Pharmacology Exam 3
What information should the nurse provide to a client prescribed eszopiclone?
the importance of taking the drug immediately before going to bed
A 22-year-old female college student presented to the clinic and was given a prescription for metronidazole 250 mg PO tid for 7 days. The nurse at the clinic understands that metronidazole is used in the treatment of which?
trichomoniasis.
What would be most important for the nurse to monitor in a client receiving amphotericin B?
complete blood count
The client has been perscribed an MAO inhibitor. As the nurse teaches the client about this medication, what foods will the client be instructed to avoid?
Aged cheeses and meats, concentrated yeast extracts, sauerkraut, and fava beans
A nurse is reviewing the health record of a client for whom antimalarial therapy is being proposed. The nurse should identify what aspect of the client's history as contraindicating the use of antimalarials?
Alcoholic liver disease
The nurse is caring for a client diagnosed with a life-threatening systemic fungal infection that is not responding to treatment with an azole. What medication should the nurse anticipate the provider may order next?
Amphotericin B
A group of nursing students answers correctly if they identify which medication as the prototype benzodiazepine?
Diazepam (Valium)
A nurse observing a client notices the client has developed muscle rigidity, altered mental status, tachycardia, and sweating. The nurse interprets these findings as suggesting which of the following?
Neuroleptic malignant syndrome (NMS)
With doses above 450 mg/d of Bupropion, what may occur?
Seizures
A sometimes fatal syndrome, characterized by hypertensive crisis, extreme agitation progressing to delirium, and coma is known as:
Serotonin syndrome.
What response should the nurse provide to explain to a parent why chloramphenicol was likely not the drug of choice for the treatment of their child diagnosed with meningococcal meningitis?
"Chloramphenicol isn't used unless there is no adequate substitute drug available."
The wife of a client who is taking haloperidol calls the clinic and reports that her husband has taken the first dose of the drug and it is not having a therapeutic effect. An appropriate response by the nurse would be which?
"Continue the prescribed dose. It may take several days to work."
As the nurse caring for Ms. Quil, you discuss home administration of zidovudine. Which statement by Ms. Quil indicates she needs additional teaching in order to understand correct self-administration?
"I can consume as many fats as I want."
Which statement by a 36-year-old client would lead the nurse to believe that the client has understood the teaching regarding metronidazole (Flagyl)?
"I will not drink alcohol while I am taking this medication."
An adult client is being treated for genital herpes with acyclovir. Which client statement indicates a need for further health education?
"It's a relief to know that this drug will stop me from spreading the infection."
What instruction should the nurse provide to the client prescribed griseofulvin for a tinea infection?
"Make sure to take your medication with food, preferably with a high-fat meal."
A client who is receiving metronidazole therapy for trichomoniasis asks the nurse how this infection occurred. Which response by the nurse would be most appropriate?
"The infection is spread during sexual intercourse."
The client has just begun taking metronidazole and calls the clinic to report that her urine has turned very dark. What is the nurse's best response to this client?
"This is an expected side effect. Your urine color will return to normal after you stop taking this drug." Metronidazole commonly causes a client's urine to turn dark. It is a temporary side effect. The color of the urine goes back to normal after the medication has been completed.
The nurse is reviewing the medication instruction for the client taking acyclovir. Which statement by the client would indicate the need for additional teaching?
"This medication will maintain the symptoms and cure my disease."
A nurse is teaching a client with herpes zoster to apply acyclovir ointment. What guidance should the nurse include in the instructions?
"Wear gloves when applying the ointment."
A client received erythromycin before dental surgery. The client has a past history of a cardiac surgery. The rest of the client's history is unremarkable. What does the nurse teach the client about this medication?
"You are receiving this medication to prevent infection that may affect your heart." The client with a prior history of a heart defect is at risk for bacteria growing in the area of the defect. The client should receive prophylactic antibiotics with any surgery or invasive procedure.
What is Phenelzine used for?
-Depression when other antidepressants have been unsuccessful in symptom management.
What is the most serious adverse effect associated with Phenelzine?
