Pharm exam 1 study questions
A patient is being prepared for colon surgery and will be receiving neomycin tablets during the day before surgery. He asks the nurse why he needs to take this medicine before he even has surgery. What is the nurse's best response? "This medicine helps clear out your bowels before surgery." "It helps reduce the number of bacteria in your intestines before surgery." "It is given to sterilize your bowel before surgery." "It is given to prevent an infection after surgery.
"It helps reduce the number of bacteria in your intestines before surgery."
A patient calls the gynecologic clinic because she has begun to menstruate while taking vaginal cream for a vaginal infection. She asks the nurse, "What should I do about taking this vaginal medicine right now?" Which is the nurse's best response? "You need to stop the medication until the menstrual flow has stopped." "Just take the medication at night only." "You should stop the medication for 3 days and then start it again." "It's okay to continue to take the medication."
"It's okay to continue to take the medication."
When asked about drug allergies, a patient says, "I can't take sulfa drugs because I'm allergic to them." Which question will the nurse ask next? "Do you have any other drug allergies?" "Who prescribed that drug for you?" "How long ago did this happen?" "What happened when you took the sulfa drug?"
"What happened when you took the sulfa drug?"
A 78-year-old patient admitted to the hospital with a stroke 2 days earlier has developed a urinary tract infection. His Foley catheter is draining urine that is cloudy and dark yellowish-orange with a strong odor. He is receiving an intravenous heparin infusion and has a history of type 2 diabetes. The physician orders cotrimoxazole (Bactrim). 1. What will the nurse assess before giving this medication? 2. Are there any potential drug interactions? 3. Why was this particular antibiotic chosen? 4. Is this antibiotic bactericidal or bacteriostatic? Explain.
1. He needs to be assessed for renal problems and blood dyscrasias. Also, the use of cotrimoxazole is contraindicated in cases of known drug allergy to sulfonamides or chemically related drugs such as sulfonylureas (used for diabetes), thiazide and loop diuretics, and carbonic anhydrase inhibitors. 2. If he is taking a sulfonylurea for his type 2 diabetes, close monitoring is needed because sulfonamides can potentiate the hypoglycemic effects of sulfonylureas in patients with diabetes. In addition, although he is currently receiving intravenous heparin and not warfarin, he may be switched to oral anticoagulants soon, so keep in mind that sulfonamides can potentiate the anticoagulant effects of warfarin and lead to hemorrhage. 3. These antibiotics achieve very high concentrations in the kidneys, through which they are eliminated. Therefore they are primarily used in the treatment of urinary tract infections. 4. Sulfonamides do not actually destroy bacteria but inhibit their growth. For this reason, they are considered bacteriostatic antibiotics. Bactericidal antibiotics kill bacteria.
Allen, a 40-year-old physician, has been diagnosed with acute lymphocytic leukemia and will be receiving chemotherapy with methotrexate. He is scheduled to receive his first treatment today. 1. What is methotrexate's classification, and how does it work? 2. What laboratory test results should be checked before he receives this medication? 3. Allen tells you that he often has problems with ankle pain from an old injury and takes ibuprofen (Motrin) for pain relief. Is this a concern? 4. What other medications may be given along with the methotrexate chemotherapy? Why?
1. Methotrexate is an antimetabolite—specifically, a folate antagonist. It inhibits the action of an enzyme that is responsible for converting folic acid to a sub-stance used by the cell to synthesize DNA for cell reproduction. As a result, the cell dies. 2. Laboratory test results should be checked for white blood cell and red blood cell counts, hemoglobin level and hematocrit, platelet counts, and renal and liver function studies. 3. The concurrent administration of nonsteroidal anti-inflammatory drugs (NSAIDs) and methotrexate may lead to possible reduced renal elimination of methotrexate with potentially fatal hematologic and gas-trointestinal toxicity. Allen should be instructed to avoid all NSAIDs, including aspirin, while taking methotrexate. 4. Antiemetic therapy will be needed to decrease nausea and vomiting. Leucovorin may be used to protect the patient from potentially fatal bone marrow suppression, a toxic effect of methotrexate.
Mr. C., a 30-year-old stockbroker, has been diagnosed with genital herpes simplex type 2 (HSV-2) infection. The health care provider has prescribed topical acyclovir (Zovirax). 1. What patient teaching do you provide to Mr. C. regarding administration of this drug? 2. Mr. C. asks you how long it will take for the acyclovir to cure his herpes. What is your reply? 3. What else will you discuss with Mr. C., who is sexually active? 4. HSV-2 is closely related to which other viruses?
