut the dose of medication in half. D. Discontinue the medication.

D The incidence of rash with gemifloxacin is much higher than with other fluoroquinolones. Women under 40 years of age are at greatest risk. Symptoms are severe in about 10% of patients who develop a rash; in the rest, symptoms are mild to moderate. As a rule, gemifloxacin-induced rash resolves spontaneously in 1 to 2 weeks, although some patients require treatment with systemic glucocorticoids. If rash develops, gemifloxacin should be discontinued.

A patient is receiving weekly subcutaneous injections of peg-interferon-alfa-2a (Pegasys) for chronic hepatitis C. A nurse teaches the patient that which adverse effect will diminish with continued therapy? A) Black, sticky, tarry stools B) Lower leg muscle weakness C) Dyspnea and wheezing D) Flulike symptoms

D The most common adverse side effect of peg-interferon-alfa-2a, a long-acting interferon used to treat chronic hepatitis C, is flulike symptoms characterized by fever, fatigue, myalgia, headache, and chills. Symptoms are likely to diminish with continued therapy over time. Black, tarry stools; lower leg muscle weakness; dyspnea; and wheezing are not adverse effects of peg-interferon-alfa-2a.

Which test is the most widely used method for assessing drug sensitivity? A) Minimum inhibitory concentration (MIC) B) Minimum bacterial concentration (MBC) C) Broth dilution D) Disk diffusion

D The most widely used method for assessing drug sensitivity is the disk diffusion test, also known as the Kirby-Bauer test. Through diffusion, an antibiotic-containing zone becomes established around each disk. As the bacteria proliferate, growth is inhibited around the disks that contain an antibiotic to which the bacteria are sensitive.

The healthcare provider orders levofloxacin [Levaquin] 500 mg PO every day for 7 days. The available medication is levofloxacin 250-mg tablets. How many tablets should the patient take each day? A. 0.5 tablet B. 1 tablet C. 1.5 tablet D. 2 tablets

D Two tablets that are each 250 mg would equal the ordered 500-mg daily dose.

The nurse is preparing to administer a dose of penicillin. Before administering the medication, the nurse assesses the patient's allergy history. Which aspect of drug therapy does this represent? A) Making PRN (as needed) decisions B) Evaluating therapeutic effects C) Ensuring proper dosage D) Identifying high-risk patients

D Identifying High-risk patients Patients receiving penicillin are at high risk for dangerous allergic reactions. This intervention represents the nurse's role in identifying situations with high risk. This situation does not represent the remaining responses.

The nurse is preparing to give a drug with certain properties. Which property of the drug is the most compelling indication that it should not be given? A) The drug produces an unwanted side effect. B) The drug is difficult to administer. C) The drug's effects are reversible. D) The drug is not effective for its intended purpose

D) The drug is not effective for its intended purpose If a drug is not effective, there is no justification for giving it. Some drugs may be given even though they produce unwanted side effects or are difficult to administer. Reversible action is a desired property for most drugs.

The nurse identifies what as the goal of drug therapy in the treatment of patients? A) Cure of the disease B) Follow-up with the prescriber C) Correct administration technique D) Production of maximum benefit with minimum harm

D) production of max benefit with min harm The goal of drug therapy in the treatment of patients is the production of maximum benefit with minimum harm. The other options are not the main goal of drug therapy.

Which statements about ototoxicity and aminoglycosides does the nurse identify as true? (Select all that apply.) A) The risk of ototoxicity is related primarily to excessive peak levels. B) The first sign of impending cochlear damage is headache. C) The first sign of impending vestibular damage is tinnitus . D) Ototoxicity is largely irreversible. E) Use of aminoglycosides for less than 10 days is recommended to avoid ototoxicity.

D,E The risk of ototoxicity with aminoglycoside use is related primarily to excessive trough levels. The first sign of impending vestibular damage is headache. The first sign of cochlear damage is tinnitus. The other two statements are true.

What is the priority instruction a nurse gives to a male patient who is scheduled to receive ribavirin (Rebetol) combined with peg-interferon-alfa-2a for treatment of hepatitis C? A) "Combining these two medications will greatly increase response rates." B) "An antidepressant can be prescribed to alleviate symptoms of depression." C) "If you are sexually active, use two reliable forms of birth control to prevent pregnancy." D) "It is very important that you have blood counts checked every 2 weeks."

C Because ribavirin is embryolethal when taken by female patients and causes sperm abnormalities when taken by males, it is a priority that pregnancy be avoided during its use. Pregnancy must be avoided both by female patients and by female partners of men taking ribavirin. Couples should use two reliable forms of birth control during treatment and for 6 months afterward. It is less important that the patient know that ribavirin is not effective against hepatitis C unless it is combined with interferon alfa. Less important information to provide than avoiding pregnancy includes: hemolytic anemia is an adverse effect; frequent blood checks are advised; and depression is an adverse effect of peg-interferon-alfa-2a for which antidepressants can be prescribed.

Which statement by a patient taking ethambutol [Myambutol] indicates understanding of adverse effects of the drug? A. "I will get up slowly when sitting to prevent me from getting dizzy." B. "I'll increase the fiber and liquids in my diet to prevent constipation." C. "I'll report any problems with blurred vision or determining colors." D. "I'll immediately report any red-orange urine to my healthcare provider."

C Ethambutol can cause optic neuritis, resulting in disturbance of color discrimination and blurred vision. Symptoms resolve when the medication is discontinued. Orthostatic hypotension, constipation, and discoloration of urine are not known adverse effects of ethambutol.

When providing teaching for a patient starting flucytosine [Ancobon] therapy, the nurse identifies what as the priority concern? A. "You will have weekly blood draws to monitor your liver function." B. "Another very strong medication may be needed in addition to this one." C. "You'll need to report any symptoms of bruising, fever, and fatigue." D. "The dose is 10 pills, so take a few at a time over a 15-minute interval."

C Flucytosine [Ancobon] is used for serious infections caused by Candida and Cryptococcus neoformans. Bone marrow suppression may cause fatal agranulocytosis, so symptoms of bruising, fever, and fatigue could indicate life-threatening conditions. The other statements are true; however, they are not the priority concern. Flucytosine [Ancobon] is usually combined with amphotericin B. Treatment may require ingestion of 10 capsules 4 times per day. Taking these pills for a short time helps to reduce nausea. Hepatotoxicity is mild and reversible; liver function is monitored while the patient is receiving treatment.

The nurse notices tan lines around the arms of a female patient who is taking levofloxacin [Levaquin]. Which action should the nurse take? A. No action is needed, because this is a temporary but expected side effect. B. Continue the antibiotic with an anti-inflammatory medication. C. Advise the patient to avoid sun exposure and wear sun screen when outside. D. Discontinue the medication.

C Fluoroquinolones pose a risk of phototoxicity. Accordingly, patients should avoid sunlight and sunlamps, and should use protective clothing and a sunscreen if they must go outdoors.

A nurse monitors a patient who is receiving an aminoglycoside (gentamicin) for symptoms of vestibular damage. Which finding should the nurse expect the patient to have first? A) Unsteadiness B) Vertigo C) Headache D) Dizziness

C Gentamicin causes irreversible ototoxicity, which results in both impaired hearing and disruption of balance. Headache is the first sign of impending vestibular damage (balance) and may last 1 to 2 days. Unsteadiness, vertigo, and dizziness appear after headache.

A nurse observes a red streak and palpates the vein as hard and cordlike at the intravenous (IV) site of a patient receiving cefepime (Maxipime). Which assessment should the nurse make about the IV site? A) An allergic reaction has developed to the drug solution. B) The drug has infiltrated the extravascular tissues. C) Phlebitis of the vein used for the antibiotic has developed. D) Local infection from bacterial contamination has occurred.

C IV cephalosporins may cause thrombophlebitis. To minimize this, the injection site should be rotated and a dilute solution should be administered slowly. An allergic response would be shown as itching, redness, and swelling. Infiltration would show as a pale, cool, and puffy IV site. Infection would show as pus, tenderness, and redness.

The nurse identifies which medication as posing a significant risk of causing confusion, somnolence, psychosis, and visual disturbances in elderly patients? A. Metronidazole [Flagyl] B. Rifampin [Rifadin] C. Ciprofloxacin [Cipro] D. Daptomycin [Cubicin]

C In elderly patients, ciprofloxacin [Cipro] poses a significant risk of confusion, somnolence, psychosis, and visual disturbances. Metronidazole, rifampin, and daptomycin are not associated with confusion in elderly patients.

The nurse identifies which medication as the drug of choice for most infections caused by herpes simplex viruses and varicella-zoster virus? A) Ganiciclovir B) Amantadine C) Acyclovir D) Oseltamivir

C Acyclovir is the drug of choice for most infections caused by herpes simplex viruses and varicella-zoster virus. Ganiciclovir is the drug of choice for prophylaxis and treatment of CMV infection in immunocompromised patients, including those with AIDS. Amantadine and Oseltamivir are drugs of choice for the treatment and prophylaxis of influenza.

A patient is scheduled to receive intravenous amphotericin B. Which medication should a nurse administer as pretreatment before the infusion? A. 10 units of regular insulin intravenously B. 20 mg famotidine [Pepcid] in 50 mL of 5% dextrose C. 50 mg of diphenhydramine [Benadryl] and 650 mg of acetaminophen D. 1 g of calcium gluconate in 100 mL of normal saline

C Almost all patients given intravenous amphotericin B develop fever, chills, and nausea. Pretreatment with diphenhydramine and an analgesic, such as acetaminophen, can minimize or prevent these adverse effects. It is not beneficial to administer calcium gluconate, insulin, or famotidine as pretreatment.

It is most important for the nurse to assess a patient taking itraconazole [Sporanox] for the development of what? A. Hair loss B. Skin rash C. Pedal edema D. Joint pain

C Itraconazole [Sporanox] has negative inotropic actions and may cause a transient decrease in the ventricular ejection fraction, thus precipitating heart failure. Pedal edema is a symptom of heart failure, and the nurse should assess for it. Skin rash, hair loss, and joint pain are unrelated to the use of itraconazole.

A patient has acquired an infection while in the hospital. The nurse identifies this type of infection as what? A) Superinfection B) Suprainfection C) Nosocomial infection D) Resistant infection

C Nosocomial infections are acquired by patients while in the hospital. Superinfection and suprainfection are terms used to describe the emergence of drug resistance.

When providing patient teaching for oral sulfonamide therapy, the nurse should instruct the patient to take the sulfonamide in what way? A) At mealtime, when food is available B) With soy or nonmilk products C) Between meals with a full cup of water D) On awakening before breakfast

C Oral sulfonamides should be taken on an empty stomach and with a full glass of water. To minimize the risk of renal damage, adults should maintain a daily urine output of 1200 mL. Sulfonamides should not be taken with soy or nonmilk products or food or before breakfast without liquids.

A nurse should recognize that for maximum therapeutic effects against the influenza virus, oseltamivir (Tamiflu) should be taken when? A) Two days or more after symptom onset B) When lung crackles are present C) Within 12 hours of symptom onset D) Only when fever is above 102°F

C Oseltamivir is a neuraminidase inhibitor that is effective against the influenza A and influenza B viruses. Its benefits decline greatly when treatment is delayed. Dosing must begin early—no later than 2 days after symptom onset. If treatment is started within 12 hours of symptom onset, symptom duration is reduced by more than 3 days. Specific symptoms, such as lung crackles and fever above 102°F, are not criteria for receiving oseltamivir.

A nurse is providing teaching to a group of patients regarding flu season in the United States. Which statement should the nurse include in the teaching? A) In the United States, flu season usually peaks in October or November. B) To insure full protection, the best time to vaccinate is September. C) For people who missed the best time, vaccinating as late as April may be of help. D) The influenza vaccine may not be administered at the same time as the pneumococcal vaccine.

