Pharm test 2
When used in combination with certain foods and drugs, monoamine oxidase inhibitors (MAOIs) can cause serious side effects. Which condition could occur in clients treated with MAOIs for depression? 1 A serious drop in blood pressure 2 A serious increase in blood pressure 3 A significant increase in liver enzymes 4 A significant increase in cholesterol levels
2 MAOIs, when taken with foods high in tyramine (e.g., pickled foods, beer, wine, aged cheeses) and drugs such as antidepressants, certain pain medications, and decongestants, can cause a life-threatening increase in blood pressure. For this reason they are seldom used to treat symptoms of depression. MAOIs do not increase liver enzymes or cholesterol levels.
A client with depression has not responded to a tricyclic antidepressant and outpatient electroconvulsive therapy (ECT). The health care provider prescribes selegiline (Eldepryl), and the nurse teaches the client about food to be avoided while taking this medication. Which foods identified by the client allow the nurse to conclude that the instructions have been understood? Select all that apply. 1 Fresh fish 2 Aged cheese 3 Fried chicken 4 Chocolate drinks 5 Leafy vegetables
2 & 4 Foods containing tyramine can cause hypertensive crisis and should be eliminated from the diet. These foods include pickled herring, beer, wine, chicken livers, aged or natural cheese, caffeine, cola, licorice, avocados, bananas, and bologna. Chocolate in moderation is safe for some patients, but it does contain caffeine. Overripe fruits and caffeine have high levels of tyramine, which can cause dangerous hypertension in clients taking monoamine oxidase inhibitors (MAOIs). Also, large amounts of caffeine can increase blood pressure and should be avoided. There is no need to limit the intake of fish, chicken, or leafy vegetables while taking an MAOI.
A client with depression is to be given fluoxetine (Prozac). What precaution should the nurse consider when initiating treatment with this drug? 1 It must be given with milk and crackers to avoid hyperacidity and discomfort. 2 Eating cheese or pickled herring or drinking wine may cause a hypertensive crisis. 3 The blood level may not be sufficient to cause noticeable improvement for 2 to 4 weeks. 4 The blood level should be checked weekly for 3 months to monitor for an appropriate level
3 Fluoxetine (Prozac) does not produce an immediate effect; nursing measures must be continued to reduce the risk for suicide. Consuming milk and crackers to help prevent hyperacidity and discomfort is not necessary. Avoiding cheese, pickled herring, and wine is a precaution taken with the monoamine oxidase inhibitors. Weekly blood level checks are not necessary with fluoxetine
A client is receiving carbamazepine (Tegretol) for the treatment of a manic episode of bipolar disorder. What should the nurse include when planning client teaching about this medication? Select all that apply. 1 "You have to eat a low-sodium diet every day." 2 "You'll have to take a diuretic with this medication." 3 "You'll have to take this medication for the rest of your life." 4 "You may want to suck on hard candy when you get a dry mouth." 5 "We'll need to test your blood often during the first few weeks of therapy."
4,5
. A patient has been taking haloperidol (Haldol) for 3 months for a psychotic disorder, and the nurse is concerned about the development of extrapyramidal symptoms. The nurse will monitor the patient closely for which effects? A. tremors and muscle twitching B. shivering C. tinnitus D. visual disturbance
A
A client visits the health care provider for treatment of tinea pedis (athlete's foot). Which medication would the nurse MOST likely instruct the client to take to treat this condition? A. Terbinafine (Lamisil) B. Voriconazole (Vfend) C. Caspofungin (Cancidas) D. Amphotericin B (Amphocin)
A
A patient has an infestation with flukes. The nurse anticipates the use of which drug to treat this infestation? a.praziquantel (Biltricide) b.pyrantel (Pin-X) c.metronidazole (Flagyl) d.ivermectin (Stromectol)
A
A patient is diagnosed with onychomycosis. The nurse anticipates use of which medication for the treatment of this condition? A) terbinafine (Lamisil) B) voriconazole (Vfend) C) fluconazole (Diflucan) D) amphotericin B (Amphocin, Fungizone)
A
The nurse would question a prescription for voriconazole (Vfend) if the client was taking which medication? A. Quinidine B. Prednisone (Deltasone) C. Captopril (Capoten) D. Clindamycin (Cleocin)
A
When administering vancomycin, the nurse knows that which of these is most important to assess before giving the medication? a. Renal function b. WBC count c. Liver function d. Platelet count
A
9) A patient who has been taking alprazolam (Xanax) and has been compliant with the therapeutic regimen for 6 weeks is now complaining of adverse effects of the medication. Which of the following substances does the nurse instruct the patient to avoid to help prevent intensification of this medication's adverse effects? (Choose all that apply.) A) Alcohol B) Opioids C) Tobacco D) Antihistamines E) Muscle relaxants F) Caffeinated drinks
A, B, D, E Because they are also central nervous system (CNS) depressants, the nurse instructs the patient to avoid alcohol, opioids, antihistamines, and muscle relaxants because, when taken together with alprazolam they can cause significant CNS depression, including respiratory depression. Tobacco use is likely to be harmful, but it is unlikely to intensify the adverse effects of a benzodiazepine. Caffeine, a xanthine stimulant, is likely to ameliorate CNS depression associated with benzodiazepines.