1. Mr. C. needs to use a glove when applying topical acyclovir (Zovirax) to the affected area, which should be kept clean and dry. Also, he should not use any other creams or ointments on the area. 2. Mr. C.'s herpes infection cannot be "cured," although the acyclovir will help to manage the symptoms. 3. Stress the importance of treatment for Mr. C. and his sexual partner and discuss with him how to prevent transmission of the virus. 4. There are several viruses in the Herpesviridae family, including herpes simplex type 1, which causes mucocutaneous herpes—usually blisters around the mouth; varicella-zoster virus (herpes simplex type 3), which causes both chickenpox and shingles; herpes-virus type 4 (also called Epstein-Barr virus); and herpesvirus type 8, which is believed by some to cause Kaposi's sarcoma, a cancer associated with acquired immunodeficiency syndrome (AIDS).
Dottie, age 63 years, has been diagnosed with midstage ovarian cancer and will be receiving chemotherapy with cisplatin after surgery. She is understandably anxious about the therapy but says she wants to "beat the cancer." 1. Cisplatin is associated with three main toxicities. Describe each one. 2. Before Dottie receives the therapy, what will be assessed? 3. During therapy, Dottie complains of an "odd tingling" in her toes. Is this a concern? Explain. 4. Dottie tells you that she'd rather "drink nothing" when she is feeling nauseated. Is this a concern? Explain what you need to teach her about fluids
1. Nephrotoxicity (possible damage to the kidneys), peripheral neuropathy (possible damage to peripheral nerves), and ototoxicity (possible damage to hearing and vestibular function) 2. Baseline renal studies need to be performed because this drug is highly nephrotoxic. If Dottie is receiving any other drugs that are potentially nephrotoxic (e.g., aminoglycoside therapy), dosage changes will need to be considered. If she has gout, concurrent use of cisplatin may result in hyperuricemia or worsening of the gout. Baseline auditory studies, baseline liver function studies, measurement of white blood cell count, hemoglobin level, hematocrit, and platelet level are needed because of the anticipated bone marrow suppression. 3. Because peripheral neuropathies may occur, numbness, tingling, or pain in the extremities must be reported to the physician immediately to prevent complications and enhance comfort. 4. Yes, this is a concern because dehydration while taking cisplatin may lead to renal damage. Patients who are at home after treatment with this drug need to be reminded of the importance of hydration and need to be told to contact a physician if they experience dry mucous membranes, very dark amber urine, little or no urinary output, or vomiting of large amounts over a period of 8 hours or less. It may be a challenge, but she needs to try to take in 3000 mL of fluid per day to prevent dehydration.
Sally has pneumonia with invasive aspergillosis. She has been treated for 2 weeks without showing much improvement, and the physician is considering starting voriconazole (Vfend) therapy. Sally is also receiving a medication for treatment of a cardiac dysrhythmia. 1. What is the reason for starting voriconazole therapy now rather than earlier? 2. What consideration may arise depending on the cardiac medication she is taking? 3. What needs to be monitored while she is taking voriconazole?
1. Voriconazole is used to treat major fungal infections in patients who do not tolerate or respond to other antifungal drugs. The physician probably tried other drugs first. 2. Use of voriconazole is contraindicated in patients taking other drugs that are metabolized by cyto-chrome P-450 enzyme 3A4 (e.g., quinidine) because of the risk for inducing serious cardiac dysrhythmias. 3. Careful cardiac monitoring is needed if Sally is also taking quinidine while taking this antifungal drug.
Virgil has been admitted to your unit and prescribed aminoglycoside therapy as part of treatment for a urinary tract infection with Pseudomonas. He is 65 years old, awake, and alert, but he is anxious about his problem and wants to "hurry up and get better." 1. For which two serious toxicities will you monitor? What are their symptoms, and how can they be prevented? 2. The physician adds penicillin to Virgil's drug regimen. Explain the reason for this. 3. Virgil's "trough" aminoglycoside level is 3.0 mcg/ mL, and his serum creatinine level is increased from 2 days earlier. Are these results a concern? What will you do? Explain.
1. You will monitor for ototoxicity and nephrotoxicity. Symptoms of ototoxicity include dizziness, tinnitus, and hearing loss. Symptoms of nephrotoxicity include urinary casts, proteinuria, and increased blood urea nitrogen and serum creatinine levels. Monitoring the drug's trough levels and renal function studies can help prevent those toxicities. 2. The aminoglycosides and penicillins are often used together because they have a synergistic effect; that is, the combined effect of the two drugs is greater than that of either drug alone. 3. Yes, there is a concern! The desired trough level is 1 mcg/mL, so a level of 3 mcg/mL could mean that he is receiving a dose that is too high. The increased serum creatinine level is also a concern because it could be an indication of impaired renal function. The physician must be notified immediately and doses of the aminoglycoside withheld until the physician responds.
A patient is to receive medication through a feeding tube. The order reads, "Give amoxicillin 250 mg per feeding tube every 8 hours." When reconstituted, the concentration of the medication is 125 mg/5 mL. How many milliliters will the nurse give per dose?