C Peak flu season in the United States is usually January or February. To ensure full protection, the best time to vaccinate is October or November. For people who missed the best time, vaccinating as late as April may be helpful. Influenza vaccine may be given at the same time as other vaccines, including pneumococcal vaccine.

An immunocompromised patient who is receiving piperacillin/tazobactam (Zosyn) develops oozing and bleeding from the gums. Which additional data should the nurse determine? A) Whether the patient has a fever above 100.5°F B) Whether the patient reports any painful teeth C) The most recent platelet count D) The last time mouth care was given

C Piperacillin/tazobactam (Zosyn) is an extended-spectrum penicillin used primarily for infections caused by Pseudomonas aeruginosa in immunocompromised hosts. It can cause bleeding secondary to disrupting platelet function; therefore, the platelet count may be altered. High fever, painful teeth, and mouth care do not address the patient's bleeding gums.

The antiretroviral medication raltegravir (Isentress) achieves therapeutic effectiveness through which action when administered to a patient infected with HIV? A) It blocks the entry of HIV into CD4 T cells. B) It increases protease enzyme activity. C) It inhibits the enzyme integrase. D) It destroys reverse transcriptase.

C Raltegravir is the first and only member of a new class of antiretroviral medications, the HIV integrase inhibitors. Integrase is one of three viral enzymes needed for HIV-derived DNA insertion into DNA of CD4 T cells. Raltegravir effectively blocks HIV replication. It does not increase protease enzyme activity or destroy reverse transcriptase. Blocking HIV entry into CD4 T cells is an action of other antiretroviral medications, not raltegravir.

An antimicrobial medication that has selective toxicity has which characteristic? A) Ability to transfer DNA coding B) Ability to suppress bacterial resistance C) Ability to avoid injuring host cells D) Ability to act against a specific microbe

C Selective toxicity refers to an antibiotic that has the ability to injure only invading microbes, not the host. Conjugation is the process through which DNA coding for drug resistance is transferred from one bacterium to another. Antibiotics do not suppress bacterial resistance, but rather promote the emergence of drug-resistant microbes. Antibiotics that are narrow spectrum are active against only a few microbes

A nurse removes a central line access device once the patient no longer requires intravenous (IV) antibiotics. This action is an example of which strategy to prevent antimicrobial resistance established by the Centers for Disease Control and Prevention (CDC)? A) Preventing transmission B) Proper diagnosis C) Preventing infection D) Prudent antibiotic use

C The CDC's campaign to prevent the development of antimicrobial resistance in hospitals focuses on four approaches: (1) prevent infection, (2) diagnose and treat infection effectively, (3) use antimicrobials wisely, and (4) prevent transmission. Expeditious removal of invasive devices, such as IV catheters, and restricting these devices to essential use are examples of the CDC's strategy to prevent infection.

Before administering a cephalosporin to a patient, it is most important for the nurse to assess the patient for an allergy history to what? A) Soy products B) Peanuts C) Penicillins D) Opioids

C The cephalosporins are beta-lactam antibiotics similar in structure and actions to the penicillins. They are contraindicated in patients with a history of severe allergic reactions to penicillins. The use of soy products, peanuts, and opioids is unrelated to cephalosporins.

A patient is receiving vancomycin (Vancocin). The nurse identifies what as the most common toxic effect of vancomycin therapy? A) Ototoxicity B) Hepatotoxicity C) Renal toxicity D) Cardiac toxicity

C The 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.

A patient who is receiving cefotetan (Cefotan) has all of these medications ordered. The nurse monitors the patient for an adverse effect related to an interaction with which medication? A) Regular insulin B) Ampicillin (Polycillin) C) Naproxen (Naprosyn) D) Bisacodyl (Dulcolax)

C Three cephalosporins—cefmetazole (Zefazone), cefoperazone (Cefobid), and cefotetan (Cefotan)—cause bleeding tendencies. Caution should be used during concurrent use of anticoagulants and other nonsteroidal medications. Regular insulin, ampicillin, and bisacodyl are unrelated to adverse effects with cefotetan.

The nurse identifies tigecycline (Tygacil) as a derivative of what? A) Penicillins B) Cephalosporins C) Tetracyclines D) Macrolides

C Tigecycline is the first representative of a new class of antibiotics, the glycyclines. It is a tetracycline derivative made to overcome drug resistance and is active against many drug-resistant strains. It has adverse effects similar to those of the tetracyclines.

A patient who has acquired immunodeficiency syndrome (AIDS) is receiving trimethoprim/sulfamethoxazole (Bactrim). Which response should a nurse expect if the medication is achieving the desired effect? A) Increase in CD4 T cells B) Increased appetite and weight gain C) Resolution of pneumonia D) Decrease in joint pain

C Trimethoprim/sulfamethoxazole is the treatment of choice for Pneumocystis pneumonia (PCP), an infection caused by Pneumocystis jiroveci (formerly thought to be Pneumocystis carinii). PCP is an opportunistic pneumonia caused by a fungus that thrives in immunocompromised hosts. It does not increase the number of CD4 T cells, the targeted cells of the human immunodeficiency virus (HIV), nor does it affect joint pain. Increased appetite and weight gain are not therapeutic actions of trimethoprim/sulfamethoxazole.

7. Which statement by a new nurse indicates that further study is indicated? A) Effectiveness is the most important property a drug can have. B) There is no such thing as a safe drug. C) Drugs are defined as illegal substances. D) There is no such thing as a selective drug; all medications cause side effects.

C) Drugs are defined as illegal substances A drug is any chemical that can affect living processes. All the other statements are correct.

A nurse is preparing to give an oral dose of drug X to treat a patient's high blood pressure. After giving the drug, the nurse finds that it reduces the blood pressure without serious harmful effects, but it also causes the patient to have nausea and a headache. Based on this information, which property of an ideal drug is this drug lacking? A) Effectiveness B) Safety C) Selectivity D) Ease of administration

C) Selectivity The drug is effective in lowering the blood pressure and safe in that it does not cause harmful effects. However, as do most drugs, it causes other effects besides the one response desired; therefore, it lacks selectivity. The oral form provides ease of administration.

When studying the impact a drug has on the body, the nurse is reviewing what? A) The drug's pharmacokinetics B) The drug's selectivity C) The drug's pharmacodynamics D) The drug's predictability

C) The drug's pharmacodynamics Pharmacodynamics can be thought of as the impact of drugs on the body. Pharmacokinetics describes the movement of drugs through the body. Selectivity is the ability of a drug to elicit only the response for which it is given. Predictability is the degree of certainty about how a patient will respond to a certain drug.

The nurse is preparing to administer a medication with the following order: "Aldomet 250 mg daily." What should the nurse do? A) Administer the medication as it was given last time. B) Administer the medication by mouth. C) Verify the order with the prescriber. D) Ask the patient how this medication is usually given.

C) Verify the order with the prescriber This order does not include a drug route. The nurse should clarify any questionable orders with the prescriber. The other responses are incorrect.

A patient has been diagnosed with respiratory syncytial virus. The nurse anticipatates administration of which drug(s)? (Select all that apply._ A) Ganciclovir B) Oseltamivir C) Ribavirin (inhaled) D) Palivizumab E) Entecavir

C,D Ribavirin (inhaled) and Palivizumab are used for the treatment of RSV. Ganiciclovir is useful in the treatment of cytomegalovirus. Oseltamivir is used for the treatment of Influenza A and B. Entacavir is a nucleoside analog used in the treatment of HBV.

When educating patients about their medications, the nurse includes information about which topics? (Select all that apply.) A) What to do if a dose is missed B) The duration of treatment C) Prescription drug coverage D) The method of drug storage E) Symptoms of adverse effects

CORRECT: A, B, D, E

Which statements about medication administration would the nurse identify as true? (Select all that apply.) A) All drugs have the potential to produce undesired effects. B) Drug therapy often can be enhanced by nonpharmacologic measures. C) Patients taking two drugs are not likely to have a drug interaction. D) Nurses' knowledge of pharmacology is more important for standing orders than for PRN medications. E) Patient adherence is essential in achieving the therapeutic objective of medications.

CORRECT: A, B, E All drugs have the potential to produce undesired effects. Drug therapy often can be enhanced by nonpharmacologic measures, such as physical therapy or dietary changes. Patient adherence is the extent to which a patient's behavior coincides with medical advice. This is especially important for patients taking medications at home. Patients taking two drugs are at risk for drug interactions. PRN medications require a high level of nursing discretion, judgment, and knowledge and are not less important than standing orders.

The nurse is obtaining a drug history for a patient admitted to the unit. The nurse obtains information about past and present health histories, currently used prescription drugs, behavioral factors, and use of over-the-counter (OTC) drugs. What other information does the nurse need to obtain? (Select all that apply.) A) Use of recreational drugs and substances B) Usual sleep patterns and disturbances C) Highest level of education completed D) Use of home remedies E) Self-treatment with complementary and alternative drugs

CORRECT: A, D, E When answering a multiple-response question, consider each option independently. In this case, three answers are correct. The nurse must take a holistic approach when assessing the drug history. Recreational drugs and substances, home remedies, and self-treatment with complementary and alternative drugs are vital components of a patient's drug history. Sleep patterns and level of education are not considered vital information in the drug history.

The nurse is caring for a patient prescribed Isoniazid for the treatment of tuberculosis. The nurse should assess for which signs and symptoms of drug-induced liver toxicity? (Select all that apply.) A. Nausea B. Malaise C. Jaundice D. Vomiting E. Clear urine

Correct answer A,B,C,D. Drug toxicity is an adverse drug reaction in which certain drugs are toxic to specific organs. Signs and symptoms of liver toxicity include jaundice, dark urine, light-colored stools, nausea, vomiting, malaise, abdominal discomfort, and loss of appetite.

The nurse reviews all of the patient's prescriptions. Which prescribed medications may cause a detrimental potentiative drug interaction? A. Aspirin and warfarin B. Sulbactam and ampicillin C. Propranolol and albuterol D. Isoniazid and rifampin

Correct answer A. Aspirin and warfarin both suppress clotting. As a result, if aspirin and warfarin are taken concurrently, the risk of bleeding is significantly increased.

The nurse prepares to administer vancomycin (Vancocin) for the treatment of Methicillin-resistant Staphylococcus aureus (MRSA) infection. Which is a priority assessment the nurse should make prior to administration? A. Serum creatinine level. B. Liver function tests. C. Serum hemoglobin. D. Blood glucose level.

Correct answer A. Comprehension question. If toxic levels of vancomycin are present in the blood, there is a risk of renal toxicity. If the serum creatinine level is increased, the dose of vancomycin is reduced to decrease the risk of kidney damage. P 1077- 1078 in Lehne discusses the adverse effects of vancomycin.

Which statement best describes the side effect of a medication? A. A secondary effect produced with normal doses of the drug. B. A psychological benefit derived from taking the drug. C. Expected beneficial effect in all clients taking the drug. D. An adverse reaction related to increased doses of the drug.

Correct answer A. Knowledge question. A side effect is related to the ACTION of the medication and is generally predictable. An example is the side effect of drowsiness after the administration of some antihistamines

The nurse cares for a client prescribe a 6-month course of treatment with isoniazid for the treatment of tuberculosis. The nurse instructs the client to increase intake of which vitamin? A. Vitamin B6. B. Vitamin B12. C. Vitamin C. D. Vitamin A.

Correct answer A. Knowledge question. Small doses of vitamin B6 (pyridoxine)may be administered to prevent peripheral neuritis. The client may report numbness or pain of hands or feet. P 1122 Lehne has a good discussion of this adverse effect.