A patient who has been taking a selective serotonin reuptake inhibitor (SSRI) is complaining of "feeling so badly" when he started taking an over-the-counter St. John's wart herbal product at home. The nurse suspects that he is experiencing serotonin syndrome. Which of these are symptoms of serotonin syndrome? (Select all that apply.) A. agitation B. diarrhea C. tremors D. vision distubance E. sweating
A, C, E
When providing instructions to clients on use of antibiotics, which instructions would the nurse include in the teaching? (Select all that apply.) A. Complete the entire course of therapy. B. Increase fluid intake up to 3000 mL/day. C. Wash your hands before and after preparing food. D. Notify the provider of any possible reactions that occur. E. Save unused medication in a cool dry place for later use.
A,B,C,D There should not be any leftover medication, but if there is, it needs to be discarded in the appropriate method. The health care provider typically only writes a prescription for the exact amount of medication needed by the client.
The nurse is administering intravenous vancomycin (Vancocin) to a patient who has had gastrointestinal surgery. Which nursing measures are appropriate? (Select all that apply.) A. Monitoring serum creatinine levels B. Restricting fluids while the patient is on this medication C. Warning the patient that a flushed feeling or facial itching may occur D. Instructing the patient to report dizziness or a feeling of fullness in the ears E. Reporting a trough drug level of 11 mcg/mL and holding the drug F. Reporting a trough drug level of 24 mcg/mL and holding the drug
A,C,D,F
A patient will be receiving nitrofurantoin (Macrodantin) treatment for a urinary tract infection. The nurse is reviewing the patient's history and will question the nitrofurantoin order if which disorder is present in the history? (Select all that apply.) A. Liver disease B. Coronary artery disease C. Hyperthyroidism D. Type 1 diabetes mellitus E. Chronic renal disease
A,E
A patient is receiving aminoglycoside therapy and will be receiving a beta-lactam antibiotic as well. The patient asks why two antibiotics have been ordered. What is the nurse's best response? A. "The combined effect of both antibiotics is greater than each of them alone." B. "One antibiotic is not strong enough to fight the infection." C. "We have not yet isolated the bacteria, so the two antibiotics are given to cover a wide range of microorganisms." D. "We can give a reduced amount of each one if we give them together."
A. " The combined effect of both antibiotics is greater than each of them alone" Rationale: Aminoglycosides are often used in combination with other antibiotics, such as beta-lactams or vancomycin, in the treatment of various infections because the combined effect of the two antibiotics is greater than that of either drug alone.
The nurse is providing teaching to a patient taking an oral tetracycline antibiotic. Which statement by the nurse is correct? A. "Avoid direct sunlight and tanning beds while on this medication." b."Milk and cheese products result in increased levels of tetracycline." c."Antacids taken with the medication help to reduce gastrointestinal distress." d."Take the medication until you are feeling better."
A. "Avoid direct sunlight and tanning beds while on this medication" Rationale: Drug-related photosensitivity occurs when patients take tetracyclines, and it may continue for several days after therapy. Milk and cheese products result in decreased levels of tetracycline when the two are taken together. Antacids also interfere with absorption and should not be taken with tetracycline. Counsel patients to take the entire course of prescribed antibiotic drugs, even if they feel that they are no longer ill.
The nurse is planning care for a client prescribed once-daily IV gentamicin (Garamycin) therapy. When should the nurse schedule a trough drug level to be drawn? A. 12 hours after completing the antibiotic infusion B. 18 hours after completing the antibiotic infusion C. 30 minutes after beginning the antibiotic infusion D. 60 minutes after beginning the antibiotic infusion
A. 12 hours after completing the antibiotic infusion Trough serum drug levels should be drawn at least 8 to 12 hours after the medication is infused.
A patient with a diagnosis of depression is being discharged with a prescription for an MAOI. Which instruction should the nurse include for this medication? A. Avoid eating aged cheese. B. Encourage use of fiber supplements. C. Explain the symptoms of tardive dyskinesia. D. Emphasize that tremors are a common adverse effect.
A. Avoid eating aged cheese.
When doing an admission drug history, the nurse notes that the patient has a prescription for lithium (Lithobid). The nurse suspects that this patient has been diagnosed with which condition? A. Bipolar disorder B. Absence seizures C. Paranoid schizophrenia D. Obsessive-compulsive disorder
A. Bipolar disorder Lithium is a mood-stabilizing drug for the treatment of manic episodes associated with bipolar disorders.
The nurse is reviewing the sputum culture results of a patient with pneumonia and notes that the patient has a gram-positive infection. Which generation of cephalosporin is most appropriate for this type of infection? A. First Generation B. Second Generation C. Third Generation D. Fourth Generation
A. First Generation Rationale: First-generation cephalosporins provide excellent coverage against gram-positive bacteria but limited coverage against gram-negative bacteria.
The client's culture has grown gram-positive cocci, and the health care provider prescribes two different antibiotics, one of which is gentamicin (Garamycin). To treat this type of infection, which type of antibiotic is typically prescribed together with gentamicin (Garamycin)? A. Penicillin B. Cephalosporin C. Fluoroquinolone D. Aminoglycoside
A. Penicillin In gram-positive cocci, gentamicin is usually given in combination with a penicillin antibiotic. The other antibiotics are not typically prescribed with gentamicin for this culture result.