-Hypertensive crisis
How long should an infusion of vancomycin be programmed to run to minimize the client's risk of developing symptoms associated with excessive histamine release? 1 to 2 hours 2 to 4 hours 3 to 4 hours 30 minutes
1 to 2 hours Explanation: For systemic infections, vancomycin is given IV and reaches therapeutic plasma levels within 1 hour after infusion. It is very important to give IV infusions slowly, over 1 to 2 hours, to avoid an adverse reaction characterized by hypotension, flushing, and skin rash. This reaction, sometimes called "red man syndrome," is attributed to histamine release.
The client is experiencing some slurred speech and the nurse notices tremors. In reviewing the client's am lab results she focuses on the serum lithium level. Which finding would indicate that the client is experiencing lithium toxicity?
1.8 mEq/L
For which clients would treatment with acyclovir be most clearly indicated?
A 77-year-old whose recent debilitating pain has been attributed to a herpes zoster infection
A pediatric nurse is caring for a 4 year-old child who has been diagnosed with the most common childhood helminthic disease in the United States. The nurse should anticipate what intervention?
A three-day course of mebendazole. Pinworms are the most frequent cause of helminth infections in the United States. Mebendazole is effective in their eradication and the chewable tablets make them ideal for young children. Ivermectin and metronidazole are not used to treat pinworms.
Lipid formulations of polyenes used for those in renal failure or neutropenic
Abelcet, AmBisome
A patient is required to be administered vancomycin for treatment of an abdominal abscess. What should the nurse ensure when monitoring the IV infusion of vancomycin in the patient when caring for him?
Administer each dose over 60 minutes.
Mrs. Coles, 45 years old, suffers from an acute case of scabies. She is prescribed a daily dosage of permethrin. She needs advice and tips regarding effective therapy because she attempted many other therapies before, which were ineffective. What permethrin usage tip should the nurse give her?
Advise the patient to leave the permethrin cream on the skin for 8 to 14 hours.
The health care provider orders eszopiclone (Lunesta) for a male client as a treatment for intermittent insomnia. The client states that he feels the prescription works well as a sleep aid, but he is having difficulty with short-term memory loss. What is this client experiencing?
An adverse reaction
A male client presents to the emergency department with an abdominal dehiscence. He states he had a hernia repair 18 days earlier, and the health care provider removed his wound staples 5 days ago. The client states that the dehiscence occurred when he lifted a box this morning for his wife. The wound is red, and there is evidence of foul-smelling drainage. The wound is cultured, and an anaerobic bacterium is identified. The nurse understands that the provider orders metronidazole because it is effective against which type of organism?Anaerobic bacteria Staphylococcus All gram-negative bacteria All gram-positive bacteria
Anaerobic bacteria Explanation: Metronidazole is effective against infections with anaerobic bacteria and some protozoa.
The nursing instructor is discussing the administration of azithromycin, a macrolide, with her clinical group. The instructor asks her students to identify the medication that will decrease the effects of azithromycin when administered concurrently. Which of the following medications would the students identify?
Antacids
A client who takes a beta blocker and loop diuretic for hypertension has been diagnosed with candidiasis. The client's provider has prescribed fluconazole 400 mg PO. What is the nurse's best action?
Assess the client and administer the drug as prescribed
A client has presented to the campus medical clinic reporting vaginal itching and burning accompanied by yellowish discharge. The client is diagnosed with trichomoniasis and prescribed metronidazole 250 mg PO t.i.d. What health education should the nurse provide?
Avoid drinking alcohol until treatment is complete.
A client is diagnosed with VRE, and the health care provider orders chloramphenicol. The nurse should monitor the client for the development of which side effect?
Blood dyscrasias
A client is being treated for histoplasmosis with amphotericin B. The nurse has completed a comprehensive assessment of the client and should report what assessment finding?
The client's urine output is 75 mL over six hours
Prior to starting therapy with diazepam (Valium), a nurse should gather which of the following information from a hospitalized client? Select all that apply:
Complete medical history Mental status exam Anxiety level Medication history
What describes how amphotericin B harms host cells?
The drug disrupts the sterols in the cell membrane.
The nurse is assessing a client who is in the military and who will leave in two weeks for a tour in an area where malaria is endemic. The client has been given a prescription by the provider reading "Chloroquine 300 mg PO weekly starting now and until four weeks after returning home." What is the nurse's best action?
Confirm the client's knowledge of the medication regimen.