The nurse cares for a client who has received intravenous antibiotics for 7 days. The client is at greatest risk to develop which infection? A. Candida albicans infection. B. Chlamydia infection. C. Hepatitis B infection. D. Herpes simplex infection.

Correct answer A. Knowledge question. Suprainfections (superinfections) refer to new infections that occur during treatment for a primary infection. Suprainfections occur when antibiotics kill host flora. During antibiotic treatment, a new infection in the genitourinary tract of gastrointestinal tracts is highly suspicious for a suprainfection. The nurse should assess for the symptoms of suprainfection during the administration of antibiotics.

The nurse is preparing a staff education inservice about specific safety measures that reduce patient medication errors. Which measure improves safety for patients during care transition? A. Medication reconciliation B. MEDWATCH program C. Risk Evaluation and Mitigation Strategy D. Regional Medication Safety Program

Correct answer A. Medication reconciliation is a widely used specific patient safety measure that reduces medication errors during transitions of care (eg, hospital admission and discharge, and moving to a different level of care within a hospital). Medication reconciliation has resulted in decreasing medication errors by 70% and reducing adverse drug reaction by 15%.

Which statement best describes the difference between a first and third generation cephalosporin antibiotic? A. Third generation cephalosporins are less expensive than first generation ones. B. Third generation cephalosporins have a broad spectrum of antimicrobial activity. C. First generation cephalosporins are safe to administer to pregnant clients. D. First generation cephalosporins most effective with once a day administration.

Correct answer B&C. Knowledge question. The nurse should understand the difference between the four generations of cephalosporins. The therapeutic use and resistance of pathogens are important considerations. P 1072 Lehne has a good discussion of the cephalosporin generations.

As part of the evaluation step of the nursing process during medication administration, which action will the nurse perform? A. Establish client centered goals and outcomes. B. Monitor the client for therapeutic and adverse effects. C. Administer the medication by the correct route. D. Determine which over-the-counter medications the client takes.

Correct answer B. Comprehension question. Evaluation is a higher level of critical thinking and clinical judgment. It is important to evaluate the therapeutic effect of the medication and the potential adverse effects of the medication. Is the effect of the medication desired? For instance, is the client's reported pain level decreased? Are any adverse effects present? Does the client report drowsiness after administration of a pain medication (side effect)? Does the client have a decrease in respiratory rate and effort after administration of a medication (adverse effect?)

Before administrating the dosage of a prescribed medication, the nurse observes precipitation formation of the intravenous (IV) solution. What is the priority nursing action? A. Verify the prescription. B. Discard the IV solution. C. Prepare another dose to administer. D. Check the expiration date of the drug.

Correct answer B. If a precipitate appears in the IV solution, that solution should be discharged.

Which antibiotic classification is the most common cause of drug allergy? A. Cephalosporins. B. Penicillins. C. Aminoglycosides. D. Tetracyclines

Correct answer B. Knowledge based question, but very important to know. The nurse must educate the client about penicillin allergy even if the client has taken penicillins before with no problem. A small dose of penicillin can cause a fatal allergic reaction. P. 1063 in Lehne has a good discussion of penicillin allergy.

The nurse prepares to administer a drug which has a "narrow therapeutic index." Which statement describes the properties of this drug? A. The drug is used for the treatment of very few diseases. B. A small increase in the dose increases the risk of drug toxicity. C. The majority of the drug is secreted in the renal tubules in the kidneys. D. The toxic range is many times greater than the minimum effective concentration.

Correct answer B. Knowledge question. Administration of a drug with a narrow therapeutic range increases the risk of adverse reactions and toxicity. The difference between the safe dose and the dose that may cause toxicity is narrow.

Which is the term used to describe the ethical practice of a nurse who seeks interventions that are good for the client? A. Autonomy. B. Beneficence. C. Confidentiality. D. Nonmaleficence.

Correct answer B. Knowledge question. Beneficence is the ethical principle stating that one should do good and prevent or avoid doing harm. This is a guiding principle for nurses to remember during the administration of medications.

Which is the best description of the "first pass effect" of a medication? A. The drug is highly protein bound to the albumin molecules. B. Rapid inactivation of certain oral drugs in the liver. C. The majority of the drug is excreted in the urine. D. Rapid onset of action of the drug after administration.

Correct answer B. Knowledge question. Think about why this knowledge is important for nursing. If an oral medication has first-pass effect, the medication is rapidly metabolized by the liver and there is no therapeutic effect. An example is nitroglycerin which is administered by the sublingual route

The nurse prepares to administer an aminoglycoside antibiotic to a client diagnosed with an abdominal infection. Which is a priority assessment for the nurse to make before administration of the medication? A. Bowel sounds. B. Level of consciousness. C. Hearing acuity. D. Appetite.

Correct answer C. Comprehension question. All aminoglycosides can accumulate in the inner ear and be toxic. Hearing acuity or ringing in the ears may occur with toxic dosages. The client may have difficulty with balance and ambulation if the vestibular apparatus. P 1097 Lehne discusses the adverse effects of aminoglycosides.

A client is to have a blood test for a trough level of an antibiotic drawn. The nurse knows that the blood test will be done at which time? A. At the expected time of the onset of the drug effect. B. Immediately after the first dose of the drug is given. C. At the time the drug plasma concentration is lowest. D. Within two hours of administration of the last dose.

Correct answer C. Comprehension question. For some medications (antibiotics) peak and trough blood levels will be drawn. To increase the therapeutic effect and avoid toxicity, the trough level must be above the minimum effective concentration. The peak level must be below the toxic level for the medication

A medication is described as "highly protein bound." Which is the best description of protein binding? A. Rapid absorption of the drug into the cells of the body. B. The client's albumin level is greater than normal. C. Less medication is distributed to the tissues of the body. D. Increased excretion of the medication in the urine.

Correct answer C. Comprehension question. You need to apply the concept of protein binding to answer this question. The greater the amount of medication attracted to the albumin in the blood, the less is available for distribution

The nurse cares for a client diagnosed with impaired liver function. Which is the best description of the impact the liver disease has on pharmacokinetics? A. Impaired absorption. B. Impaired distribution. C. Impaired metabolism. D. Impaired excretion.

Correct answer C. Knowledge question. As a nurse, it is important to be able to assess liver function. Know the names of the liver function tests discussed in class.

The nurse prepares to administer a medication by the sublingual route. The client asks why the medication must be given under the tongue. Which is the best explanation by the nurse? A. "There is a slow steady absorption of medications from under the tongue." B. "The acid in your stomach dissolves this medication too quickly." C. "The tablet is absorbed very quickly into the blood vessels under the tongue." D. "Tablets that are this small must be given underneath the tongue."

Correct answer C. Knowledge question. Oral medications with a first pass effect are given by the sublingual route to bypass the liver. More of the medication reaches the tissues in the body. The onset of action is very rapid due to the rapid absorption into the blood.

Which legal act required pharmaceutical companies to establish the safety of a new drug before its approval for use? A. Federal Food and Drugs Act of 1906. B. Federal Food, Drug and Cosmetic Act of 1938. C. Kefauver-Harris Amendments of 1962. D. Durham-Humphrey Amendment of 1952.

Correct answer C. Knowledge question. The law tightened controls on drug safety. Thalidomide was discussed in class.

The majority of drugs are excreted mainly through which routes? A. Skin and lungs. B. Lungs and gastrointestinal tract. C. Bowel and renal tubules. D. Saliva and skin.

Correct answer C. Knowledge question. The majority of medications are excreted through the kidneys. Another common route is through the bowel or gastrointestinal tract. pp 41 - 42 discuss the routes of excretion of medications. It is important as a nurse to consider routes of excretion. If a client has decreased renal function, there is a greater risk of toxicity.

The nurse cares for a client diagnosed with Lyme disease. While instructing the client about doxycycline (Vibramycin), the nurse tells the client to avoid exposure to sunlight. The client asks why this is necessary. Which is the best explanation by the nurse? A. "Exposure to ultraviolet light decreases the effectiveness of the medication." B. "Ultraviolet light will increase the intensity of the rash associated with Lyme disease." C. "If you do not protect yourself from the sun, you have a greater risk of sunburn." D. " As you get older, you should be more careful about exposure to ultraviolet light."

Correct answer C. Knowledge question. The tetracycline classification of medications can increase the sensitivity of the skin to ultraviolet light. This is called photosensitivity. It is priority for the nurse to educate clients about proper clothing, sunscreen etc to reduce exposure to ultraviolet light.

Why are infants especially sensitive to drugs that affect CNS function? A. The blood-brain barrier is especially strong in infants. B. The blood-brain barrier does not exist until 1 year of age. C. The blood-brain barrier is not fully developed at birth. D. The blood-brain barrier is weakened by the birth process.

Correct answer C. The blood-brain barrier is not fully developed at birth. The other statements are not true.

Which nursing action results in the most common cause of fatal medication errors? A. Miscalculation of dosage B. Miscommunication of drug orders C. Misreads the healthcare provider's handwriting D. Administers a drug intravenously (IV) instead of intramuscular (IM)

Correct answer D. According to the Institute of Medicine (IOM), among fatal medication errors, the most common cause are human factors. Of the human factors, the main causes of errors are performance deficits (29.8%), such as administering a drug IV instead of IM, followed by knowledge deficits (14.2%) and miscalculation of dosage (13%).

The nurse prepares to administer trimethoprim/sulfamethoxazole (Bactrim), a sulfonamide preparation. Which is the most common reason this sulfonamide preparation is prescribed? A. Pulmonary tuberculosis. B. Bacterial pneumonia. C. Candida albicans infection. D. Urinary tract infections.

Correct answer D. Comprehension question. Sulfonamides are broad-spectrum antibiotics and the majority of pathogens that cause urinary tract infections are susceptible. It is important for the nurse to instruct the client to increase fluid intake to reduce the risk of crystal formation in the urine. When these two medications are combined, resistance to the medications is reduced compared to use of one drug alone.

The nurse administers a wrong dose of a medication to a client. Which is the first action the nurse should take? A. Document the error in the client record. B. Discuss the error with the client. C. Monitor the client for adverse reactions. D. Notify the prescriber of the error.

Correct answer D. Comprehension question. The prescriber should be notified immediately so that treatment can begin as soon as possible. The error is never documented in the client record; an incident report is completed.

Which condition requires the treatment with two or more drugs? A. Acute ear infections. B. Oral candida albicans infection. C. Bacterial pneumonia. D. Active tuberculosis.

Correct answer D. Comprehension question. Tuberculosis has become resistant to many medications due to mutation. In addition to the use of 2 or more drugs to treat TB, it is important for the client to take the medication for the prescribed amount of time. If the client does not finish the full course of treatment, there is increased risk of mutation. Pp. 1117-1118 Lehne has a good discussion of this

5. Which statement best describes the onset of drug action? A. The dose of the drug needed for an immediate response to the drug. B. The dose of the drug most likely to cause side effects. C. The highest plasma concentration of a drug at a specific time. D. The time to reach the minimum effective concentration of the drug.

Correct answer D. Knowledge question. For therapeutic effects to occur, the drug must be in concentrations at or above the level of the minimum effective concentration.

The nurse prepares to administer furosemide 40 mg oral to a client. Which term is used to describe the name of the medication? A. Chemical name. B. Trade name. C. Official name. D. Generic name.

Correct answer D. Knowledge question. It is important to use generic names as you prepare for NCLEX due to the 2015 change in the exam.

The nurse prepares to administer antibiotics to a client diagnosed with bacterial pneumonia. Which blood test must be completed prior to administration of the antibiotic? A. Red cell count. B. Blood glucose level. C. Serum sodium level. D. Culture and sensitivity test.