The client's culture has grown gram-positive cocci, and the health care provider prescribes two different antibiotics, one of which is gentamicin (Garamycin). To treat this type of infection, which type of antibiotic is typically prescribed together with gentamicin (Garamycin)? A. Penicillin B. Cephalosporin C. Fluoroquinolone D. Aminoglycoside
A. Penicillin In gram-positive cocci, gentamicin is usually given in combination with a penicillin antibiotic. The other antibiotics are not typically prescribed with gentamicin for this culture result.
When reviewing the medication orders for a patient who is taking penicillin, the nurse notes that the patient is also taking the oral anticoagulant warfarin (Coumadin). What possible effect may occur as the result of an interaction between these drugs? A. The penicillin will cause an enhanced anticoagulant effect of the warfarin. B.The penicillin will cause the anticoagulant effect of the warfarin to decrease. C. The warfarin will reduce the anti-infective action of the penicillin. D. The warfarin will increase the effectiveness of the penicillin.
A. The penicillin will cause and enhanced anticoagulant effect of the warfarin. Rationale: Administering penicillin reduces the vitamin K in the gut (intestines); therefore, enhanced anticoagulant effect of warfarin may occur. The other options are incorrect.
4) A nurse reads in the patient's medication history that the patient is taking buspirone (BuSpar). The nurse interprets that the patient may have which disorder? a. Anxiety disorder b. Depression c. Schizophrenia d. Bipolar disorder
ANS: A Buspirone is indicated for the treatment of anxiety disorders, not depression, schizophrenia, or bipolar disorder.
Before beginning a patient's therapy with tricyclic antidepressant, the nurse should assess for concurrent use of which medications or medication class? a.anticoagulants b.antihistamines c.antitubercular drugs d.antimalarial drugs
Anticoagulants
A patient has been receiving therapy with the aminoglycoside tobramycin, and the nurse notes that the patient's latest trough drug level is 3 mcg/mL. This drug is given daily, and the next dose is to be administered now. Based on this trough drug level, what is the nurse's priority action? a. Administer the drug as ordered. b. Hold the drug, and notify the prescriber. c. Call the laboratory to have the test repeated and verified. d. Hold this dose, but administer the next dose as scheduled.
B
The nurse is assessing a patient who is about to receive antifungal drug therapy. Which problem would be of most concern? a. Endocrine disease b. Hepatic disease c. Cardiac disease d. Pulmonary disease
B
When teaching a patient who is taking nystatin lozenges for oral candidiasis, which instruction by the nurse is correct? a. "Chew the lozenge carefully before swallowing." b. "Dissolve the lozenge slowly and completely in your mouth." c. "Dissolve the lozenge until it is half the original size, and then swallow it." d. "These lozenges need to be swallowed whole with a glass of water."
B
A patient with a history of abusing opioid analgesics needs an antianxiety agent. Which medication should the nurse expect to administer? A) Diazepam (Valium) B) Buspirone (BuSpar) C) Venlafaxine (Effexor) D) Escitalopram (Lexapro)
B) Buspirone (BuSpar) Because the potential for abuse is low, buspirone is a suitable antianxiety agent for this patient. Diazepam is contraindicated because benzodiazepines are highly addictive. Venlafaxine is a serotonin-norepinephrine reuptake inhibitor and escitalopram is a selective serotonin reuptake inhibitor; both medications have a low potential for abuse and are first-line antidepressant therapies. The nurse does not know whether the patient has depression along with the anxiety, so these drugs are not indicated.
The patient is being switched from amitriptyline (Elavil) to citalopram (Celexa). Which statement made by the patient reflects understanding of patient education? A) I can just stop taking my Elavil and start taking the Celexa as ordered B) I will not get this dizzy when I change positions after I switch medications C) the doctor switching me to this medication because it is less expensive but just as effective D) I will need to limit my intake of cheese been taking Celexa to prevent arise and my blood pressure
B) I will not get his dizzy when I change positions after switch medications - Citalopram, and SSRI, produces minimal anticholinergic and cardiovascular side effects.
Which patient is a poor candidate for therapy with diazepam (Valium) to treat generalized anxiety disorder? A) One who had convulsions as a child B) One with a history of alcoholism C) One who has had a myocardial infarction D) One with type 2 diabetes mellitus
B) One with a history of alcoholism The patient with a history of alcoholism is a poor candidate for therapy with diazepam because of the potential for substance abuse and the adverse effects of therapy. The patient has an addictive personality, meaning that the patient has resorted to habitual use of a substance to manage anxiety; as a means of preventing additional substance abuse, benzodiazepines will be withheld from this patient.
The patient currently prescribed duloxetine (Cymbalta) comes to the health clinic complaining of restlessness, agitation, diaphoresis, and tremors. The nurse suspects serotonin syndrome and questions the patient regarding concurrent use of which substance? A) ibuprofen B) St. John's wort C) vitamin E D) glucosamine/chondroitin
B) St. John's wort - Serotonin syndrome may occur with SSRIs when they're combined with herbal products such as ginseng and St. John's wort
6) A female patient who takes lorazepam (Ativan) for anxiety tells the nurse that she plans to become pregnant. What is the best instruction for the nurse to give the patient? A) Visit a women's healthcare provider. B) Taper off the drug before conception. C) Form another plan to manage anxiety. D) Eat a well-balanced diet that includes milk.