The nurse is assessing a pediatric client who has been diagnosed with pinworms. The client's parent states, "The health care provider prescribed some pills that I have to give my child for three weeks. It will be hard to remember to give them every day." What is the nurse's best action?
Confirm the length of the course of treatment with the provider. Pinworms are normally treated with a three-day course of mebendazole, not a three-week course.
The nurse is educating an 82-year-old client regarding amphotericin B (Fungizone). The nurse knows the client understand when the client states that he could develop which adverse effect?
Damage to his kidneys
A client has been prescribed metronidazole for treatment of Giardia. What instruction is most important for the nurse to give to this client? Do not drink alcohol while taking this medication. Do not smoke while taking this medication. Do not eat dairy foods while taking this medication. Regularly use sunscreen products while taking this medication.
Do not drink alcohol while taking this medication. Explanation: Clients who are receiving metronidazole should not drink alcohol because the client will develop a disulfiram-type reaction if alcohol is consumed while the client is receiving metronidazole.
A 49-year-old farmer who normally enjoys good health has become seriously ill in recent days and the results of an extensive diagnostic work up have resulted in a diagnosis of histoplasmosis. The patient has been admitted to the hospital and has begun treatment with amphotericin B. The nurse who is providing care for the patient should prioritize which of the following diagnostic results during his course of treatment?
Electrolytes, blood urea nitrogen, and creatinine
A client has an upper respiratory infection and is allergic to penicillin. What medication does the nurse expect will be ordered?
Erythromycin. A macrolide can be given safely to a client who is allergic to penicillin. Ampicillin, Ancef, and cephalosporins cannot be given because of the risk of cross-sensitivity.
A client's thought disorder has been treated with haloperidol (Haldol). For what adverse effect should the nurse most closely monitor the client?
Extrapyramidal effects
A 28-year-old woman has been diagnosed with schizophrenia. The health care provider has prescribed a typical antipsychotic, haloperidol. Which will the nurse include in the teaching related to the most common adverse effects?
Extrapyramidal symptoms
Clients taking benzodiazepines, especially older adult clients, are at high risk for which effect?
Falls
The client is admitted for IV administration of antifungal medication with the plan to discharge the client on oral medication in a few days. What medication would be most appropriate if it must be available by both IV and PO routes?
Fluconazole
A client has received a benzodiazepine for sedation before a diagnostic procedure. Which agent would the nurse expect the client to receive to reverse the sedative effects?
Flumazenil
A parenteral form of an antipsychotic is prescribed for a client who has become aggressive. When administering the drug, which site would be most appropriate for the nurse to use?
Gluteus
A nurse is caring for a patient who is being administered alprazolam. What initial adverse reaction of alprazolam should the nurse assess for?
Headache
A common reaction associated with the intravenous administration of vancomycin is "red man syndrome." What is the cause of red man syndrome?
Histamine release.
Amphotericin B is given by which route?
IV, oral, and topical
An elderly female client is admitted to the medical floor with pustules on her body that travel along the nerve route in her legs and arms. The health care provider prescribes the drug acyclovir (Zovirax). What disease is this client demonstrating?
Shingles
The nurse is caring for a client who has a severe fungal infection. The health care provider has prescribed a lipid formulation of amphotericin B. The nurse is aware that this form of medication is given for what reason?
It is less nephrotoxic.
In which condition present in the client should macrolides be used with caution? Glaucoma Diabetes mellitus Liver dysfunction Hypertension
Liver dysfunction Explanation:All macrolides should be used with caution in clients with liver dysfunction. Pre-existing liver disease is a contraindication.Diabetes, hypertension and glaucoma are not contraindicated.
Chloroquine acts against erythrocytic forms of plasmodial parasites to prevent or treat what condition?
Malaria
A 9-year-old boy was diagnosed with hookworm infection and will be sent home with a prescription for mebendazole. When providing education, the nurse should teach the mother which measures to avoid reinfection following treatment?
The importance of vigilant hygiene for the client and the other members of the family
A client develops antibiotic-induced colitis. The symptoms have worsened within the past 72 hours. The nurse expects the health care provider to order what medication, which is considered the initial drug of choice? Bismuth subsalicylate Metronidazole Psyllium Loperamide
Metronidazole Explanation:In antibiotic-associated colitis, stopping the causative drug is the initial treatment. If symptoms do not improve within 3 or 4 days, oral metronidazole or vancomycin is given for 7 to 10 days.