Correct answer D. Knowledge question. The purpose of a culture and sensitivity test is to determine the cause of the infection and which antibiotics are effective for treatment. The health care provider may begin treatment with an antibiotic that most likely will be effective, but it is important to identify the specific cause and effective treatment. P 1051 Lehne discusses the selection of antibiotics.

For medications that do not have established pediatric doses, the most common method of extrapolating the appropriate dose is based on which measurement? A. Age B. Weight C. Height/length D. Body surface area

Correct answer D. Pediatric doses have been established for a few drugs but not for most. For drugs that do not have an established pediatric dose, dosage can be extrapolated from adult doses. The method of conversion employed most commonly is based on body surface area.

Which statement best describes the movement of drugs throughout the body? A. Distribution, absorption, metabolism, elimination. B. Absorption, metabolism, distribution, elimination. C. Absorption, distribution, metabolism, elimination. D. Metabolism, absorption, distribution, elimination.

Correct answer: C. Knowledge (memorization) question. As a nurse, think about factors that affect pharmacokinetics.

A nurse prepares to administer acetaminophen (Tylenol) to a patient with an oral temperature of 101.7°F. Which preparation would the nurse expect to have the most rapid onset of action? A) Tylenol elixir B) Tylenol tablets C) Tylenol capsules D) Tylenol gel caps

Correct: A A liquid does not have to dissolve first to allow absorption; therefore, the onset of action occurs more quickly than with capsules, tablets, or gel caps.

The nurse should instruct a patient complaining of pain to do what to reduce fluctuations in drug levels? A) "Take pain medication around the clock at specified intervals and doses." B) "Take pain medication when the pain level reaches an 8 or 9 on a 1 to 10 scale." C) "Take pain medication at night before bed and avoid daytime dosing because of drowsiness." D) "Take pain medication after breakfast and dinner to reduce stomach upset."

Correct: A One technique to reduce drug level fluctuations is to take a specified dose at reduced dosing intervals. A patient who waits for the pain to peak will have to wait longer for the pain medicine to reach a plateau level of pain control. Avoiding daytime dosing because of drowsiness and avoiding stomach upset does not address the question of how to reduce fluctuations in drug levels.

What is a result of the Prescription Drug User Fee Act (PDUFA) of 1992? A) New drugs reach the market sooner than ever before. B) Controlled substances are categorized into schedules. C) Drugs for acquired immunodeficiency syndrome (AIDS) receive accelerated approval. D) More research is conducted on drug safety in children.

Correct: A PDUFA was a response to complaints about the length of time required for approval of new drugs by the U.S. Food and Drug Administration (FDA). Under this act, drug sponsors pay fees to the FDA that are used to fund additional reviewers. The FDA then must adhere to strict turnaround times for drug review processes.

When administering a central nervous system depressant, the nurse should closely observe for drug toxicity in which patient? A) A 3-week-old neonate B) A 12-year-old boy C) A 25-year-old woman D) A 15-month-old infant

Correct: A The blood-brain barrier is not fully developed at birth. As a result, newborns are much more sensitive than older children or adults to medicines that act on the brain.

The nurse is administering warfarin, an anticoagulant, to a patient with a low albumin level. As a result, the nurse can expect to observe which effect of this medication? A) Increased PT/INR levels B) Deep vein thromboses C) Reduced risk of bruising D) Increased platelet aggregation

Correct: A Warfarin is an anticoagulant with a high affinity for binding with albumin. If the albumin level is low, more free drug is available for action, resulting in an increased prothrombin time/international normalized ratio (PT/INR). Deep vein thromboses can be prevented with warfarin. An increased risk of bruising and bleeding would occur with more free drug available. Warfarin acts on vitamin K, not on platelets. Aspirin is an example of an antiplatelet aggregator.

Which response would the nurse anticipate when giving two drugs that have a potentiative effect, such as meperidine and Phenergan? A) Increased pain relief B) Increased nausea and vomiting C) Decreased itching D) Increased alertness

Correct: A A potentiative effect occurs when one drug intensifies the effects of another. An inhibitory effect would cause reduced therapeutic effects or reduced adverse effects. Potentiative effects are not unique responses. Meperidine is a morphine derivative for pain relief. Phenergan is an antiemetic that potentiates the effect of meperidine. The patient should experience decreased pain and also may be drowsy.

The nurse is reviewing the laboratory work for a patient who is taking atorvastatin (Lipitor). Which laboratory value is most useful for monitoring this drug? A) Aspartate aminotransferase (AST) B) Blood urea nitrogen (BUN) C) International normalized ratio (INR) D) C-reactive protein (CRP)

Correct: A AST is a liver enzyme that is helpful for monitoring liver function (hepatotoxicity). Lipitor, a lipid-lowering drug, is a commonly prescribed example of a hepatotoxic drug. The BUN is a measure of kidney function. The INR is a comparative rating of prothrombin time ratios that is used to monitor patients taking the anticoagulant agent warfarin. The CRP is elevated in inflammatory and neoplastic disease, myocardial infarction, and the third trimester of pregnancy. It is used as a cardiac risk marker.

The nurse is caring for a 12-year-old boy who weighs 72 pounds. The healthcare provider should make the most precise dosage adjustments for this patient's medications based on what? A) Body surface area B) Body mass index C) Body weight D) Body fat percentage

Correct: A Adjustments based on the body surface area account not only for the patient's weight, but also for how fat or lean the person may be.

The nurse prepares to give a drug that will prevent receptor activation. Which term would describe this drug? A) Antagonist B) Selective C) Agonist D) Potent

Correct: A An antagonist is a drug that prevents receptor activation. An agonist is a molecule that activates receptors. A selective drug has only the desired response but may not activate receptors. A potent drug requires a lower dose to achieve its effect.

The drug dobutamine acts as an agonist of norepinephrine (NE) receptors. Which effect is the nurse likely to observe in a patient receiving this medication? A) Increased heart rate B) Atrioventricular heart block C) Decreased force of heart contraction D) Reduced cardiac output

Correct: A Dobutamine mimics the action of NE at receptors on the heart, thereby causing and increase in the heart's rate and force of contraction.

The nurse is caring for a group of female patients receiving medication therapy. Which factor is of greatest concern with regard to drug therapy in these patients? A) Most drug research has been carried out exclusively in male subjects. B) Hormonal differences make managing drug therapy more difficult in most women. C) Overall, women tend to be less compliant with medication therapy. D) Women tend to be caregivers and may not take time to care for themselves.

Correct: A For most drugs, not much is known about gender-related differences, because until recently all drug research was done in men.

The nurse is teaching a patient taking felodipine (Plendil), a drug for hypertension, about taking the medication at home. Which statement by the nurse is the most appropriate to include in the teaching session? A) "Avoid grapefruit juice while you are taking this medication." B) "Citrus juices are an important part of a heart-healthy diet." C) "Herbal agents can help this drug work more effectively." D) "This drug is free of dangerous drug interactions."

Correct: A Grapefruit juice can raise levels of felodipine by as much as 400% because of the effect grapefruit juice has on the CYP3A4 isozyme.

The nurse is concerned with minimizing adverse drug-drug interactions for the patient. Which drug characteristic could result in the most serious consequences from a drug-drug interaction? A) Low therapeutic index B) High biologic half-life C) Low potency D) First-pass effect

Correct: A Interactions are especially important with drugs that have a low therapeutic index, because an interaction that produces a modest increase in drug levels can cause toxicity.

The nurse is preparing to give a drug that is not classified according to a Pregnancy Risk Category. What should the nurse do? A) Administer the medication, because the nurse knows that it was in use before 1983 B) Notify the healthcare provider before administering the drug, because it should be considered a teratogen C) Hold the medication, because the drug has a proven risk of fetal harm D) Return the medication to the pharmacy to be assigned a Pregnancy Risk Category

Correct: A Many drugs are not classified according to the U.S. Food and Drug Administration (FDA) Pregnancy Risk Categories. These drugs were in use before the classification system came into use in 1983. They are considered safe but may not have been studied in controlled trials. The pharmacy cannot assign a pregnancy risk category to a drug.

When administering a medication known to be metabolized by the liver, the nurse will closely monitor for adverse drug reactions in which patient? A) A 3-month-old infant B) A 12-month-old infant C) An 18-month-old toddler D) A 13-year-old adolescent

Correct: A Neonates are especially sensitive to drugs that are eliminated primarily by hepatic metabolism. When these drugs are used, dosages must be reduced. The capacity of the liver to metabolize many drugs increases rapidly about 1 month after birth and approaches adult levels a few months later. The liver has matured completely by 1 year of age.

A nursing instructor knows that further instruction about drug selectivity is needed when a nursing student makes which statement? A) "Botulinum toxin is very selective and therefore very safe for administration." B) "Selective drug action is made possible by many types of receptors in the body." C) "The more selective a drug is, the fewer side effects it will produce." D) "Even though a drug is selective, it can produce nonselective results."

Correct: A Selectivity does not guarantee safety. Botulinum toxin can cause paralysis of respiratory muscles, resulting in respiratory arrest. All of the remaining statements about receptors and selectivity of drug action are correct.

Which intervention would the nurse choose to minimize the risk of drug toxicity in neonates and infants? A) Reduce the amount of drug given B) Administer the medication before meals C) Shorten the interval between doses D) Administer the medication intravenously

Correct: A The albumin in neonates and infants has a lower binding capacity for medication. A lower binding capacity leaves more of the free drug available for action; therefore, a lower dose is required to prevent toxicity.

When preparing a teaching session for residents at an assisted living facility, the nurse will include what? A) The importance of avoiding intentional underdosing B) The importance of using multiple pharmacies for cost-effective savings on prescription drugs C) The importance of taking double amounts of missed doses to maintain therapeutic levels of medications D) The importance of reducing protein intake while taking prescription medications

Correct: A Underdosing, with resulting therapeutic failure, is much more common (90%) than overdosing among the elderly. In most cases (75%), the nonadherence is intentional because of the patient's conviction that the drug was simply not needed or because of unpleasant side effects. Polypharmacy should be avoided, as should doubling missed doses. Doubling a dose could result in intentional overdosing. Reducing protein intake can result in decreased drug binding to albumin; consequently, the amount of free drug is increased, which could result in drug toxicity

Which statement about the Family Smoking Prevention and Tobacco Control Act (2009) would the nurse identify as true? (Select all that apply.) A) All ingredients in tobacco products must be listed on the warning label. B) A gradual reduction of nicotine to nonaddictive levels is required. C) Marketing to youth is prohibited. D) Harmful additives are restricted. E) Purchasers of tobacco products must be age 21 years or older.

Correct: A, B, C, D All of the statements about the Family Smoking Prevention and Tobacco Control Act (2009) are true except option E. The legal age for purchasing tobacco products, as set by the act, is 18 years.

The nurse is aware of which examples of individual variations in drug responses? (Select all that apply.) A) Age B) Genetic makeup C) Gender D) Diet E) Failure to take medication as prescribed

Correct: A, B, C, D, E All of the responses are examples of individual variations in drug responses.

Older adult patients are at high risk for adverse drug reactions (ADRs). Which measures can reduce the incidence of ADRs? (Select all that apply.) A) Taking a thorough drug history, including over-the-counter (OTC) medications. B) Monitoring clinical response and laboratory results to help determine proper dosage. C) Using as many drugs as possible to reduce symptoms and improve outcome. D) Regularly monitoring patients for drug-drug and drug-nutrient interactions. E) Helping patients to avoid prescriptions for drugs on the Beers list

Correct: A, B, D, E A thorough drug history and careful monitoring can help reduce ADRs. Nurses should help patients use the simplest regimen possible to reduce the risk of ADRs. Monitoring patients for interactions reduces ADRs. The Beers list identifies drugs with a high likelihood of causing adverse effects in the elderly.