B) Taper off the drug before conception. The best instruction for the nurse to provide includes health promotion for the mother and fetus, so the nurse instructs the patient to taper off therapy as a means of avoiding the adverse effects of withdrawal and to prevent fetal harm. Therapy must be stopped before conception because benzodiazepines are lipid soluble and cross the placenta, increasing the risk of fetal harm. To promote fetal development, the nurse instructs the patient to visit a provider for folic acid and prenatal vitamin prescriptions and to eat a well-balanced diet. To help prevent a crisis, the nurse instructs the patient to develop an alternative plan for managing anxiety with the assistance of a healthcare provider.
When performing discharge teaching for a client prescribed oral linezolid (Zyvox) to treat methicillin-resistant Staphylococcus aureus (MRSA), the nurse should emphasize which important information? A. Stop the drug as soon as you feel better. B. Avoid ingestion of foods containing tyramine. C. Report any occurrence of constipation or facial flushing. D. Take the drug with an antacid to avoid gastrointestinal (GI) upset
B. Avoid ingestion of foods containing tyramine. Hypertension may occur in clients consuming tyramine-containing foods such as aged cheese or wine, soy sauce, smoked meats or fish, and sauerkraut while taking linezolid. Linezolid causes diarrhea, not constipation, and should be taken with food to decrease GI distress. An antacid would interfere with absorption.
Selective serotonin reuptake inhibitors (SSRIs) and antidepressants (TCAs) both function by which mechanism? A. Decrease the catecholamine release into the blood B. Block the reuptake of neurotransmitters at nerve endings C. Inhibit an enzyme that stops the action of neurotransmitters D. Stimulate areas of the brain associated with mental alertness
B. Block the reuptake of neurotransmitters at nerve endings
For a client receiving an intravenous (IV) infusion of gentamicin (Garamycin), the nurse would monitor which laboratory values? A. Hematocrit and hemoglobin B. Blood urea nitrogen (BUN) and creatinine C. Prothrombin time and partial thromboplastin time D. Serum glutamic-oxaloacetic transaminase and alanine transaminase
B. Blood urea nitrogen (BUN) and creatinine Gentamicin has a high potential for nephrotoxicity. Nephrotoxicity typically occurs in 5% to 25% of clients. Thus, the client's renal function test results for BUN and creatinine must be monitored closely throughout therapy.
8) A patient prescribed lorazepam (Ativan) for the treatment of anxiety states, "I feel drowsy all the time, and it's interfering with every aspect of my life." The nurse knows that a better drug therapy option for this patient is which anxiolytic medication? A. Alprazolam (Xanax) B. Buspirone (BuSpar) C. Chlordiazepoxide (Librium) D. Hydroxyzine hydrochloride salt (Vistaril)
B. Buspirone (BuSpar
10) A nurse is caring for a hospitalized client who is receiving intradermal fentanyl (Duragesic) for severe pain. Which of the following medications should the nurse expect to cause an adverse effect when administered concurrently with fentanyl? A. Ampicillin (Principen) B. Diazepam (Valium) C. Furosemide (Lasix) D. Prednisone
B. CORRECT: Diazepam, a benzodiazepine, is a CNS depressant, which may interact to cause severe sedation when administered concurrently with an opioid agonist or agonist/antagonist.
Which laboratory test should be monitored closely to assess for a potential life-threatening adverse effect to clozapine (Clozaril)? A. Liver function studies B. Complete blood count C. Immunoglobulin levels D. Glomerular filtration rate
B. Complete blood count Patients taking clozapine must be monitored for the life-threatening adverse effect of agranulocytosis, evidenced by a severe reduction in the number of white blood cells.
A client who is prescribed metronidazole (Flagyl) for a gynecologic infection provides the nurse with a list of medications that are routinely taken. Which medication would lead the nurse to question the prescription for Flagyl? A. Ibuprofen (Advil) B. Lithium (Eskalith) C. Levothyroxine (Synthroid) D. Multivitamin (Thera-Tabs)
B. Lithium (Eskalith) Concomitant use of lithium and metronidazole may result in lithium toxicity. Thus, a client who reports taking lithium should alert the nurse to notify the health care provider because of the potential significant interaction.
The nurse is reviewing the medication history of a patient who will be taking a sulfonamide antibiotic. During sulfonamide therapy, a significant drug interaction may occur with which of these drugs or drug classes? (Select all that apply.) A. Opioids B. Oral Contraceptives C. Sulfonlylureas D. Antihistamines E. Phenytoin (Dilantin) F. Warfarin (Coumadin)
B. Oral Contraceptives C. Sulfonlylureas E. Phenytoin (Dilantin) F. Warfarin (Coumadin) Rationale: Sulfonamides may potentiate the hypoglycemic effects of sulfonylureas in diabetes treatment, the toxic effects of phenytoin, and the anticoagulant effects of warfarin, which can lead to hemorrhage. Sulfonamides may also reduce the efficacy of oral cont
A patient will be having oral surgery and has received an antibiotic to take for 1 week before the surgery. The nurse knows that this is an example of which type of therapy? A. Empiric B. Prophylactic C. Definitive D. Resistance
B. Prophylactic Rationale: Prophylactic antibiotic therapy is used to prevent infection. Empiric therapy involves selecting the antibiotic that can best kill the microorganisms known to be the most common causes of an infection. Definitive therapy occurs once the culture and sensitivity results are known. Resistance is not a type of antibiotic therapy.