A client develops antibiotic-induced colitis. The symptoms have worsened within the past 72 hours. The nurse expects the health care provider to order what medication, which is considered the initial drug of choice?
Metronidazole. In antibiotic-associated colitis, stopping the causative drug is the initial treatment. If symptoms do not improve within 3 or 4 days, oral metronidazole or vancomycin is given for 7 to 10 days.
A patient has been prescribed lithium therapy. Which of the following signs and symptoms will the nurse tell the patient to report immediately?
Muscle twitching
The nurse should monitor the client for which common side effects of erythromycin therapy?Shortness of breath and sore throat Nausea, vomiting, and diarrhea Headache and fever Urticaria and opthalmic drainage
Nausea, vomiting, and diarrhea Explanation: Gastrointestinal problems (e.g., nausea, vomiting, and diarrhea) are common side effects of erythromycin and other macrolides. Headache, fever, opthalmic drainage, uticaria, shortness of breath and sore throat are no common side effects.
A nurse has admitted a 25-year-old female to the unit. What would be the most important information before this client begins systemic antifungal agents?
Renal and hepatic function
A 70-year-old man is being treated for herpes zoster virus. He has been prescribed acyclovir (Zovirax). The clinic nurse should prioritize assessments of which of the following?
Renal function
Your client asks why she is receiving IV fluid hydration prior to initiation of her amphotericin B infusion. Your best response would be:
Renal impairment occurs in most patients within the first 2 weeks of therapy. However, increasing fluid levels and monitoring blood tests minimizes permanent renal impairment.
A nurse determines the possibility of benzodiazepine toxicity based on assessment of which adverse effect?
Respiratory depression
A 43-year-old man is traveling to an area where malaria is endemic and is being treated prophylactically. The nurse will explain which regimens of chloroquine prescribed by the health care provider?
Taking the medication for 2 weeks before the trip and for 4 to 6 weeks after the trip
A nurse is charting on a client who has repetitive tongue and jaw movements, and a facial tick. What term could the nurse use to document these findings?
Tardive dyskinesia
While caring for a client who is receiving antipsychotic therapy, the nurse observes lip smacking, a darting tongue, and slow and aimless arm movements. The nurse interprets this as:
Tardive dyskinesia
A client who is planning to travel to Africa is prescribed chloroquine to prevent malaria. The nurse would instruct the client to begin the therapy at approximately which time?
Ten days before leaving on the trip. Chloroquine is usually started 1 to 2 weeks before exposure and then continues for 4 weeks after leaving the area.
A female patient with giardiasis is taking oral metronidazole. After 3 weeks of therapy, she comes to the clinic for a checkup. Which would be the most important nursing action?
Test a stool specimen.
The patient is receiving vancomycin (Vancocin) intravenously. The nurse assesses the patient and finds that the patient has flushed skin, a rash, and a drop in blood pressure. Which of the following actions probably has happened?
The IV infusion is too fast.
A client tells the nurse that she has taken several doses of over-the-counter fluconazole to treat a "yeast infection." When assessing the client's risk for drug toxicity, what aspect of the client's health status should the nurse prioritize?
The client client has decreased renal function following recent pyelonephritis
A client who is experiencing withdrawal from alcohol has developed psychosis and is being treated with haloperidol. Which assessment findings should prompt the care team to assess the client for neuroleptic malignant syndrome?
The client develops muscle rigidity and a sudden, high fever.
A 45-year-old client is prescribed acyclovir for the treatment of genital herpes. Which is an expected outcome for this client?
The client will experience fewer recurrences.
Ms. Jones, 64 years old, is placed on IV amphotericin B for a systemic fungal infection. Part of your care involves the development of a nursing plan of care. You identify the following nursing problem: ineffective protection related to drug-induced leukopenia and thrombocytopenia. What would be the most appropriate goal for this patient?
The patient will remain free from nosocomial infections during the hospital stay.
A client's medication has been changed to clozapine (Clozaril). What assessment should the nurse perform to identify a life-threatening adverse effect early?