The nurse is teaching young parents about medication administration in their child. Which statements are appropriate to include in the teaching plan? (Select all that apply.) A) "Guard against spills and spitting to ensure that your child gets an accurate dose." B) "Do not mix your child's medication with food or drink." C) "This calibrated spoon will help your child get an accurate dose." D) "Keep a medication record to make sure you do not give more than one dose at a time." E) "If your child spits some medication out, give another full dose at that time."

Correct: A, C, D Spills and spitting are common causes of inaccurate dosing in children. It is often helpful to mix medication with food or juice to mask the taste when allowed. Calibrated spoons and medication records can improve accuracy. To prevent overdosing, parents should estimate the amount a child spits out and replace only that amount

Which statement about over-the-counter (OTC) drugs would the nurse identify as true? (Select all that apply.) A) Most illnesses initially are treated with an OTC agent. B) More prescription drugs than OTC agents are administered each year in the United States. C) The average home medicine cabinet contains eight OTC preparations. D) Forty percent of Americans take at least one OTC drug every 2 days. E) Some drugs that originally were sold by prescription are now OTC.

Correct: A, D, E Most illnesses are initially treated with an OTC agent. OTC drugs account for 60% of all doses administered. The average home medicine cabinet contains 24 OTC preparations.

The nurse is preparing to give a medication for pain. The label states that the drug is "lipid soluble." Based on the nurse's knowledge of lipid-soluble drugs, how quickly would the nurse expect to observe the effects of the drug? A) Slowly B) Rapidly C) Unpredictably D) Variably

Correct: B Cell membranes are composed of lipids; therefore, a lipid-soluble drug passes through rapidly. A water-soluble drug passes through more slowly. The nurse would expect to observe the effects of a lipid-soluble drug more quickly, because the drug is absorbed more rapidly.

N-acetyl-para-aminophenol is an example of which type of drug name? A) Proprietary B) Chemical C) Generic D) Trade

Correct: B The chemical name is a description of a drug using the nomenclature of chemistry. The proprietary or trade name of the drug is the brand name under which the drug is marketed by one or more companies. The generic name is the name assigned by the U.S. Adopted Names Council and is the same regardless of who manufactures the drug.

The nurse administers 100 mg of drug X by mouth. After the drug moves through the hepatic system, very little active drug is left in the general circulation as a result of what? A) Therapeutic range B) First-pass effect C) Biologic half-life D) Plasma protein binding

Correct: B The term first-pass effect refers to the rapid hepatic inactivation of certain oral drugs. Drugs that undergo the first-pass effect often are administered parenterally. The therapeutic range is the range of drug level between the minimum effective concentration (MEC) and the toxic concentration. The biologic half-life is the time required for the amount of drug in the body to decrease by 50%. Plasma protein binding is involved with the transport of drugs through the bloodstream.

A new graduate nurse, who is preparing to administer medications, knows that what is required for a drug to move through the body? A) Selectivity and effectiveness B) The ability to cross membranes C) Development of an electric charge D) A transporter protein

Correct: B To move through the body, drugs must cross membranes. They cross membranes to enter the bloodstream, to exit the bloodstream and reach the site of action, and to undergo metabolism and excretion. Selectivity and effectiveness are not related to drug movement. Development of an electric charge (ionization) reduces a drug's ability to be absorbed. Transporter proteins are not required for drugs to move through the body.

A nurse prepares to administer a newly prescribed medication to a 22-year-old woman. The insert in the medication package states, "Category X." Select the nurse's best action. A) Ask the patient, "Have you been sexually active during the past year?" B) Ask the patient, "When was your last menstrual period?" C) Inform the patient of the primary actions of the medication. D) Assess the patient for a history of sexually transmitted disease

Correct: B Category X means that the drug will be harmful to the fetus if the patient is pregnant. The patient may not know she is pregnant; therefore, asking her when her last menstrual period occurred gives the nurse a better indication of whether the patient might be pregnant.

The nurse is caring for a patient with epilepsy who is on anticonvulsant therapy and is also breast-feeding. Which patient teaching instruction should minimize the risk to the baby? A) "Give the dose just before breast-feeding." B) "Avoid drugs that have a long half-life." C) "Discontinue the drug until you have stopped breast-feeding." D) "Increase your fluid intake."

Correct: B Dosing immediately after breast-feeding minimizes the drug concentration in milk. Drugs with a shorter half-life are excreted by the mother more quickly. If possible, drugs should be avoided during breast-feeding; however, patients with chronic illnesses, such as epilepsy, may require medication for their own health. The maternal fluid intake is not related to medication safety during breast-feeding.

The nurse will monitor which laboratory result closely when administering medications to an older adult patient while assessing for adverse drug reactions (ADRs)? A) Serum creatinine levels B) Creatinine clearance C) Serum albumin levels D) Liver function tests

Correct: B Drug accumulation secondary to reduced renal excretion is the most important cause of ADRs in the elderly. Creatinine clearance, not serum creatinine levels, is the proper index of renal function in older adult patients.

The nurse administers naloxone to a patient receiving morphine sulfate who has a respiratory rate of 8 breaths per minute. Why? A) Naloxone causes hypersensitivity of the opioid receptors. B) Naloxone prevents the activation of opioid receptors. C) Naloxone is a partial agonist, requiring a lesser dose to achieve pain relief. D) Naloxone is an agonist, leading to desensitization of the opioid receptors.

Correct: B Naloxone is an antagonist, which prevents the activation of opioid receptors, reversing the respiratory depression effects of morphine. Continuous exposure of cells to antagonists can result in hypersensitivity. Continuous exposure of cells to agonists can lead to desensitization, refractoriness, or down-regulation.

The nurse is caring for a group of very young patients receiving a variety of medications. Which concept guides the nurse's care of these patients? A) Drugs given intravenously (IV) leave the body more quickly in infants than in adults. B) Drugs given subcutaneously (SC) remain in the body longer in infants than in adults. C) Gastric emptying time is shorter in infants than in children and adults. D) The blood-brain barrier protects the infant's brain from toxic drugs

Correct: B The very young are at risk for drug effects that are more intense and prolonged than those seen in adults. Drugs given by the SC route reach higher levels and remain in the system longer than in adults. Drugs given IV leave the body more slowly in infants than in adults. Gastric emptying time is prolonged in infants. The blood-brain barrier is not fully developed in infants.

The nurse is caring for a patient who is experiencing a respiratory rate of 6 breaths per minute as a result of a large dose of pain medication. Which term most accurately describes this reaction? A) Side effect B) Toxicity C) Allergic reaction D) Idiosyncratic reaction

Correct: B Toxicity is an adverse drug reaction caused by excessive dosing. A side effect is a nearly unavoidable secondary drug effect produced at a therapeutic dose. An allergic reaction is an immune response. An idiosyncratic effect is an uncommon drug response resulting from a genetic predisposition.

The nurse identifies appropriate use of antimicrobials to prevent infection in which situations? (Select all that apply.) A) Cardiac surgery B) Recurrent urinary tract infections in women C) Anemia D) Treatment of fever of unknown origin E) Hysterectomy

A,B,E Prophylactic use of antibiotics can reduce the incidence of infection in certain kinds of surgery. Procedures in which prophylactic efficacy has been documented include cardiac surgery, peripheral vascular surgery, orthopedic surgery, and surgery on the gastrointestinal (GI) tract (stomach, duodenum, colon, rectum, and appendix). Prophylaxis is also beneficial for women undergoing a hysterectomy or an emergency cesarean section. Severe neutropenia, not anemia puts individuals at high risk of infection. In young women with recurrent urinary tract infection, prophylaxis with trimethoprim/sulfamethoxazole may be helpful. Unless the cause of a fever is a proven infection, antibiotics should not be used. Fever by itself constitutes a legitimate indication for antibiotic use only when the fever occurs in a severely immunocompromised person. Because fever may indicate infection and because infection can be lethal to immunocompromised individuals, these patients should be given antibiotics when fever occurs, even if fever is the only indication that an infection may be present.

The nurse identifies which statements about Stevens-Johnson syndrome as true? (Select all that apply.) A) Patients with Stevens-Johnson syndrome have a mortality rate of about 25%. B) Toxemia is associated with Stevens-Johnson syndrome. C) Short-acting sulfonamides do not induce Stevens-Johnson syndrome. D) Patients with Stevens-Johnson syndrome usually are hypothermic. E) Lesions of the mucous membranes are a characteristic of Stevens-Johnson syndrome.

A,B,E Short-acting sulfonamides do induce Stevens-Johnson syndrome on rare occasions, and patients with Stevens-Johnson syndrome usually are hyperthermic. The other three statements are true.

The nurse identifies terbinafine [Lamisil] as useful for treating which conditions? (Select all that apply.) A. Onychomycosis B. Tinea corporis C. Oropharyngeal candidiasis D. Vulvovaginal candidiasis E. Tinea pedis

A,B,E Terbinafine [Lamisil] is highly active against dermatophytes and is used to eradicate fungal infection of the nails (onychomycosis) and as topical therapy for ringworm infections (tinea corporis, tinea pedis). It is not effective against oropharyngeal and vulvovaginal candidiasis.

A nurse administering flu vaccines at an annual clinic should recognize that which individuals should be vaccinated, as recommended by the Advisory Committee on Immunization Practices (ACIP)? (Select all that apply.) A) Women who will be pregnant during flu season B) All children 6 months and older and older adults C) Those who report severe allergy to chicken eggs D) Those who have a history of Guillain-Barré syndrome E) Those 6 months to 18 years old receiving aspirin therapy

A,B,E The ACIP recommends flu vaccination for all children 6 months and older and for older adults. Individuals at high risk of complications from the flu who also should be vaccinated include women who will be pregnant during flu season and children receiving long-term therapy with aspirin (to prevent Reye's syndrome). Influenza vaccines are produced from viruses grown in eggs and should be avoided in persons with allergies to chicken eggs. Influenza vaccine may carry a small risk of Guillain-Barré syndrome, a paralyzing neuromuscular disorder, and should be avoided in those who have experienced it.

Which instructions will the nurse include when teaching a patient about cephalosporin therapy? (Select all that apply.) A) "Notify your healthcare provider if you develop diarrhea." B) "Take aspirin if you develop a headache." C) "Notify your healthcare provider if you develop a rash." D) "Cephalosporins may not be taken with food." E) "Do not take cephalosporins if you have lactose intolerance."

A,C Cephalosporins may enhance bleeding tendencies, so drugs such as aspirin that may promote bleeding should be avoided. Cephalosporins may be taken with food, and they are safe to take if a patient has lactose intolerance. Severe diarrhea should be reported, because it may indicate the development of C. difficile infection. Any indication of an allergic reaction, including a rash, should be reported to the healthcare provider.

Which medications does the nurse identify as having antibacterial properties? (Select all that apply.) A) Rifampin B) Zidovudine C) Imipenem D) Amphotericin B E) Amantadine

A,C Zidovudine and amantadine are antiviral drugs. Amphotericin B is an antifungal drug. Rifampin and imipenem are antibacterial drugs

The nurse identifies rifampin as useful in the treatment of which disorders? (Select all that apply.) A. Tuberculosis B. Active meningococcal infection C. Leprosy D. Prophylaxis of meningitis caused by Haemophilus influenzae E. C. difficile infection

A,C,D Rifampin is useful in the treatment of tuberculosis and can be used for prophylaxis of meningitis caused by H. influenzae. The treatment of leprosy is an unlabeled use. Rifampin is indicated for treatment of carriers of meningococcal infection, but not for active meningococcal infection. Rifampin is not indicated for the treatment of C. difficile infection.