Which nursing diagnosis is appropriate for a patient who has started aminoglycoside therapy? A. Constipation B. Risk for injury (renal damage) C. Disturbed body image related to gynecomastia D. Imbalanced nutrition, less than body requirements, related to nausea
B. Risk for Injury (Renal Damage) Rationale: Patients on aminoglycoside therapy have an increased risk for injury caused by nephrotoxicity. The other options are incorrect.
Eating foods high in tyramine, including aged cheese, can cause a hypertensive crisis in patients taking MAOIs. What is another approved and indicated use for the antidepressant bupropion (Zyban)? A. Nocturnal enuresis B. Smoking cessation C. Tourette's syndrome D. Orthostatic hypotension
B. Smoking cessation Zyban is a sustained-release form of bupropion that is useful in helping patients to quit smoking.
A patient diagnosed with depression is being discharged with a prescription for TCAs after no improvement of symptoms on an SSRI. Which instruction should the nurse include about this new medication? A. There are no drug or food contraindications with this medication. B. There is a risk of toxicity when this medication is taken with alcohol. C. Take St. John's wort every day to minimize the adverse effects of the medication. D. This drug does not cause problems with sleep, constipation, or low blood pressure.
B. There is a risk of toxicity when this medication is taken with alcohol.
The nurse would teach a client prescribed metronidazole (Flagyl) to avoid ingestion of which drink? A. Milk B. Wine C. Coffee D. Orange juice
B. Wine A disulfiram-like (Antabuse) reaction may occur with concurrent ingestion of metronidazole and alcohol, leading to facial flushing, tachycardia, palpitations, nausea, and vomiting
A group of office workers is concerned because a package was opened that contained a white powder substance. There is a concern that the white powder is anthrax. Which drug does the nurse anticipate being prescribed for the office workers? A) daptomycin (Cubicin) B) colistimethate (Coly-Mycin) C) ciprofloxacin (Cipro) D) quinupristin/dalfopristin (Synercid)
C
A patient has been admitted for treatment of an infected leg ulcer and will be started on intravenous linezolid. The nurse is reviewing the list of the patient's current medications. Which type of medication, if listed, would be of most concern if taken with the linezolid? a. Beta blocker b. Oral anticoagulant c. AN SSRI-Selective serotonin reuptake inhibitor antidepressant d. Thyroid replacement hormone
C
During an infusion of amphotericin B, the nurse knows that which administration technique may be used to minimize infusion-related adverse effects? a. Forcing of fluids during the infusion b. Infusing the medication quickly c. Infusing the medication over a longer period of time d. Stopping the infusion for 2 hours after half of the bag has infused, and then resuming 1 hour later
C
Medications used to treat HIV infections are more specifically classified as A. antifungal drugs. B. antiviral drugs. C. antiretroviral drugs. D. antiparasitic drugs.
C
When giving intravenous quinolones, the nurse needs to keep in mind that these drugs may have serious interactions with which drugs? a. Selective serotonin reuptake inhibitor antidepressants b. Nonsteroidal antiinflammatory drugs c. Oral anticoagulants d. Antihypertensives
C
Which antifungal drug can be given intravenously to treat severe yeast infections as well as a one-time oral dose to treat vaginal yeast infections? A. Voriconazole (Vfend) B. Nystatin (Mycostatin) C. Fluconazole (Diflucan) D. Caspofungin (Cancidas)
C
While monitoring a patient who is receiving intravenous amphotericin B, the nurse expects to see which adverse effect(s)? a. Hypertension b. Bradycardia c. Fever and chills d. Diarrhea and stomach cramps
C
7) A male patient taking lorazepam (Ativan) reports lethargy and confusion. Which action should the nurse implement next? A) Tell the patient that the symptoms will dissipate gradually. B) Plan nursing care to manage a benzodiazepine overdose. C) Ask the patient how many doses he has taken in the past 8 hours. D) Instruct the patient to rest at home until he is thinking clearly again.
C) Ask the patient how many doses he has taken in the past 8 hours. The nurse's next intervention is to investigate the patient's complaint completely before planning or implementing nursing care, because nursing care is based on patient assessment data. The nurse assesses the patient's condition by asking how much of the medication he has taken recently. In doing so, the nurse can plan nursing care more accurately. The nurse avoids planning care for an overdose, because this has not been determined. Instructing the patient to rest at home is a reasonable nursing response to prevent patient injury and may be indicated once a complete assessment has been performed. Once an overdose has been ruled out, the nurse can help the patient understand that the adverse effects of therapy often disappear over time.
. The nurse is administering an intravenous aminoglycoside to a patient who has had gastrointestinal surgery. Which nursing measures are appropriate? (Select all that apply.) a. Report a trough drug level of 0.8 mcg/mL, and hold the drug. b. Enforce strict fluid restriction. c. Monitor serum creatinine levels. d. Instruct the patient to report dizziness or a feeling of fullness in the ears. e. Warn the patient that the urine may turn darker in color.