Vital signs monitoring
Which test should be scheduled every week for a patient taking clozapine?
WBC count
The home care nurse is following a client discharged from the hospital with a prescription for diazepam. On the initial visit what is the nurse's priority related to this medication?
Warning signs that may indicate serious adverse effects
A client is being treated with clozapine. What should the nurse monitor most closely?
White blood cell count
A client who begun treatment with clozapine 2 weeks ago is now reporting worsening flu-like symptoms, including a high fever. The nurse's assessment should be conducted with the goal of identifying signs and symptoms of what possible adverse medication reaction?
agranulocytosis
After administration of haloperidol to an acutely dehydrated client, the nurse should prioritize what nursing assessment?
blood pressure
A client is admitted to the hospital for the treatment of malaria. The health care provider has ordered chloroquine. Which symptoms would indicate a serious adverse reaction?
blurred vision
Following an extensive diagnostic workup, a 20-year-old man has been diagnosed with bipolar disorder and begun lithium therapy. The nurse's priority assessment in the care of the patient is
careful monitoring of the patient's serum lithium levels.
What is the prototype for the classification of drugs referred to as benzodiazepines?
diazepam
A client is taking an oral contraceptive and requires antifungal therapy. The nurse understands that which antifungal can lead to decreased effectiveness of the client's oral contraceptive?
griseofulvin
The nurse admitted a client diagnosed with a systemic fungal infection. Before administering ketoconazole as prescribed, what should the nurse confirm?
hepatic function
A nurse, reviewing a newly admitted client's previous health records, notes that the client is currently prescribed acyclovir. The nurse should assess the client for signs and symptoms associated with what medical diagnosis?
herpes simplex virus
The patient receiving IV acyclovir should be monitored for which adverse reaction?
increased BUN and creatinine levels
A client has been placed on amphotericin B. The nurse caring for this client should administer this medication:
intravenously.
What medication would the nurse anticipate being prescribed for a client diagnosed with trichomoniasis? metronidazole penicillin rifaximin clindamycin
metronidazole Explanation:.Metronidazole is effective against anaerobic bacteria, including gram-negative bacilli such as Bacteroides, gram-positive bacilli such as Clostridia, and some gram-positive cocci. It is also effective against protozoa that cause amebiasis, giardiasis, and trichomoniasis. None of the other options would effectively manage this infection.
The nurse realizes that vancomycin is a powerful drug and can treat serious gram-positive infections that do not respond to treatment with other anti-infectives. Serious adverse effects classic for vancomycin include which of the following? (Select all that apply.)
nephrotoxicity ototoxicity
The nurse is caring for a client receiving amphotericin B. Which condition should the nurse assess for in this client?
phlebitis
A 22-year-old female client has been diagnosed with trichomoniasis, and treatment with metronidazole is indicated. What characteristic of the woman's health would contraindicate the use of metronidazole?
pregnancy. Pregnancy is a contraindication for the use of metronidazole
A nurse is getting ready to begin intravenous (IV) vancomycin therapy for a client and must determine the rate of administration before hanging. The nurse proceeds to run it over 60 minutes. Doing so prevents what complication?
profound drop in blood pressure
A client is receiving amphotericin B. The nurse would assess the client closely for which adverse reaction?
renal impairment
What diagnostic test would the nurse monitor to determine the effectiveness of mebendazole prescribed for a helminth infection?
stool sample
A client developed a pressure area on the hip that has become infected. If the wound culture reveals methicillin-resistant Staphylococcus aureus, which medication would the nurse expect to be prescribed? vancomycin penicillin erythromycin metronidazole
vancomycin Explanation: Vancomycin is active only against gram-positive microorganisms. It acts by inhibiting cell wall synthesis. Parenteral vancomycin has been used extensively to treat infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant staphylococcal species non-aureus (SSNA, including Staphylococcus epidermidis), and endocarditis caused by Streptococcus viridans (in clients allergic to or with infections resistant to penicillins and cephalosporins) or E. faecalis (with an aminoglycoside). None of the other options would effectively manage this infection.
For clients taking clozapine, it is necessary to regularly monitor what lab test during the initial months of therapy and periodically thereafter?
white blood cell (WBC) count