The human immunodeficiency virus (HIV) uses which enzymes to replicate and infect a host cell? (Select all that apply.) A) Integrase B) Dihydrofolate reductase C) Reverse transcriptase D) Carbonic anhydrase E) Protease

A,C,E HIV is a retrovirus that replicates itself in a host cell by transcribing RNA into DNA. The enzyme used for this process is viral RNA-dependent DNA polymerase, commonly known as reverse transcriptase. HIV DNA becomes integrated into the host's DNA under the influence of a viral enzyme called integrase. Final maturation of HIV depends on protease, which breaks large HIV polyproteins into smaller, functional forms. Dihydrofolate reductase and carbonic anhydrase are other enzymes used to catalyze chemical cellular reactions, but they are not participants in HIV replication.

A nurse should recognize that antibiotic prophylaxis is appropriate in patients with which medical conditions? (Select all that apply.) A) Aortic valve replacement B) Ruptured appendix C) Bronchitis D) Neutropenia E) Chickenpox

A,D Antibiotic prophylaxis is appropriate and effective in certain situations. These include patients who have prosthetic valves and are at risk for bacterial endocarditis. The use of antibiotics in "dirty" surgeries, such as those for ruptured organs, is considered treatment, not prophylaxis. Severe neutropenia can put patients at risk for severe infection, and antibiotics can reduce infections but may encourage fungal invasion. Antibiotics are not prescribed preventively for bronchitis or chickenpox.

When teaching a patient about therapy with Famciclovir, which statement(s) does the nurse include? (Select all that apply.) A) Famciclovir is generally well tolerated. B) Famciclovir is safe to use during pregnancy. C) Famciclovir is administered intravenously. D) Famiciclovir is used in the treatment of acute herpes zoster. E) Famiciclovir is contraindicated in the treatment of herpes simplex genitalis.

A,D Famiciclovir is generally well tolerated and is used in the treatment of acute herpes zoster as well as herpes simplex genitalis. The safety of Famiciclovir during pregnancy and breat-feeding and in children younger than 18 years has not been established. Famiciclovir is supplied in tablets for oral dosing.

Which is a true statement about new drug development? (Select all that apply.) A) Preclinical testing of drugs is always performed in healthy, nonpregnant adults. B) Drug trials require that those involved not know which subjects are receiving the drug or control. C) During preclinical testing, drugs are evaluated for toxicities, kinetic properties, and useful effects. D) When a new drug is released, all adverse effects are known.

Correct: B, C Preclinical drug testing is not performed in humans; it is done mostly in animals. Because drug testing occurs in a relatively small number of patients, those patients are carefully selected, the drug is taken for a relatively short time, and not all adverse effects are detected during the drug testing process. During the testing process, randomized controlled trials are used, in which the participants are unaware of which subjects are getting drug, placebo, or control. Kinetics, toxicities, and effectiveness are tested during the preclinical phase of drug testing.

When administering an IV medication, the nurse injects the medicine in what minimum amount of time to reduce the risk of injury to the patient? A) 10 seconds B) 30 seconds C) 60 seconds D) 30 minutes

Correct: C IV drugs should be injected over at least 1 minute or longer, because all the blood in the body is circulated about once every minute. This allows the drug to be diluted in the largest volume of blood possible.

Which is a true statement about new drug development in the United States? A) Development and testing of new drugs take about 3 to 5 years. B) About 50% of drugs undergoing clinical trials gain approval. C) Randomized controlled trials are the best way to assess drug therapy. D) The cost of developing a new drug is usually around $1 million.

Correct: C New drug development takes about 6 to 12 years, and costs can exceed $ 1 billion. Only about 1 in 5 drugs undergoing clinical trials gains approval. Randomized controlled trials are the most reliable way to objectively assess drug therapies and are used to evaluate all new drugs.

What term is commonly used for nonprescription drugs? A) Legend B) Generic C) Over-the-counter D) Pharmaceutical

Correct: C Over-the-counter (OTC) drugs are also known as nonprescription drugs.

Which legislation set rules for the manufacture and distribution of drugs considered to have the potential for abuse? A) Food, Drug, and Cosmetic Act of 1938 B) Harris-Kefauver Amendments of 1962 C) Controlled Substances Act of 1970 D) Food and Drug Administration Modernization Act of 1997

Correct: C The Controlled Substances Act of 1970 set rules covering drugs of abuse and defined categories of controlled substances.

Why are trade names much easier to say and remember than generic names? A) The FDA assigns every drug's generic name. B) Trade names must be the same regardless of which drug company manufactures the drug. C) Companies have a marketing advantage when the trade name is easier to recognize. D) Trade names improve oral and written communication in the healthcare system.

Correct: C The U.S. Adopted Names Council assigns a drug's generic name. Generic names, not trade names, are the same regardless of which company manufactures the drug. Trade names do not contribute to ease and clarity of communication in the healthcare system, because healthcare professionals do not always know what compound is described by the trade name.

The nurse is administering a drug with a low therapeutic index and monitors the patient closely. Why? A) The average lethal dose of the drug is much higher than the therapeutic dose. B) The dose required to produce a therapeutic response in 50% of patients is low. C) The highest dose needed to produce a therapeutic effect is close to the lethal dose. D) There is a low variability of responses to this drug

Correct: C A low therapeutic index indicates that the high doses needed to produce therapeutic effects in some people may be large enough to cause death. A high therapeutic index is more desirable, because the average lethal dose is higher than the therapeutic dose. Low variability of responses to a drug is not the definition of a low therapeutic index.

Which drug property is most enhanced by the presence of many different types of receptors throughout the body? A) Potency B) Safety C) Selectivity D) Convenience

Correct: C Because each receptor regulates just a few processes, selective drug action is possible. Multiple types of receptors do not have as much effect on potency, safety, or convenience.

The nurse is caring for a patient who has jaundice, dark urine, malaise, light-colored stools, nausea, and vomiting. This patient is most likely experiencing what? A) An idiosyncratic drug effect on the bone marrow B) Iatrogenic disease of the kidneys C) Drug toxicity of the liver D) An allergic reaction

Correct: C Drug toxicity is an adverse drug reaction in which certain drugs are toxic to specific organs. Signs and symptoms of liver toxicity include jaundice, dark urine, light-colored stools, nausea, vomiting, malaise, abdominal discomfort, and loss of appetite.

The drug the nurse is about to give induces P-glycoprotein (PGP). What outcome might the nurse expect when this drug is given with other drugs? A) Increased levels of other drugs B) Increased side effects of other drugs C) Reduced absorption of other drugs D) Reduced drug elimination

Correct: C Drugs that induce PGP can cause reduced absorption of other drugs, which would reduce their levels. A PGP inducer would not increase the side effects of other drugs and could increase elimination of other drugs.

The nurse understands that the dose-response relationship is graded and therefore would expect to observe what? A) Once a drug is given, the response is predictably all-or-nothing. B) The response is maintained at a specific level when the therapeutic objective is achieved. C) As the dosage increases, the response becomes progressively greater. D) A graded response is based on relative potency and maximal efficacy.

Correct: C If drug responses were all-or-nothing instead of graded, drugs could produce only one intensity level of response. The response may be maintained at a specific level when the therapeutic objective is achieved, but that option does not pertain to a dose-response relationship that is graded.

The nurse is caring for a patient with acute renal failure. The nurse should carefully assess for what? A) Increased drug excretion B) Decreased drug levels in the blood C) Accumulation of drugs in the body D) Increased tolerance to the medication

Correct: C Kidney disease can reduce drug excretion, causing drugs to accumulate in the body. If the dosage is not lowered, the drug may accumulate to toxic levels.

The nurse demonstrates the concept of maximal efficacy by administering which drug for a headache that the patient describes as a "mild dullness" and a 2 and on a 1-10 scale? A) Meperidine (Demerol) B) Pentazocine (Talwin) C) Acetaminophen (Tylenol) D) Morphine sulfate

Correct: C Maximal efficacy is the greatest effect a drug can produce. Potency is the amount of drug that must be given to elicit an effect. Maximal efficacy illustrates the fact that all drugs have a maximal effect, and dosages beyond this do not increase the effect. The goal is to match the intensity of the response to the patient's needs; therefore, a drug with high maximal efficacy is not always most desirable. Demerol, Talwin, and morphine all have a higher maximal efficacy than Tylenol; therefore, Tylenol is the most desirable drug for a headache rated as "mild."

The nurse is preparing to begin giving phenobarbital, which is known to induce CYP isozymes, to a patient on oral contraceptives. What patient teaching will the nurse expect to provide for this patient? A) "Continue taking your medications as prescribed." B) "Condoms are not necessary while taking phenobarbital. It is not an antibiotic." C) "Plan to use another form of birth control while taking phenobarbital." D) "Your dose of birth control pills will be reduced while you are taking phenobarbital."

Correct: C Phenobarbital induces CYP isozymes; therefore, it will increase the metabolism of other drugs. Because phenobarbital is an inducer, it will increase the metabolism of oral contraceptives. The nurse would anticipate that this would likely reduce the blood levels of birth control pills. The patient should use another form of birth control while taking phenobarbital.

The nurse is monitoring a group of patients for adverse drug reactions (ADRs). Which patient is most at risk for developing drug toxicity? A) A 30-year-old man admitted for altered mental status B) A 55-year-old woman with abnormal arterial blood gas values C) A 70-year-old woman with an elevated creatinine level D) A laboring 25-year-old woman with a positive Homans' sign

Correct: C The liver, kidneys, and bone marrow are important sites of drug toxicity. Creatinine is a measure of kidney function and would be the most helpful for monitoring for ADRs. In addition, patients over age 60 are at greater risk for ADRs. Mental status is a measure of central nervous system (CNS) function, which may be affected by drugs but is not one of the most important and common sites of drug toxicity. Arterial blood gas measurements reflect respiratory and acid-base function. Homans' sign is used to detect deep vein thromboses.

A new medication becomes available for treatment of a debilitating neurologic disease. What would the nurse expect about the safety of the drug? A) The drug is safe for administration to children. B) The drug has been tested in pregnant women. C) All possible adverse effects have been identified by animal testing. D) The drug has passed the FDA approval process.

Correct: D A new medication must meet the FDA's stringent requirements before it comes to market. Most drugs have not been tested in women (including pregnant women) or children. Animal testing cannot identify all possible adverse effects.

The nurse should provide which teaching point when administering an enteric-coated oral tablet to a patient? A) "Chew the tablet before swallowing." B) "Break the tablet in half before swallowing." C) "Allow the tablet to be absorbed under the tongue." D) "Swallow the tablet whole after double-checking the dose."

Correct: D Enteric-coated tablets are covered with a material designed to dissolve in the intestine instead of the stomach. They should not be chewed or broken before administration. Sublingual tablets are placed under the tongue for absorption and are not enteric coated.

The nurse should strictly follow safety precautions when administering intravenous (IV) medications for which reason? A) The IV route can result in delayed absorption of the medication. B) The IV route results in a delayed onset of action. C) Control over the levels of drug in the body is unpredictable. D) IV administration is irreversible.

Correct: D The IV route allows precise control over levels of drug in the blood and a rapid onset of action. Absorption of IV medication is instantaneous and complete. Once a drug has been injected, there is no turning back; the drug is in the body and cannot be retrieved.