C,D
which antibiotic causes fetal harm - bilateral congenital deafness? (select all that apply) a) penicillin b) vancomycin c) gentamicin d) tobramycin e) amikacin
C,D, E all aminoglycosides have contraindications with pregnancy because they could cause fetal harm; only used in the event of life threatening infection
Quinolones are a class of antibiotics known for several significant complications. Which are possible adverse effects with these drugs? (Select all that apply.) A. Ototoxicity B. Nephrotoxicity C. Tendon rupture D. Prolongation of the QT interval E. Abnormal cartilage development in children
C,D,E Quinolones are not used in prepubescent children because of the risk of cartilage development issues. Quinolones may also cause a cardiac effect that involves prolongation of the QT interval on the electrocardiogram. The use of these medications can result in tendonitis or ruptured tendons in adults. Nephrotoxicity and ototoxicity are not associated with quinolones.
When a patient is receiving a second-generation antipsychotic drug, such as risperidone (Risperdal), the nurse will monitor for which therapeutic effect? A. Increase sleeping B. Decrease in dizziness C. Decreased paranoia and delusion D. Increase in visual acuity
C.
When reviewing the allergy history of a patient, the nurse notes that the patient is allergic to penicillin. Based on this finding, the nurse would question an order for which class of antibiotics? A. Tetracyclines B. Sulfonamides C. Cephalosporins D. Quinolones
C. Cephalosporins Rationale: Allergy to penicillin may also result in hypersensitivity to cephalosporins. The other options are incorrect.
The nurse should assess a client for nephrotoxicity and ototoxicity when administering which antimicrobial? A. Cefazolin (Ancef) B. Clindamycin (Cleocin) C. Gentamicin (Garamycin) D. Erythromycin
C. Gentamicin (Garamycin) Aminoglycoside antibiotics, including gentamicin, have a high risk for nephrotoxicity and ototoxicity.
A patient with a long-term intravenous catheter is going home. The nurse knows that if he is allergic to seafood, which antiseptic agent is contraindicated? A. Chlorhexidine gluconate (Hibiclens) B. Hydrogen peroxide C. Povidone-iodine (Betadine) D. Isopropyl alcohol
C. Povidone- Iodine (Betadine) Rationale: Iodine compounds are contraindicated in patients with allergies to seafood. The other options are incorrect.
A patient with a long-term intravenous catheter is going home. The nurse knows that if he is allergic to seafood, which antiseptic agent is contraindicated? A. Chlorhexidine gluconate (Hibiclens) B. Hydrogen peroxide C. Povidone-iodine (Betadine) D. Isopropyl alcohol
C. Povidone- Iodine (Betadine) Rationale: Iodine compounds are contraindicated in patients with allergies to seafood. The other options are incorrect.
A patient is receiving his third intravenous dose of a penicillin drug. He calls the nurse to report that he is feeling "anxious" and is having trouble breathing. What will the nurse do first? A. Notify the prescriber. B. Take the patient's vital signs. C. Stop the antibiotic infusion. D. Check for allergies.
C. Stop the antibiotic infusion Rationale: Hypersensitivity reactions are characterized by wheezing; shortness of breath; swelling of the face, tongue, or hands; itching; or rash. The nurse should immediately stop the antibiotic infusion, have someone notify the prescriber, and stay with the patient to monitor the patient's vital signs and condition. Checking for allergies should have been done before the infusion.
A patient has a urinary tract infection. The nurse knows that which class of drugs is especially useful for such infections? A.Macrolides B. Carbapenems C. Sulfonamides D. Tetracyclines
C. Sulfonamides Rationale: Sulfonamides achieve very high concentrations in the kidneys, through which they are eliminated. Therefore, they are often used in the treatment of urinary tract infections.
When a patient is on aminoglycoside therapy, the nurse will monitor the patient for which indicators of potential toxicity? A. Fever B. White Blood cell count of 8,000 cells/mm 3 C. Tinnitus and Dizziness D. Decreased Blood Urea Nitrogen (BUN) levels
C. Tinnitus and Dizziness Rationale: Dizziness, tinnitus, hearing loss, or a sense of fullness in the ears could indicate ototoxicity, a potentially serious toxicity in a patient. Nephrotoxicity is indicated by rising blood urea nitrogen and creatinine levels. Fever may be indicative of the patient's infection; a white blood cell count of 7000 cells/mm3 is within the normal range of 5000 to 10,000 cells/mm3.
A patient who has been hospitalized for 2 weeks has developed a pressure ulcer that contains multidrug-resistant Staphylococcus aureus (MRSA). Which drug would the nurse expect to be chosen for therapy? A. Metronidazole (Flagyl) B. Ciprofloxacin (Cipro) C. Vancomycin (Vancocin) D. Tobramycin (Nebcin)
C. Vancomycin (Vancocin) Rationale: Vancomycin is the drug of choice for the treatment of MRSA. The other drugs are not used for MRSA
A patient has developed an aspergillosis infection. Which tissue does the aspergillosis affect? A) Skin B) Nails C) Blood D) Lungs
D
A patient is receiving amphotericin B lipid complex. The nurse knows that an advantage of the lipid formulations of this drug is that they A) have a lower cost. B) can be administered quickly. C) take longer to be absorbed. D) cause fewer adverse effects.