10ml
The orders read, "Administer normal saline, 3 L, over 24 hours, beginning 12 hours before the cisplatin chemotherapy begins." The nurse will pro-gram the infusion pump to deliver the normal saline at what rate?
125ml/hr
The order reads, "Give colistimethate 2.5 mg/kg/day IVPB. Infuse over 5 minutes." The patient weighs 165 pounds. How many milligrams will the patient receive per dose? (Record answer using one decimal place.)
187.5mg
In an effort to prevent the complications associated with intravenous infusion of antifungal drugs such as amphotericin B, the nurse will administer them over which time frame? 30 minutes 60 minutes 1 to 2 hours 2 to 6 hours
2 to 6 hours
The order for a 1-year-old child reads, "Give amantadine 4.4 mg/kg/day in 2 divided doses." The child weighs 22 lb. How many milligrams will the child receive per dose?
22ml
A patient will be receiving daily doses of asparaginase. The order is for 200 units/kg/day up to 40,000 units per dose IV. The patient weighs 275 lb. How many units will the patient receive per dose? Is this dose within the safe limit?
25,000 units, yes
A patient is to receive 2 million units of penicillin G potassium per day, every 6 hours in IV piggyback doses. The medication is available in vials of 1 million units/50 mL, and each dose needs to be mixed in 50 mL of D5W. How many milliliters will the nurse draw up for each IV piggyback dose?
25ml
A patient will be taking oral neomycin before having bowel surgery. The order reads, "Give 1 g per hour for 4 doses PO." The patient cannot swallow pills, so an oral solution has been ordered. The solution is 125 mg/5 mL. How many milliliters will the nurse give for each 1-g dose?
40ml
A patient will be receiving cisplatin chemotherapy. The order reads, "Give 100 mg/m2 in 1000 mL D5W over 22 hours." The nurse will program the infusion pump to deliver the infusion at what rate?
46ml/hr
The order reads, "Give amphotericin B 20 mg in 300 mL D5W over 6 hours." The nurse will set the infusion pump to what rate?
50ml/hr
The order reads, "Give acyclovir, 0.25 g IVPB now." The medication comes in a vial that contains 1000 mg. The label reads, "Add 20 mL of diluent for a solution that contains 50 mg/mL." The medication will be added to 100 mL D5W for IV piggyback infusion. How many milliliters of reconstituted medication will the nurse add to the 100-mL bag for infusion?
5ml
A patient is to receive voriconazole as follows: 6 mg/ kg q12h 2 doses, then change to 4 mg/kg q12h. The patient weighs 242 lb. How much will the patient receive for each 6-mg/kg dose? The 4-mg/kg dose?
660mg 440mg
Explain the concept of "trough" levels during aminoglycoside therapy and the way in which renal function is monitored.
A blood sample for measurement of "trough" level is drawn at least 8 to 12 hours after completion of dose administration. The therapeutic goal is a trough level at or below 1 mcg/mL. If the trough level is above 2 mcg/mL, then the patient is at greater risk for oto-toxicity and nephrotoxicity. Trough levels are nor-mally monitored initially and then once every 5 to 7 days until the drug therapy is discontinued. The patient's serum creatinine level will also be mea-sured at least every 3 days as an index of renal function, and drug dosages will be adjusted as needed for any changes in renal function.
Which statement is true regarding cancer chemotherapy? Only selected antineoplastic drugs are effective against all types of cancer. Most cancer drugs have a high therapeutic index. A combination of drugs is usually more effective than single-drug therapy. Side effects can be eliminated with appropriate administration times.
A combination of drugs is usually more effective than single-drug therapy.
When reviewing the use of amantadine, the nurse expects that the drug would be used most appropri-ately in which patient? A 29-year-old man who tests positive for HIV A 22-year-old woman who is in her eighth month of pregnancy and tests positive for HIV A heart transplant patient who has influenza A Older adult patients who require prophylaxis for influenza B
A heart transplant patient who has influenza A
thrush
A term for fungal infection of the mouth
fungi
A very large, diverse group of eukaryotic, thallus-forming microorganisms that requires an external carbon source
The nurse is administering an antifungal drug to a patient who has a severe systemic fungal infection. Which drug is most appropriate for this patient? Amphotericin B Fluconazole Griseofulvin Flucytosine
Amphotericin B
Nystatin
An antifungal drug commonly used to treat candidal diaper rash
mycosis
An infection caused by fungi
imidazoles
Another of the major groups of antifungal drugs; includes ketoconazole
The nurse is reviewing the medication list for a patient who will be receiving mitotane treatments. A drug from which class would cause the most concern if administered along with the mitotane? Benzodiazepine Thyroid replacement hormone Insulin Beta blocker
Benzodiazepine
When administering ganciclovir, the nurse keeps in mind that the main dose-limiting toxicity for this drug is which condition? Renal failure Gastrointestinal disturbances Peripheral neuropathy Bone marrow suppression
Bone marrow suppression
When administering antineoplastic drugs, the nurse needs to keep in mind that these drugs include which general adverse effects? (Select all that apply.) Bone marrow suppression Infertility Diarrhea Urinary retention Nausea and vomiting Stomatitis
Bone marrow suppression Infertility Diarrhea Nausea and vomiting Stomatitis
The nurse is monitoring a patient who has developed thrombocytopenia after two rounds of chemotherapy. Which signs or symptoms will the nurse look for in this patient? (Select all that apply.) Bruising Increased fatigue Ulcerations on mucous membranes inside the mouth Temperature above 100.5° F (38.1° C) Increased bleeding from venipunctures
Bruising Increased bleeding from venipunctures
A patient who has cancer is to receive a course of chemotherapy with doxorubicin. Which coexisting condition will require very close monitoring while the patient is taking this drug? Hypertension Diabetes mellitus Gout Cardiomyopathy
Cardiomyopathy
Mr. R., a 50-year-old banker, is scheduled for colon surgery tomorrow. The surgeon is planning to administer a prophylactic antibiotic. What drug is frequently used for this purpose? Why?