When assessing for drug effects in the older adult, which phase of pharmacokinetics is the greatest concern? A) Absorption B) Distribution C) Metabolism D) Excretion

Correct: D Although pharmacokinetic changes in older adults affect all phases of kinetics, drug accumulation secondary to reduced renal excretion is the most important cause of ADRs in the older adult

The nurse is caring for a pregnant patient who has chronic asthma. When administering medications to this patient, the nurse should do what? A) Give the medications as ordered, because most drugs do not cross the placenta. B) First assess the creatinine level, because renal blood flow decreases during pregnancy. C) Hold the medications and notify the ordering physician, because drugs that are not known teratogens may not be safe during pregnancy. D) Advise the patient that taking asthma medications during pregnancy improves fetal outcomes.

Correct: D Essentially all drugs can cross the placenta. Renal blood flow increases during pregnancy, which increases the clearance of some drugs, such as lithium. Lack of proof of teratogenicity does not mean that a drug is safe; it only means that the available data are insufficient to make a definitive judgment. Uncontrolled maternal asthma is more dangerous to the fetus than the drugs used to treat it.

A teratogenic drug, such as methotrexate, is most likely to cause learning deficits during which phase of fetal development? A) Conception through week 2 B) Weeks 3 to 8 C) First trimester D) Second and third trimesters

Correct: D Exposure to teratogens during the second and third trimesters usually disrupts function rather than producing obvious anatomic abnormalities. Exposure to teratogens during the first 2 weeks of pregnancy usually results in an "all-or-nothing" response that may result in fetal death. Exposure during the remainder of the first trimester may result in anatomic malformations

A nursing student is caring for a patient who has been taking morphine sulfate for pain for 2 weeks. The nursing student shows an understanding of pharmacodynamic tolerance by describing it to the instructor in what way? A) "It is a form of tolerance that is a reduction in drug responsiveness brought on by repeated dosing over a short period." B) "It affects the minimum effective concentration." C) "It is a drug response caused by psychologic factors, not by biochemical or physiological properties." D) "It is a condition in which the patient requires increased doses of morphine sulfate to achieve pain relief."

Correct: D Pharmacodynamic tolerance is the phenomenon of decreased responsiveness to a drug as a result of repeated drug administration. Tachyphylaxis is a form of tolerance brought on by repeated dosages over a short period (less than 24 hours). Metabolic tolerance results from accelerated drug metabolism and not repeated dosages; therefore, the minimum effective concentration is not affected. The placebo effect is a drug response caused by psychologic factors and not by the drug's properties.

A nurse develops a plan of care for a patient who has an outbreak of recurrent genital herpes and is taking oral acyclovir (Zovirax). Which outcome should be included? A) Minimal scarring from lesions B) Less frequent eruption of lesions C) Prevention of transmission to contacts D) Complete eradication of the virus

B Acyclovir is used to treat herpes simplex infections caused by type 2 herpes simplex virus (HSV-2). For patients with recurrent herpes genitalis, oral therapy reduces the frequency with which lesions appear. It does not eradicate the virus or produce cure. Acyclovir does not prevent transmission of the virus to sexual contacts. It does not affect scarring from lesions.

When administering an aminoglycoside to a patient with myasthenia gravis, it is most important for the nurse to assess what? A) Deep tendon reflexes B) Breath sounds C) Eyelid movement D) Muscle strength

B Aminoglycosides can inhibit neuromuscular transmission, causing potentially fatal respiratory depression. Patients with myasthenia gravis (MG) are at an increased risk. Deep tendon reflexes, eyelid movement, and muscle strength are important assessments for a patient who has MG, but they are not as important as airway and breathing ability.

Which instructions should a nurse provide to a patient who is to start taking amoxicillin/clavulanate (Augmentin)? A) "Take Augmentin once per day and only at bedtime." B) "Augmentin may be taken with food or meals." C) "Avoid taking Augmentin with grapefruit juice." D) "Use a minimal amount of liquid to swallow the Augmentin."

B Amoxicillin/clavulanate is a broad-spectrum aminopenicillin that may be taken with meals. Most other oral penicillins must be taken with a full glass of water 1 hour before or 2 hours after meals. Taking oral penicillins only at bedtime, avoiding grapefruit juice, and taking the drug with only minimal water are not necessary.

The development of a new infection as a result of the elimination of normal flora by an antibiotic is referred to as what? A) Resistant infection B) Superinfection C) Nosocomial infection D) Allergic reaction

B Antibiotic therapy can destroy the normal flora of the body, which normally would inhibit the overgrowth of fungi and yeast. When the normal flora is decreased, these organisms can overgrow and cause a new infection, or superinfection

What does the nurse identify as an adverse effect of clindamycin (Cleocin) therapy? A) Cyanosis and gray discoloration of the skin B) Frequent loose, watery stools with mucus and blood C) Reduction in all blood cells produced in the bone marrow D) Elevated bilirubin, with dark urine and jaundice

B Clostridium difficile-associated diarrhea (CDAD) is the most severe toxicity associated with clindamycin and is characterized by profuse, watery stools. The cause is superinfection of the bowel with Clostridium difficile, an anaerobic gram-positive bacillus. Gray syndrome, which usually occurs in infants and those with aplastic anemia, is an adverse effect of chloramphenicol (Chloromycetin). Hepatotoxicity is associated most closely with telithromycin (Ketek).

A patient is taking daptomycin [Cubicin]. The nurse should obtain a creatine phosphokinase (CPK) level when the patient shows what? A. Increased urination and urinary urgency B. Muscle pain and weakness C. Abdominal bloating and diarrhea D. Headache and visual disturbances

B Daptomycin is one of the cyclic lipopeptides, a class of antibiotics that can kill gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA). It may pose a small risk of myopathy (muscle injury). Patients should be warned about muscle injury and told to report any pain or weakness. In addition, CPK levels should be measured weekly. Increased urination and urinary urgency, abdominal bloating and diarrhea, and headache and visual disturbances are not associated with daptomycin.

A patient has been prescribed efavirenz (Sustiva). The nurse should instruct the patient to use which administration approach to minimize central nervous system (CNS) adverse effects? A) The drug should be taken in divided doses throughout the day. B) Bedtime dosing is most effective. C) The drug should be mixed only with an acidic beverage. D) A steroid medication should be used concurrently.

B Efavirenz frequently causes CNS symptoms of dizziness, impaired consciousness, drowsiness, vivid dreams, and nightmares. Bedtime dosing can minimize CNS effects, which typically resolve in 2 to 4 weeks. Mixing with an acidic beverage, using a steroid medication concurrently, and taking efavirenz in divided doses throughout the day are not effective means of minimizing CNS effects.

The nurse develops a care plan for a patient in the continuation phase of treatment for active tuberculosis (TB). The care plan includes teaching about which medication regimen? A. Pyrazinamide and ethambutol B. Isoniazid and rifampin C. Ethambutol and isoniazid D. Rifampin and ethambutol

B If drug resistance is not a factor, treatment for active TB consists of a four-drug induction phase and a two-drug continuation phase. The continuation phase lasts at least 4 months, and therapy consists of two drugs—isoniazid and rifampin. Pyrazinamide and ethambutol, ethambutol and isoniazid, and rifampin and ethambutol are not the preferred regimens for the continuation phase.

A patient taking a sulfonamide is breast-feeding an infant. Which complication in the infant would the nurse associate with kernicterus? A) Hemolytic anemia B) Neurologic deficits C) Hepatocellular failure D) Ophthalmic infection

B Kernicterus is a disorder in newborns caused by deposition of bilirubin in the brain, which leads to severe neurologic deficits and death. Sulfonamides promote kernicterus by displacing protein-bound bilirubin from the proteins, leaving newly freed bilirubin access to brain sites. Sulfonamides are not administered to infants under 2 years old, nor are they given to pregnant patients near term or nursing mothers. Hemolytic anemia, hepatocellular failure, and ophthalmic infection are not associated sulfonamide effects in infants.

When caring for a patient receiving mafenide (Sulfamylon) for treatment of a severe burn, it is most important for the nurse to monitor which laboratory value? A) Blood glucose level B) Acid-base status C) Sodium level D) Peak mafenide level

B Mafenide (Sulfamylon) therapy is associated with the development of acidosis. Peak mafenide levels are not obtained. The blood glucose and sodium levels are not affected by mafenide.

A patient who takes multiple antibiotics starts to experience diarrheal stools. The nurse anticipates administration of which antibiotic if a stool sample tests positive for Clostridium difficile? A. Rifaximin [Xifaxan] B. Metronidazole [Flagyl] C. Daptomycin [Cubicin] D. Gemifloxacin [Factive]

B Metronidazole is the treatment of choice for antibiotic-associated colitis caused by C. difficile. Rifaximin, daptomycin, and gemifloxacin are not used in the treatment of C. difficile infection.

A nurse planning care for a patient who is receiving nystatin [Mycostatin] should establish which outcome on the care plan? A. Relief of nasal congestion B. Decrease in mouth pain C. Productive cough D. Absence of urticaria

B Nystatin is an antifungal medication that is used for candidiasis of the skin, mouth, esophagus, intestine, and vagina. It can be administered orally and topically and will heal mouth lesions from oral candidiasis. Nystatin has no effect on nasal congestion and cough production. It does not cause urticaria.

Which instruction should a nurse include in the discharge teaching for a patient who is to start taking tetracycline (Sumycin)? A) "You may stop taking the pills when you begin to feel better." B) "Use sunscreen and protective clothing when outdoors." C) "You'll have to come back to the clinic for weekly blood work." D) "Take the medication with yogurt or milk so you won't have nausea."

B Tetracyclines are bacteriostatic antibiotics; photosensitivity and severe sunburn are common adverse effects. A full course of antibiotics must always be taken. Blood studies are not necessary for therapeutic levels. Absorption decreases after ingestion of chelates, such as calcium and magnesium, so doses should be given 2 hours before or 2 hours after ingestion of milk products.

A nurse should recognize that which laboratory result is used as a major factor in deciding when antiretroviral therapy is indicated for a patient infected with HIV? A) Plasma HIV RNA assay B) CD4 T-lymphocyte count C) Western blot assay D) OralQuick Rapid HIV-1 Antibody Test

B The CD4 T-cell count is the principal indicator of how much immunocompetence remains when a patient is infected with HIV. It is used as a guide in the initiation, discontinuation, and resumption of medications for opportunistic infections. A plasma HIV RNA assay is a measure of viral load that indicates HIV replication and magnitude and accordingly is used to predict clinical outcomes. The Western blot assay and OralQuick Rapid HIV-1 Antibody Test, respectively, are used for initial screening and follow-up confirmation of HIV infection.

What is the minimum bactericidal concentration (MBC)? A) The lowest concentration of an antibiotic needed to suppress bacterial growth completely B) The lowest concentration of an antibiotic needed to reduce the number of bacterial colonies by 99.9% C) The lowest concentration of an antibiotic needed to produce effects D) The lowest dose of an antibiotic needed to eradicate bacteria

B The MBC is the lowest concentration of drug that produces a 99.9% decline in the number of bacterial colonies (indicating bacterial kill). The lowest antibiotic concentration needed to suppress bacterial growth or to produce effects and the lowest antibiotic dose needed to eradicate bacteria are incorrect descriptions of MBC.

The nurse is assessing a patient who is receiving a sulfonamide for treatment of a urinary tract infection. To monitor the patient for the most severe response to sulfonamide therapy, the nurse will assess for what? A) Diarrhea B) Skin rash and lesions C) Hypertension D) Bleeding

B The nurse's priority is to monitor for hypersensitivity reactions. The most serious response to sulfonamide therapy is Stevens-Johnson syndrome, which manifests as symptoms of the skin and mucous membranes, lesions, fever, and malaise. In rare cases, hematologic effects occur, requiring periodic blood studies.

Before administering intravenous (IV) penicillin, the nurse should do what? A) Flush the IV site with normal saline. B) Assess the patient for allergies. C) Review the patient's intake and output record. D) Determine the latest creatinine clearance result.

