Review for GNUR 294 Final

A client has received a prescription for a sulfonamide. Which statement by the client indicates a need for further instruction? A. "If I develop a fever or severe diarrhea, I will call my health care provider." B. "I will call the health care provider if my symptoms have not improved in the next few days." C. "I will limit my fluid intake to about three glasses per day." D. "I will return for my scheduled appointment for lab work."

"I will limit my fluid intake to about three glasses per day."

The client tells the nurse that she has been prescribed phenytoin (Dilantin) for 2 years and is still having too many side effects. She wants to stop taking it. What is the best response by the nurse? A. "This is the best medication for you; we can add another medication to decrease the side effects associated with phenytoin (Dilantin)." B. "Please do not stop the medication abruptly, as you will have withdrawal seizures." C. "You have probably been on the medication long enough; I'll let your doctor know you are stopping it." D. "Side effects are a problem, but they are not as bad as the seizures you were having."

"Please do not stop the medication abruptly, as you will have withdrawal seizures."

A client has been diagnosed with Alzheimer disease. What is the most accurate medication education the nurse can give to the client's spouse? A. "Symptoms should begin to improve in a few days." B. "The medication has side effects that require periodic breaks from treatment." C. "There is no cure. The medication might help with symptoms for a period of time." D. "Symptoms will improve as long as the medication is taken daily at the same time."

"There is no cure. The medication might help with symptoms for a period of time."

A client diagnosed with GERD asks the nurse what his treatment will be. The nurse correctly states: A. "You likely will be instructed to change your lifestyle to see if that helps relieve your symptoms." B. "We will start you on an over-the-counter agent because you have easy access to them and a small chance of overdosing on them." C. "We need to attack this early, and will start with combination therapy." D. "GERD will require a surgical treatment for symptom relief."

"You likely will be instructed to change your lifestyle to see if that helps relieve your symptoms."

The client who is prescribed valproic acid (Depakote) for seizure control would like to have a baby. How should the nurse respond A. "Since your epilepsy may flare up during pregnancy, your doctor will likely have you take aantiepileptic medication." B. "Thankfully, most modern antiepileptic medications will not interfere with your getting pregnant." C. "Your current antiepileptic medication should not be used when you are pregnant." D. "You should consider adopting a baby instead since there are so many problems associated with epilepsy and pregnancy."

"Your current antiepileptic medication should not be used when you are pregnant."

Memantine - Interactions (NMDA receptor blocker)

+ OTC antacids and other drugs that increases pH = increase memantine can cause toxicity + Levadopa/carbidopa = increase s/e of levadopa/carbidopa + NMDA antagonists amantandine and ketamine = increase memantine level.

J. A nurse is caring for a client receiving gentamicin IV. What statement made by the client should most concern the nurse?

- "I am experiencing ringing in my ears."

A. A client has received a prescription for sulfonamide. Which statement by the client indicates a need for further instruction?

- "I will limit my fluid intake to about 3 glasses per day"

J. A client with a diagnosis of trigeminal neuralgia is started on a regimen of Tegretol. The nurse provides instructions to the client about the side/adverse effects of this medication. Which client statements indicates an understanding of the side/adverse effects of this med?

- "I will report a fever or sore throat to my health care provider"

H. Phenytoin (Dilantin), 100 mg to be given orally 3 times daily for seizure control. The home health nurse visits the client and provides instructions regarding the medication. Which statement would indicate understanding of the instructions?

- "I will use a soft toothbrush to brush my teeth."

F. Zidovudine (Retrovir) has been prescribed for a client, and the nurse provides instructions to the client about expected effects of this med. Which statement by the client indicates a need for FURTHER instruction?

- "If I experience diarrhea, I need to contact my Health care provider"

B. The nurse is instructing a female client about therapy with tetracycline (sumycin). Which statement should be included in the instruction?

- "If taking oral contraceptives, an additional form of birth control is recommended." (decrease the effectiveness of oral contraceptive therapy)

A. A client is receiving carbamazepine (Tegretol) for control of seizures. The client tells the nurse she plans to become pregnant. What is the best response by the nurse?

- "Please talk to your doctor; this drug is contraindicated in pregnancy" (Category D)

A. The client has epilepsy and receives phenytoin (Dilantin). The client has been seizure free and asks the nurse why he still needs blood tests when not having seizures. What is the nurse's best response?

- "There is a narrow range between a helpful dose of the medication and a dose that could make you feel sicker."

B. The client is receiving phenobarbital for seizure control. The client asks the nurse how this little pill can stop seizures. What is the best response by the nurse?

- "This medication increases chemical GABA that calms down the excitability in your brain that causes your seizures."

A. A parent says to the nurse, "the doctor prescribed ethosuximide (Zarontin) for my child, who has absence seizures. What does this mean? What is the best response by the nurse?

- "Your child's seizures manifest as a staring into space for a few seconds. Ethosuximide (Zarontin) is a good medication for this type of seizure

D. The nurse has given medication instructions to a client receiving Dilantin. Which statement indicates that the client has an adequate understanding of the instructions?

- "good oral hygiene is needed, including brushing and flossing"

E. The nurse is observing a new nursing graduate who is preparing an IV infusion of phenytoin (Dilantin) for a client with a diagnosis of seizures. Which solution used by the nursing graduate should indicate to the nurse an understanding of proper preparation of this medication?

- 0.9% sodium chloride (normal saline)

B. A client has a prescription for sucralfate (Carafate), orally four times daily. The nurse writes which schedule for this medication on the medication administration record?

- 1 hour before meals and at bedtime

C. The nurse has a prescription to administer diazepam (Valium) 5 mg by IV route to a client. The nurse should administer the medication over a period of at least how long?