Cefoxitin (Mefoxin) is frequently used in patients undergoing abdominal surgeries because it can effectively kill intestinal bacteria, including anaerobic bacteria.
The nurse monitors very closely for signs of renal toxicity when which of these antineoplastic drugs is given? Doxorubicin Cisplatin Bevacizumab Mitotane
Cisplatin
Which laboratory test will the nurse monitor in the patient taking daptomycin? Liver function studies Red blood cell counts Platelet levels Creatinine phosphokinase
Creatinine phosphokinase
Describe the concept of cytoprotection, and provide at least two examples of how this may be accomplished during chemotherapy.
Cytoprotective drugs help to reduce the toxicity of various antineoplastics. As a result, the adverse effects may be reduced, so increased dosages of the antineoplastic medication may be tolerated, which allows greater destruction of cancer cells. Examples include the following: • Amifostine (Ethyol), used during therapy with cisplatin to reduce renal toxicity • Dexrazoxane (Zinecard), used during therapy with doxorubicin to reduce cardiac toxicity
The nurse is administering a new order for amphotericin B and reviews the patient's current medications. Which medications, if also ordered, may cause an interaction with the amphotericin B? (Select all that apply.) Digoxin, a cardiac glycoside Metoprolol, a beta blocker Warfarin, an oral anticoagulant Levothyroxine, a hormone replacement Hydrochlorothiazide, a thiazide diuretic
Digoxin, a cardiac glycoside Hydrochlorothiazide, a thiazide diuretic
The nurse knows the use of tetracyclines is limited in children because of the occurrence of which side effect? Stunting of the growth plate Threat of sunburn Discoloration of teeth Pseudomembranous colitis
Discoloration of teeth
A patient will be receiving a one-dose treatment for vaginal candidiasis. The nurse expects to administer which drug? Ketoconazole Fluconazole Griseofulvin Terbinafine
Fluconazole
The nurse is reviewing the list of medications for a patient who will be starting antibiotic therapy with an aminoglycoside. Which medications, if present, may present a potential interaction with the aminoglycoside? (Select all that apply.) Metoprolol, a beta blocker Furosemide, a loop diuretic Warfarin, an oral anticoagulant Vancomycin, an antibiotic Levothyroxine, a thyroid hormone
Furosemide, a loop diuretic Warfarin, an oral anticoagulant Vancomycin, an antibiotic
Matt has had an organ transplant. What antiviral drug may be used, even though he does not have a viral infection at this time?
Ganciclovir may be administered to prevent cyto-megalovirus disease (generalized infection) in high-risk patients, such as those receiving organ transplants.
The nurse would recognize which symptom as a side effect of cyclophosphamide? Thrombocytopenia Vasculitis Osteopenia Hemorrhagic cystitis
Hemorrhagic cystitis
A patient is receiving imipenem-cilastatin (Primaxin) and asks the nurse, "Why does that medicine bag have two names listed? Am I receiving two drugs?" What is the best explanation for the patient?
Imipenem-cilastatin (Primaxin) does contain two drugs, but one of the drugs (cilastatin) works to prevent the antibiotic (imipenem) from being destroyed by bacterial enzymes that can make the antibiotic ineffective.
The method of action of antiviral agents is identified by which statement? Inhibiting the virus's ability to replicate Interfering with receptor site activity Interrupting the viral cell wall membrane Destroying the nucleus of the cell
Inhibiting the virus's ability to replicate
Which statement accurately describes the method of action of penicillin? Interruption of bacterial protein synthesis Inhibition of bacterial cell wall synthesis Interruption of bacterial DNA replication Increased bacterial cell wall permeability
Inhibition of bacterial cell wall synthesis
Which statement accurately describes the method of action of quinolones? Interruption of bacterial protein synthesis Inhibition of bacterial cell wall synthesis Interruption of bacterial DNA replication Increased bacterial cell wall permeability
Interruption of bacterial DNA replication
Amy is 12 weeks into her pregnancy when she dis-covers that she is HIV positive. Amy is very upset and says, "I won't live long enough to have this baby. We're both going to die." Is it possible to treat Amy, the fetus, or both? Explain your answer.