D
A patient who is HIV- positive has been receiving medication therapy that includes zidovudine(Retrovir). However, the prescriber has decided to stop the zidovudine because of its dose-limiting adverse effect. Which of these conditions is the dose-limiting adverse effect of zidovudine therapy? a. Retinitis b. Renal toxicity c. Hepatoxicity d. Bone marrow suppression
D
An 82-year-old woman is unable to take the influenza vaccine due to allergies, but she has been exposed to the virus through a family reunion. She does not yet have symptoms of the flu. Which option would be best for her? A) She should receive the flu vaccine as soon as possible. B) She should receive zanamivir (Relenza) in the inhalation form. C) She should begin oral oseltamivir (Tamiflu) therapy when symptoms begin. D) She should begin oral oseltamivir (Tamiflu) therapy as soon as possible.
D
During therapy with an intravenous aminoglycoside, the patient calls the nurse and says, "I'm hearing some odd sounds, like ringing, in my ears." What is the nurse's priority action at this time? a. Reassure the patient that these are expected adverse effects. b. Reduce the rate of the intravenous infusion. c. Increase the rate of the intravenous infusion. d. Stop the infusion immediately.
D
The nurse notes in a patient's medication history that the patient is taking terbinafine (Lamisil). Based on this finding, the nurse interprets that the patient has which disorder? a. Vaginal candidiasis b. Cryptococcal meningitis c. Invasive aspergillosis d. Onychomycosis
D
When administering antifungal drug therapy, the nurse knows that an issue that contributes to many of the drug interactions with antifungals is the patient's a. history of cardiac disease. b. history of gallbladder surgery. c. ethnic background. d. cytochrome P-450 enzyme system.
D
While assessing a woman who is receiving quinolone therapy for pneumonia, the nurse notices that the patient has a history of heart problems. The nurse will monitor for which potential cardiac effect of quinolone therapy? a. Bradycardia b. Dysrhythmias c. Tachycardia d. Prolonged QT interval
D
Which statement by the patient indicates the need for additional teaching on phenothiazine (Thorazine) drug therapy? A. "I need to change positions slowly to prevent dizziness." B. "I will call my health care provider for abnormal tongue movements" C. "I will need to wear sunscreen and protective clothing when outdoors." D. "It is okay to take this drug with a small glass of wine to help relax me."
D Drinking alcohol with phenothiazines puts the patient at risk for increased central nervous system depression
3) A patient is detoxifying from alcohol abuse. Which type of medication is indicated to help the patient through withdrawal? A) Dibenzapine B) Benzisoxazole C) Phenothiazine D) Benzodiazepine
D) Benzodiazepine A benzodiazepine is indicated in the management of the clinical manifestations of alcohol withdrawal because of their wide range of therapeutic effects. Dibenzapines, benzisoxazoles, and phenothiazines are antipsychotic agents and are not indicated for alcohol withdrawal.
5) After benzodiazepine treatment fails, the nurse administers buspirone (BuSpar) to a patient with an anxiety disorder. What patient teaching should the nurse provide to help the patient realize the full benefit of buspirone therapy? A) Avoid taking serotonergic agents. B) Stand up slowly to help minimize any dizziness. C) Take the medication with food to help prevent nausea. D) Self-administer buspirone on a consistent basis.
D) Self-administer buspirone on a consistent basis. The nurse instructs the patient to take buspirone daily and to adhere to the dosing schedule to realize the full benefit of therapy, because consistent dosing is important in achieving the full therapeutic effect. Although unrelated to achieving the therapeutic effect, instructing the patient to avoid serotonergic agents, as a means of preventing serotonin syndrome, is a reasonable nursing intervention for a patient taking buspirone. The nurse instructs the patient to change positions slowly if dizziness occurs. Nausea is an unusual effect of buspirone.
11. What atypical antipsychotic medication would the nurse anticipate a provider prescribing for treatment refractory schizophrenia? A) trazodone (Desyrel) B) Phenelzine (Nardil) C) amoxapine (Asendin) D) risperidone (Risperdal)
D) risperidone (Risperdal)
A 58-year-old man is receiving vancomycin as part of the treatment for a severe bone infection. After the infusion, he begins to experience some itching and flushing of the neck, face, and upper body. He reports no chills or difficulty breathing. The nurse should suspect: A) an allergic reaction has occurred. B) an anaphylactic reaction is about to occur. C) the medication will not be effective for the bone infection. D) the IV dose may have infused too quickly
D) the IV dose may have infused too quickly These symptoms are know as red man syndrome and may occur during or after an infusion of vancomycin. This syndrome is characterized by flushing and/or itching of the head, face, neck, and upper trunk area. Symptoms can usually be alleviated by slowing the rate of infusion to at least 1 hour. Red man syndrome is bothersome but usually not harmful. Rapid infusions may also cause hypotension.
During drug therapy with a tetracycline antibiotic, a patient complains of some nausea and decreased appetite. Which statement is the nurse's best advice to the patient? A. "Take it with cheese and crackers or yogurt." B. "Take each dose with a glass of milk." C. "Take an antacid with each dose as needed." D. "Drink a full glass of water with each dose."
D. "Drink a full glass of water with each dose" Rationale: Oral doses should be given with at least 8 ounces of fluids and food to minimize gastrointestinal upset; however, antacids and dairy products will bind with the tetracycline and make it inactive.