B The principal adverse effect of penicillins is allergic reaction. Penicillins are contraindicated in patients with a history of severe allergic reactions to penicillins, cephalosporins, or carbapenems. IV patency is important, as is monitoring renal function, because impairment can cause penicillins to reach toxic levels; however, these are not as important as determining allergy status.

A nurse obtains a specimen from which body fluid when performing the QuantiFERON-TB Gold (QFT-G) test for latent tuberculosis? A. Saliva B. Blood C. Urine D. Sputum

B The specimen for the QFT-G test is obtained from blood, not from saliva, urine, or sputum. It is a new test for latent TB and is as sensitive as the tuberculin skin test and more specific. The results are available within 24 hours, and unlike with the skin test, a follow-up visit to a healthcare provider's office is not required.

Before administering trimethoprim, it is most important for the nurse to assess the patient for a history of what? A) Heart failure B) Alcoholism C) Diabetes D) Emphysema

B Trimethoprim inhibits bacterial synthesis of folic acid. It is avoided in patients when folate deficiency is likely, such as in alcoholism, because bone marrow suppression may occur. Heart failure, diabetes, and emphysema are unrelated to adverse effects with trimethoprim.

A nurse is administering a daily dose of tobramycin (Nebcin) at 1000. At which time should the nurse obtain the patient's blood sample to determine the trough level? A) 0800 B) 0900 C) 1130 D) 1200

B Trough levels determine the lowest level between doses. Blood is drawn just before the next dose is administered when a divided dose is used or 1 hour before the next dose if a single daily dose is used.

The nurse identifies which host factor as the most important when choosing an antimicrobial drug? A) Age B) Competent immune function C) Genetic heritage D) Previous medication reactions

B Two factors—host defenses and the site of infection—are unique to the selection of antibiotics. It is critical for success that antibiotics act synergistically with the immune system to subdue infection. Other host factors, such as age, genetic heritage, and previous drug reactions, are the same factors that must be considered when choosing any other medication.

Which cardiovascular finding does the nurse identify as a possible adverse effect of erythromycin (Ery-Tab) therapy? A) Heart rate of 52 beats per minute B) Prolonged QT interval C) Jugular vein distention D) Grade III diastolic murmur

B When present in high levels, erythromycin can prolong the QT interval, causing a potentially fatal ventricular dysrhythmia. It should be avoided by patients taking class IA or class III antidysrhythmic medications or others that inhibit metabolism.

The nurse knows that there is an increased risk of ototoxicity in a patient receiving an aminoglycoside if which level is high? A) Concentration B) Trough C) Peak D) Dose

B When trough levels remain elevated, aminoglycosides are unable to diffuse out of inner ear cells, thus exposing the cells to the medication for an extended time. Prolonged exposure (i.e., high trough levels), rather than brief exposure to high levels, underlies cellular injury.

When studying the effects of drugs in humans, the nurse is learning about what? A) Pharmacology B) Clinical pharmacology C) Therapeutics D) Effectiveness

B) Clinical Pharmacology Clinical pharmacology is the study of the effects of drugs in humans. Pharmacology can be defined as the study of drugs and their interactions with living systems, Therapeutics, also known as pharmacotherapeutics, is the use of drugs to diagnose, prevent, or treat disease or to prevent pregnancy. The term effectiveness indicates that the drug elicits the intended response or responses.

The nurse teaches a patient not to consume alcohol with nitroglycerine, because the blood pressure often drops significantly when nitroglycerine is taken with alcohol. Which drug property does this illustrate? A) Chemical instability B) Drug interaction C) Reversible action D) Drug selectivity

B) Drug Interaction When two or more drugs are taken together, they can interact, causing either increased or decreased drug responses. In this case, alcohol would increase the nitroglycerine response. Chemical instability, reversible action, and drug selectivity are not related to this situation.

Which aspect of drug therapy indicates to the nurse whether a drug is having a beneficial effect? A) Performing a preadministration assessment B) Evaluating therapeutic responses C) Minimizing adverse effects D) Managing toxicity

B) Evaluatig therapeutic responses Evaluation is one of the most important aspects of drug therapy, because it tells the nurse whether a drug is having its intended effect. The other aspects of drug administration are important but do not give information about a drug's effectiveness.

The nurse is managing the care of a group of patients with cancer who will be receiving chemotherapy. The nurse defines goals, sets priorities, identifies interventions, and establishes criteria for evaluating success. Which phase of the nursing process does this represent? A) Assessment B) Planning C) Implementation D) Evaluation

B)Planning These activities are all carried out in the planning phase of the nursing process. Assessment is a time of data gathering, implementation begins with carrying out the interventions, and evaluation is performed to determine the degree to which treatment has succeeded

The nurse is caring for a group of older adult patients who are all receiving multiple medications. The nurse understands that it is essential to individualize each patient's therapy. Which is the best rationale for this practice? A) The percentage of drug absorbed often is decreased in older adults. B) Most older adults have decreased body fat and increased lean mass. C) Hepatic metabolism tends to increase in older adults, resulting in decreased drug levels. D) Renal function declines with age, leading to decreased drug excretion

Correct: D Renal function declines in older adults, leading to decreased excretion and potential drug accumulation. Although absorption may be delayed in older adults, the percentage absorbed does not change. Most older adult patients have increased body fat and decreased lean mass. Hepatic metabolism tends to decline with age.

A patient who has human immunodeficiency virus (HIV) infection has a tuberculin skin test (TST) for latent tuberculosis. The nurse assesses the result 48 hours after the injection. An induration of what size indicates that the patient needs to be treated for latent tuberculosis? A. 1 mm B. 2 mm C. 3 mm D. 5 mm

D A positive reaction on the TST is indicated by an area of induration (hardness) around the injection site. The decision to treat latent tuberculosis is based on the risk category and size of the induration area. Treatment is recommended in high-risk individuals, such as those with HIV infection, for an induration of 5 mm. An induration of 10 mm is required to treat moderate-risk individuals. An induration of more than 15 mm is required to treat low-risk individuals.

It is most important for the nurse to assess a patient receiving a cephalosporin for the development of which manifestation of antibiotic-associated pseudomembranous colitis (AAPMC)? A) Rigidity B) Ileus C) Ascites D) Diarrhea

D AAPMC, which is manifested initially by diarrhea and abdominal cramping, especially may develop with the use of broad-spectrum cephalosporins. Rigidity, ileus, and ascites are unrelated to cephalosporin use.

A nurse is assessing the effects of antimicrobial therapy in a patient with pneumonia. The nurse should establish which outcomes when planning care? (Select all that apply.) A) Potassium level of 4 mEq/dL B) Reduction of fever C) Sterile sputum cultures D) Oxygen saturation of 98% E) Elastic skin turgor

B,C,D Antimicrobial therapy is assessed by monitoring clinical and laboratory responses. Clinical indicators of success in a patient with pneumonia may include afebrile status and resolution of an infectious infiltrate, resulting in an oxygen saturation above 95%. The disappearance of infectious organisms from post-treatment cultures also indicates resolution of infection. Potassium levels and elastic skin turgor are not assessment parameters for clinical infections, including pneumonia.

When performing a skin test for penicillin allergy, the nurse will do what? (Select all that apply.) A) Inject a tiny amount of the allergen subcutaneously. B) Observe for a local allergic response. C) Have epinephrine readily available. D) Have respiratory support readily available. E) Administer diphenhydramine (Benadryl) as the first-line agent should anaphylaxis occur.

B,C,D For a penicillin allergy skin test, a small amount of allergen is injected intradermally. The nurse observes for a local allergic reaction and has epinephrine and respiratory support readily available. Epinephrine is administered as the first-line agent should anaphylaxis occur.

Which manifestations does the nurse associate with the development of hemolytic anemia? (Select all that apply.) A) Urticaria B) Fever C) Pallor D) Jaundice E) Diarrhea

B,C,D Urticaria and diarrhea are not associated with the development of hemolytic anemia. Fever, pallor, and jaundice are associated with the development of hemolytic anemia.

Which statements about CDAD associated with clindamycin therapy does the nurse identify as true? (Select all that apply.) A) Leukopenia commonly occurs. B) It is a potentially fatal condition. C) Patients usually experience abdominal pain. D) Anticholinergics are effective in treating the diarrhea. E) Clindamycin therapy should be discontinued and vancomycin started.

B,C,E CDAD is a potentially fatal condition in which patients experience abdominal pain. If CDAD develops, clindamycin therapy should be stopped and vancomycin or metronidazole therapy started. Leukocytosis, not leukopenia, develops. Anticholinergics can make the diarrhea worse and therefore should be avoided.

To promote treatment adherence in a patient with tuberculosis, the nurse will include which interventions? (Select all that apply.) A. Use a single medication, to keep the treatment simple. B. Teach the patient about intermittent-dose therapy. C. Teach the patient about the need for long-term treatment. D. Use a signed consent form to enhance patient compliance. E. Directly watch the patient take the medication.

B,C,E In patients with TB, nonadherence is the most common reason for treatment failure, relapse, and increased medication resistance. Because treatment is necessary for at least 6 months, directly observed therapy (DOT) is a standard of care, as is intermittent dosing. Multiple medication regimens are needed to prevent drug resistance. Education about the length of treatment and the regimen is essential to compliance. A signed consent form does not increase patient compliance.

Which are examples of the improper use of antibiotic therapy? (Select all that apply.) A) Using surgical drainage as an adjunct to antibiotic therapy B) Treating a viral infection C) Basing treatment on sensitivity reports D) Treating fever in an immunodeficient patient E) Using dosing that results in a superinfection

B,E Common misuses of antibiotics include (1) treatment of a viral infection, which results in exposure of the patient to the risks of the medication without providing any benefits; and (2) improper dosing (dosing that is too high results in superinfection). The other answers are examples of the proper use of antimicrobial therapy.

A microbe acquires antibiotic resistance by which means? A) Development of medication resistance in the host B) Over-riding of the minimum bactericidal concentration C) Incorrect dosing, which contributes to ribosome mutations D) Transfer of DNA coding to other bacteria

D All alterations in structure and function result from changes in the microbial genome. The microbe, not the host, becomes medication resistant. Genetic changes in a microbe result either from spontaneous mutation or from acquisition of DNA from conjugation with other bacteria. The minimum bacterial concentration (MBC) is used in testing for drug sensitivity. Incorrect dosing does not lead to microbe mutations.

The nurse identifies what as the first step in the Campaign to Prevent Antimicrobial Resistance, established in 2002 by the CDC? A) Target the pathogen B) Access the experts C) Isolate the pathogen D) Vaccinate

D Although all responses are components of the Campaign to Prevent Antimicrobial Resistance, step one is vaccination.

A patient who is receiving an aminoglycoside (gentamicin) has a urinalysis result with all of these findings. Which finding should a nurse associate most clearly with an adverse effect of gentamicin? A) White blood cells (WBCs) B) Glucose C) Ketones D) Protein

D Aminoglycoside-induced nephrotoxicity usually presents as acute tubular necrosis. Symptoms of concern are protein in the urine, dilute urine, and elevation of the serum creatinine and blood urea nitrogen (BUN) levels. WBCs, glucose, and ketones are not specifically related to gentamicin use.

A patient is receiving amphotericin B. It is most important for the nurse to monitor which laboratory result? A. Serum pH B. Protein level C. Glucose level D. Creatinine level

D Amphotericin B is toxic to cells of the kidneys. To evaluate renal injury, the plasma creatinine level should be monitored every 3 or 4 days, as well as intake and output. It is not necessary to monitor the serum protein or glucose levels or the serum pH in patients taking amphotericin B.