It is possible to treat both Amy and the fetus. Zido-vudine, one of the few anti-human immunodefi-ciency virus (HIV) drugs known to prolong patient survival, can be used for maternal and fetal treat-ment. During the pregnancy, Amy can receive the oral form of the drug. During labor, she can receive the drug intravenously. Drug therapy for the infant can begin within 12 hours of delivery and continue for 6 weeks.
The nurse will instruct a patient who is receiving a tetracycline antibiotic to take it using which guideline? It needs to be taken with milk. It needs to be taken with 8 oz of water. It needs to be taken 30 minutes before iron preparations are taken. An antacid should also be taken to decrease GI discomfort.
It needs to be taken with 8 oz of water.
A patient receiving chemotherapy for a testicular tumor complains of hearing a "loud ringing sound" in his ears. The nurse expects what to happen next regarding the chemotherapy? It will continue as ordered. It will be stopped until the patient's hearing is evaluated. It will be withheld for a day and then be resumed. It will be stopped until renal studies are performed.
It will be stopped until the patient's hearing is evaluated.
David has a severe fungal infection, and the physician has prescribed a lipid formulation of amphotericin B (Fungizone). Why was this formulation ordered, and what are the advantages and disadvantages?
Lipid formulations of amphotericin B have been developed in an attempt to decrease the incidence of its adverse effects and increase its efficacy. The disadvantage is that they are more expensive than conventional amphotericin B.
A patient is receiving leucovorin as part of his che-motherapy regimen. The nurse expects that the patient is receiving which antineoplastic drug? Cladribine Fluorouracil Vincristine Methotrexate
Methotrexate
molds
Multicellular fungi characterized by long, branching filaments called hyphae, which entwine to form a mycelium
During an infusion of amphotericin B, the nurse monitors for which adverse effects? (Select all that apply.) Nausea Fever Malaise Constipation Chills Hypertension
Nausea Fever Malaise Hypertension
Nitrofurantoin has been ordered for a patient who has a severe urinary tract infection caused by Escheri-chia coli. Explain why this drug is used for this type of infection.
Nitrofurantoin is used primarily to treat urinary tract infections because it is renally excreted and concentrates in the urine.
During a busy evening shift, an oncologist tells the nurse that he wants to start Mrs. N.'s chemotherapy immediately. The oncologist asks the nurse to mix the drug as soon as possible and start the infusion. Should the nurse do this? Explain your answer.
No! In most facilities, institutional guidelines direct that the pharmacy department mix these drugs. Special requirements must be met for the safety of those working with these drugs, including the use of a laminar airflow hood and appropriate personal protective equipment (e.g., gown, mask, and gloves). It would not be safe for the nurse or for those around the nurse to mix the chemotherapy drug on the nursing unit.
The nurse overhears a coworker explaining to a student nurse the procedure for administering acyclovir intravenously. "After the acyclovir is diluted in sterile water," the coworker says, "we'll administer this over at least an hour." Should the nurse intervene? Explain your answer.
No. The nurse's coworker is doing fine. Acyclovir administered by intravenous infusion is first diluted in the solution recommended by the manufacturer and is administered slowly over at least 1 hour to prevent renal damage.
Stacy has had flu symptoms for 4 days and feels miserable. She calls the nurse practitioner in the clinic to ask for "that medicine, Tamiflu, that is supposed to make the flu symptoms better." Will Stacy receive this medication at this time? Explain your answer.
No. Therapy with oseltamivir (Tamiflu) needs to begin within 2 days of the onset of influenza. It is probably too late for this medication to be effective for Stacy.
After an infusion of colistimethate (Coly-Mycin), the nurse will report to the prescriber if the patient complains of which adverse effects? (Select all that apply.) Numbness Vertigo Upset stomach insomnia Dizziness
Numbness Vertigo Dizziness
An infant has thrush. The nurse expects to administer which drug for the treatment of thrush? Amphotericin B Fluconazole Nystatin Miconazole
Nystatin
Chrissie has a prescription for nystatin oral troches to treat thrush. After a few days, she calls the nurse practitioner to report that her mouth is not better. "I've been chewing them slowly every time I take one. I don't understand why it's not working!" she says. What is the nurse's response?
Nystatin oral troches or lozenges are to be dissolved slowly and completely in the mouth for the best effects and should not be chewed or swallowed. Chrissie needs a review of how to use this medication. .