The nurse will question the use of a fluoroquinolone antibiotic in a client already prescribed which medication? A. Furosemide (Lasix) B. Omeprazole (Prilosec) C. Metoprolol (Lopressor) D. Amiodarone (Cordarone)
D. Amiodarone (Cordarone Dangerous cardiac dysrhythmias are more likely to occur when quinolones are taken by clients receiving class I and class III antidysrhythmic drugs such as disopyramide and amiodarone. For this reason, such drug combinations should be avoided.
A patient is admitted with a fever of 102.8° F (39.3° C), origin unknown. Assessment reveals cloudy, foul-smelling urine that is dark amber in color. Orders have just been written to obtain stat urine and blood cultures and to administer an antibiotic intravenously. The nurse will complete these orders in which sequence? A. Blood culture, antibiotic dose, urine culture B. Urine culture, antibiotic dose, blood culture C. Antibiotic dose, blood and urine cultures D. Blood and urine cultures, antibiotic dose
D. Blood and urine cultures, antibiotic dose. Rationale: Culture specimens should be obtained before initiating antibiotic drug therapy; otherwise, the presence of antibiotics in the tissues may result in misleading culture and sensitivity results. The other responses are incorrect.
The nurse is preparing to use an antiseptic. Which statement is correct regarding how antiseptics differ from disinfectants? A. Antiseptics are used to sterilize surgical equipment. B. Disinfectants are used as preoperative skin preparation. C. Antiseptics are used only on living tissue to kill microorganisms. D. Disinfectants are used only on nonliving objects to destroy organisms.
D. Disinfectants are used only on nonliving objects to destroy organisms Rationale: Antiseptics primarily inhibit microorganisms but do not necessarily kill them. They are applied exclusively to living tissue. Disinfectants are able to kill organisms and are used only on nonliving objects.
The nurse is administering a vancomycin (Vancocin) infusion. Which measure is appropriate for the nurse to implement in order to reduce complications that may occur with this drug's administration? A. Monitoring blood pressure for hypertension during the infusion B. Discontinuing the drug immediately if red man syndrome occurs C. Restricting fluids during vancomycin therapy D. Infusing the drug over at least 1 hour
D. Infusing the drug over at least 1 hour Rationale: Infuse the medication over at least 1 hour to reduce the occurrence of red man syndrome. Adequate hydration (at least 2 L of fluid in 24 hours) during vancomycin therapy is important for the prevention of nephrotoxicity. Hypotension may occur during the infusion, especially if it is given too rapidly.
The nurse is reviewing the medication orders for a patient who will be receiving gentamicin therapy. Which other medication or medication class, if ordered, would be a potential interaction concern? A. Calcium channel blockers B. Phenytoin C. Proton pump inhibitors D. Loop diuretics
D. Loop Diuretics Rationale: Concurrent use of aminoglycosides, such as gentamicin, with loop diuretics increases the risk for ototoxicity. The other drugs and drug classes do not cause interactions.
The nurse is monitoring a patient taking an antipsychotic medication for extrapyramidal symptoms. Which clinical finding indicates an adverse effect of this drug? A. Dry mouth and constipation B. Blood pressure of 80/50 mm Hg C. Presence of myoglobin in the blood D. Muscle cramps of the head and neck
D. Muscle cramps of the head and neck Dystonia, or sudden and painful muscle spasms, is the only extrapyramidal adverse effect listed. The other adverse effects also occur but are not extrapyramidal effects.
Which is a complication of vancomycin IV infusions? A. Angioedema B. Neurotoxicity C. Cardiomyopathy D. Red man syndrome
D. Red man syndrome When infused too rapidly, clients receiving vancomycin may develop hypotension accompanied by flushing or itching of the head, face, neck, and upper trunk area. This phenomenon is called red man syndrome.
What atypical antipsychotic medication should the nurse anticipate the health care provider prescribing for treatment of refractory schizophrenia? A. Phenelzine (Nardil) B. Prazodone (Desyrel) C. Amoxapine (Asendin) D. Risperidone (Risperdal)
D. Risperidone (Risperdal) Risperidone is effective for schizophrenia, including negative symptoms. The other medications listed are antidepressants.
A depressed client has been prescribed a tricyclic antidepressant. How long should the nurse inform the client that it will take before the client notices a significant change in the depression? 4 to 6 days 2 to 4 weeks 5 to 6 weeks 12 to 16 hours
It takes 2 to 4 weeks for the tricyclic antidepressant to reach a therapeutic blood level.
When monitoring a patient who is receiving caspofungin, the nurse will look for which serious adverse effects? (Select all that apply.) a. Blood dyscrasias b. Hypotension c. Pulmonary infiltrates d. Tinnitus e. Hepatotoxicity
a,b,e
The nurse is providing counseling to a woman who is HIV positive and has just discovered that she is pregnant. Which anti-HIV drug is given to HIV-infected pregnant women to prevent transmission of the virus to the infant? a. Acyclovir (Zovirax) b. Zidovudine (Retrovir) c. Ribavirin (Virazole) d. Foscarnet (Foscavir)
b
A patient has been admitted to the emergency department with a suspected overdose of a tricyclic antidepressant. The nurse will assess for what immediate concern? tremors cardiac dysrhythmias cold sweats diarrhea
cardiac dysrhythmias
what are the signs and symptoms of superinfection?
fever, perineal itching, cough, lethargy, or any unusual discharge