Which intervention is the priority for the nurse to perform before beginning antibiotic therapy? Obtain a specimen for culture and sensitivity. Give with an antacid to reduce gastrointestinal (GI) upset. Monitor for adverse effects. Restrict oral fluids.
Obtain a specimen for culture and sensitivity.
polyenes
One of the major chemical groups of antifungal drugs; includes amphotericin B and nystatin
griseofulvin
One of the older antifungal drugs that acts by preventing susceptible fungi from reproducing
Amphotericin B would be contraindicated in which patients? (Select all that apply.) One with severe bone marrow suppression One with ulcer disease One with renal impairment One with hypertension One with asthma
One with severe bone marrow suppression One with renal impairment
The nurse is reviewing the drugs ordered for a patient. A drug interaction occurs between penicillins and which drugs? (Select all that apply.) Alcohol Oral contraceptives Digoxin Nonsteroidal antiinflammatory drugs Warfarin Anticonvulsants
Oral contraceptives Nonsteroidal antiinflammatory drugs Warfarin
When patients are receiving aminoglycosides, the nurse must monitor for tinnitus and dizziness, which may indicate which problem? Cardiotoxicity Hepatotoxicity Ototoxicity Nephrotoxicity
Ototoxicity
During chemotherapy, the nurse will monitor the patient for which symptoms of stomatitis? Indigestion and heartburn Severe vomiting and anorexia Pain or soreness of the mouth Diarrhea and perianal irritation
Pain or soreness of the mouth
A patient is to receive antibiotic therapy with a cephalosporin. When assessing the patient's drug history, the nurse recognizes that an allergy to which drug class may be a possible contraindication to cephalosporin therapy? Cardiac glycosides Thiazide diuretics Penicillins Macrolides
Penicillins
The nurse is preparing to administer the aerosol form of ribavirin. Which condition is a contraindication to the drug? Asthma Pregnancy Hypertension Type 2 diabetes
Pregnancy
A patient will be receiving chemotherapy with paclitaxel. What will the nurse expect to do along with administering this drug? Administer platelet infusions. Provide acetaminophen as needed. Keep the patient on "nothing by mouth" status because of expected nausea and vomiting. Premedicate with a steroid, an H2 receptor antagonist, and an antihistamine.
Premedicate with a steroid, an H2 receptor antagonist, and an antihistamine.
A patient calls the clinic nurse to ask for oseltamivir (Tamiflu) "because I was exposed to the flu over the weekend at a family reunion." The nurse knows that Tamiflu is indicated for which conditions? (Select all that apply.) Prevention of infection after exposure to influenza virus types A and B Reduction of the duration of influenza in adults Treatment of topical herpes simplex virus infections Reduction of the severity of shingles symptoms e. Treatment of lower respiratory tract infections caused by respiratory syncytial virus
Prevention of infection after exposure to influenza virus types A and B Reduction of the duration of influenza in adults
Which is a common adverse effect that occurs when vancomycin (Vancocin) is infused too quickly? Bone marrow suppression Tubular necrosis Red man's syndrome Colitis
Red man's syndrome
When reviewing the health history of a patient who is to receive foscarnet, the nurse knows that which condition would be a contraindication to its use? Renal failure CMV retinitis Asthma Immunosuppression
Renal failure
A patient who is receiving vancomycin therapy needs to notify the nurse immediately if which effects are noted? (Select all that apply.) Ringing in the ears Dizziness Hearing loss Flushing of the face Nausea
Ringing in the ears Dizziness Hearing loss
Sandra has bronchitis and has been taking an anti-biotic for 1 week. She calls the nurse and complains of severe genital itching and a whitish discharge in her vaginal area. What has happened, and what caused it?
She is experiencing a superinfection because the antibiotics she has been taking for bronchitis have reduced the normal vaginal bacterial flora, and the yeast that is usually kept in balance by this normal flora has an opportunity to grow and cause an infection.
Yeast
Single-celled fungi that reproduce by budding
Which of the following agents would the nurse expect to be used in the treatment of hepatitis C? (Select all that apply.) Sofosbuvir Daclatasvir Ribavirin Oseltamivir Zanamivir
Sofosbuvir Daclatasvir Ribavirin
If extravasation of an antineoplastic drug occurs, what will the nurse do first? Remove the intravenous catheter immediately. Stop the drug infusion without removing the intravenous catheter. Aspirate residual drug or blood from the tube if possible. Administer the appropriate antidote.
Stop the drug infusion without removing the intravenous catheter.
When teaching a patient who is receiving outpatient chemotherapy about potential problems, the nurse needs to mention signs and symptoms of an oncologic emergency, which include which of the following? (Select all that apply.) Swollen tongue Alopecia Blood in the urine Nausea and vomiting Temperature of 100.5° F (38.1° C) or higher Chills
Swollen tongue Blood in the urine Temperature of 100.5° F (38.1° C) or higher Chills
Angie has a severe infection and is receiving an aminoglycoside once a day. She says, "They tell me I have a terrible infection. Why am I not getting the antibiotic more than once a day? I don't understand!" What will the nurse tell her?
The current practice is once-a-day aminoglycoside dosing. The nurse can tell her that studies have shown that once-daily dosing provides a sufficient plasma drug concentration to kill bacteria and has either an equal or lower risk for toxicity compared with multiple daily dosing. Hopefully, this type of dosing will be safer and more effective for her.
Amphotericin B
The drug of choice for many severe, systemic fungal infections; also, the oldest antifungal drug
Mrs. S. has been receiving bleomycin to treat a lung tumor, and lately she has been experiencing increased difficulty breathing. She tells the nurse, "I guess this cancer is getting worse. The medicine is not working." Will the nurse agree, or is there another possible concern?
The nurse will not agree. The nurse recognizes that the most likely cause of the patient's respiratory problems is the development of pulmonary toxicity (pulmonary fibrosis and pneumonitis) secondary to therapy with bleomycin.
Mr. G., who had been receiving an infusion of mechlorethamine, has an infiltrated intravenous site. He wants the nurse to pull out the intravenous line immediately because "it hurts so much." What will the nurse do? What will the treatment of extravasation involve?
The nurse will stop the infusion immediately but won't pull out the intravenous catheter quite yet. The physician must be notified immediately, and the nurse will expect to receive orders to treat this extravasation of mechlorethamine by injecting a solution of 10% sodium thiosulfate and sterile water (see Table 46-2) through the existing line into the extravasated site (and then remove the line) and through multiple subcutaneous injections into the site. Over the next few hours, the patient will receive repeated subcutaneous injections into the area, and cold compresses will be applied to the site.
A 25-year-old man has acquired immunodeficiency syndrome (AIDS). He was treated with zidovudine for several months, but now the physician has switched him to didanosine powder. What frequently is the reason that patients are switched from zidovudine to another anti-HIV drug?
The patient may be experiencing zidovudine's major dose-limiting adverse effect, which is bone marrow suppression.
The nursing student would correctly identify which description as the method of action of the alkylating agents? These agents alter the chemical structure of the cells' deoxyribonucleic acid (DNA). These agents interfere with the ability of the cell to initiate angiogenesis. These agents enhance the host's autoimmune response. These agents disrupt cellular cytoplasm, and the cell dies.
These agents alter the chemical structure of the cells' deoxyribonucleic acid (DNA).
The nursing student asks the pharmacist what it means that an agent is "cell-cycle specific." Which statement is correct? These drugs are effective in only certain types of cancers. These drugs are effective throughout all stages of cancer reproduction. These drugs are effective on slower-growing cells because they target one phase of reproduction. These drugs are cytotoxic during a specific cycle of cancer cell growth.
These drugs are cytotoxic during a specific cycle of cancer cell growth.
During a class on health care-associated infections, the nurse shares several facts about these infections. Which statements about health care-associated infections are true? (Select all that apply.) They are contracted in the home or community. They are contracted in a hospital or institution. They are more difficult to treat. The organisms that cause these infections are more virulent. The infection is incubating at the time of admission.
They are contracted in a hospital or institution. They are more difficult to treat. The organisms that cause these infections are more virulent.
Which statement accurately describes the action of antiseptics? They are used to kill organisms on nonliving objects. They are used to kill organisms on living tissue. They are used to sterilize equipment. They are used to inhibit the growth of organisms on living tissue.
They are used to inhibit the growth of organisms on living tissue.
While hanging a new infusion bag of a chemotherapy drug, the nurse accidentally spills a small amount of solution on the floor. What is the nurse's best action? Let it dry and then mop the floor. Wipe the area with a paper towel. Use a spill kit to clean the area. Ask the housekeeping department to wipe the floor.
Use a spill kit to clean the area.
A patient has been admitted to the unit with a stage IV pressure ulcer. After 2 days, the wound culture results come back positive for methicillin-resistant Staphylococcus aureus (MRSA). The nurse knows that the drug of choice for the treatment of MRSA infection is which drug? Vancomycin Gentamicin Ciprofloxacin Colistimethate
Vancomycin
The nurse is administering acyclovir and recalls that it is considered the drug of choice for treatment of which viral infection? Cytomegalovirus (CMV) Human immunodeficiency virus (HIV) Respiratory syncytial virus (RSV) Varicella-zoster virus (VZV)
Varicella-zoster virus (VZV)
Viral infections and viruses are more difficult to eradicate than bacteria for which reason? Viruses replicate at a faster rate. Viruses grow as an attachment to host cells and must first be removed from the cell wall. Viruses require folic acid synthesis. Viruses replicate only inside host cells, so medications must enter the cell.
Viruses replicate only inside host cells, so medications must enter the cell.
A patient will be receiving mitotane, and the nurse is reviewing the patient's medication list for potential interactions. Which drugs may interact with mitotane? (Select all that apply.) Digoxin Warfarin Phenytoin Glucophage Spironolactone
Warfarin Phenytoin Spironolactone
Greg has been taking amiodarone for a heart rhythm problem. He has developed an infection from an open wound, and the sensitivity report indicates that levofloxacin (Levaquin) is the best choice to fight this infection. Are there any concerns?
Yes. In patients who receive amiodarone therapy, dangerous cardiac dysrhythmias are more likely to occur when quinolones are taken. Hopefully, another drug besides levofloxacin has shown effectiveness against the bacteria that is causing his infection
A patient will be receiving chemotherapy with IV cladribine. The order reads, "Give 0.09 mg/kg each day for 7 days." The medication is to be added to 500 mL of normal saline and is available in a 1-mg/ mL solution. The patient weighs 200 lb. a. How many mg is each daily dose? (Record answer using one decimal place.) ______________ b. How many milliliters of medication will be added to each infusion? ______________
a. 8.2 mg b. 8.2 mL
Bailey, a 53-year-old teacher, has shingles. a. What drug will the nurse expect the physician to prescribe? b. Several months later, Bailey calls the office to say that her symptoms have returned. What action will the nurse expect to be taken now?
a. Acyclovir (Zovirax) is indicated for herpes zoster (shingles). b. Bailey will be treated with acyclovir again; it is the drug of choice for treatment of both initial and recurrent episodes of shingles.
The physician is planning intravenous amphotericin B therapy for James. a. What guidelines will the nurse follow in administering the drug? b. What adverse effects will the nurse expect James to experience? c. Should the nurse stop the infusion if those effects occur? Explain your answer.
a. Amphotericin B needs to be diluted according to the manufacturer's guidelines and administered using an infusion pump. The nurse must not use solutions that are cloudy or that have visible precipitates. Before administration, the nurse will check for an order to premedicate the patient with an antiemetic, antihistamine, antipyretic, or corticosteroid to prevent or minimize infusion-related reactions. b. The nurse will monitor closely for expected adverse effects such as cardiac dysrhythmias, visual disturbances, paresthesias (numbness or tingling of the hands or feet), respiratory difficulty, pain, fever, chills, and nausea. c. No, unless a severe reaction occurs (e.g., exacerbation of adverse effects or a decline in vital signs). To decrease the severity of expected adverse effects, the patient may be pretreated with an antipyretic (e.g., acetaminophen), antihistamines, and antiemetics
Mr. K. has cryptococcal meningitis, and the physi-cian has prescribed fluconazole (Diflucan). a. Why did the physician choose this drug rather than one of the other -azole antifungals? b. The results of Mr. K.'s cerebrospinal fluid culture eventually come back negative. When he hears the good news, he says, "Great! I'm tired of taking this medicine." What will be the nurse's response?
a. Fluconazole (Diflucan), unlike itraconazole and other -azoles, can pass into the cerebrospinal fluid (CSF), which makes it useful in the treatment of cryptococcal meningitis. b. Unfortunately, Mr. K. will need to remain on the medication (at a reduced dosage) for 10 to 12 weeks after the negative results on his CSF culture
Brenda, age 2 years, has bronchopneumonia caused by respiratory syncytial virus (RSV). a. What antiviral drug is used to treat RSV? b. Brenda's mother wonders whether the treatment will be completed before Brenda's birthday, which is 2 weeks away. What will the nurse tell her?
a. Ribavirin is used to treat infections caused by respiratory syncytial virus. b. Yes. Brenda's treatment will last at least 3 days but not longer than 7 days.
Sean is a 19-year-old college freshman who has been diagnosed with gonorrhea. The provider has prescribed doxycycline therapy. During the nursing assessment, Sean discusses his diet, which includes "lots of meat, milk, and veggies." Sean also tells the nurse that he jogs frequently and is a member of the tennis team. a. In addition to instruction about sexually transmitted infections, what patient teaching about the medication does Sean require? b. A few days later, Sean calls and complains of an upset stomach and diarrhea. What does the nurse suspect might be wrong with Sean?
a.Sean must not take doxycycline with milk because that can result in a significant reduction in the absorption of the drug. Also, Sean needs to be aware that tetracyclines can cause photosensitiv-ity; he needs to avoid direct exposure to sunlight and use sunscreen or protective clothing. b. The diarrhea is probably the result of alteration of the intestinal flora caused by the drug therapy.
As the nurse is preparing to give the patient chemotherapy, the patient asks the nurse why more than one drug is used. The nurse will explain that combinations of chemotherapeutic drugs are used to... reduce drug resistance. reduce the incidence of adverse effects. decrease the cost of treatment. reduce treatment time.
reduce drug resistance.