- 1 minute

D. The nurse is caring for a teenager with PUD. The nurse recommends that client begin taking ranitidine (Zantac) OTC because the client is older than __ years?

- 12 years

I. The nurse in the health care provider's office is reviewing the results of a client's phenytoin (Dilantin) level determination performed that morning. The nurse identifies that a therapeutic drug level has been achieved if which result is noted?

- 15 mcg/mL (Therapeutic range 10-20)

B. The nurse is providing teaching to a client with GERD on OTC antacids. The nurse correctly states that the client can expect relief from these agents within 10-__ minutes of administration?

- 15 minutes

C. A client admitted to the medical nursing unit has a diagnosis of GERD. Reglan has been prescribed four times a day. The nurse should schedule administration of the medication for which times?

- 30 minutes before meals and at bedtime

F. After review of a clients laboratory values, the nurse notes that a phenytoin (Dilantin) level for a client receiving Dilantin is 7 mcg/mL. The nurse makes which interpretation regarding this lab result?

- 50 mg/min

C. Which client should be monitored closely for adverse effects directly related to receiving penicillin G?

- A client who has diabetes and is on dialysis

A. A client reports no improvement after 5 days of therapy with tetracycline. The nurse suspects drug resistance and knows that drug resistance can develop in which ways?

- A drug is prevented from concentrating inside the bacterial cell - A broad spectrum antibacterial drug is used instead of a narrow-spectrum drug - Drug therapy is not completed for the prescribed duration of time - The shape of the bacteria mutates and prevents an antibiotic from binding to it

I. A client is diagnosed with herpes simplex type I. The health care provider prescribes a topical medication for treatment. The nurse anticipates that which medication will be prescribed?

- Acyclovir (Zovirax)

C. A client in a long-term care facility is ordered to receive ranitidine (Zantac). When should the nurse administer this medication?

- After the evening meal

B. A client has a PRN prescription for loperamide hydrochloride (Imodium). For which condition should the nurse administer this medication?

- An episode of diarrhea

H. Carbamazepine (Tegretol) has been prescribed for a client, and the client asks the nurse about the action of the medication. The nurse's response should incorporate which information as the PRIMARY effect of this medication?

- Anticonvulsant effect

C. The client states "I cant swallow those capsules," so the nurse plans to open the carbamazepine for administration. Which food found on the clients tray should the nurse use for administering this medication?

- Applesauce, Mashed potatoes

A. The elderly client has been started on phenobarbital for seizure control. What is the most important intervention for the nurse to add to the clients care plan?

- Assess respiratory rate and depth every hour

D. A client has a prescription for valproic acid (Depakene) 250 mg once daily. To maximize the client's safety, the nurse should plan to schedule the medication at what time?

- At bedtime

G. The nurse is caring for a patient who is receiving a high dose of tetracycline (Sumycin). Which laboratory values will the nurse expect to monitor while caring for this patient?

- BUN (high doses can lead to nephrotoxicity)

B. Pencillin's antibacterial activity is based on its?

- Beta lactam ring, which terminates construction of the cell wall.

A. The client is receiving valproic acid (Depakene) for treatment of seizures. The client has also been taking a daily 81 mg aspirin tablet prophylactically for a cardiac condition. Because of the use of these two drugs, the nurse closely observes the client for which occurrence?

- Bleeding from the gums and bruising of the skin

I. The HCP writes a prescription for carbamazepine (Tegretol) for a client who was admitted to the hospital. The nurse contacts the HCP to verify the prescription if which condition is noted in the assessment data?

- Bone marrow depression

A. A priority system of assessment in a client recently started on efavirenz (Sustiva) includes?

- CNS

B. Administering an aminoglycoside as monotherapy?

- Can lead to resistant bacterial strains

E. The nurse is administering medications to a client with trigeminal neuralgia. The nurse expects that which medication will be prescribed for pain relief?

- Carbamazepine (Tegretol) and gabapentin (Neurotonin)

A. Classes of antibiotics that exert their antibacterial effect by interfering with the synthesis of the bacterial cell wall include?

- Cephalosporins (beta-lactam antibiotics)

A. A nurse is caring for a client with a UTI. The culture report reveals the presence of Pseudomonas aeruginosa. The nurse anticipates that which medication will be prescribed to treat the infection?

- Ciprofloxacin

A. A client is diagnosed with a gastric ulcer secondary to NSAID overuse. The nurse would question which health care provider order?

- Clarithromycin (This is for H. Pylori treatment)

B. A client with a diagnosis of Parkinsons began taking amantadine (Symmetrel) approximately 2 weeks ago. The client reports to the clinic for a follow-up evaluation. The nurse determines that the client is experiencing an adverse effect related to the use of this medication if which is noted?

- Client complains of urinary retention

B. Which clients on erythromycin will the nurse monitor closely for drug-drug interactions? Select all

- Client wearing a fentanyl patch for chronic pain syndrome - Client taking theophylline for chronic obstructive pulmonary disease - Recovering heroin addict who takes methadone daily.

D. Zidovudine (Retrovir) has been prescribed for a client. The nurse should tell the client that which blood test will be done periodically while the client is taking this medication?

- Complete blood cell count (CBC)

C. A patient is about to start taking omeprazole (Prilosec) to treat a duodenal ulcer. Which of the following instructions should you include when talking with the patient about taking this drug?

- Consume adequate vitamin D and calcium

D. The nurse is preparing to administer amoxicillin (Amoxil) to a patient and learns that the patient previously experienced a rash when taking penicillin. Which action will the nurse take?

- Contact the provider to discuss using a different antibiotic

A. It is crucial for the nurse to monitor which laboratory test when a client is taking acyclovir (Zovirax)?

- Creatinine

C. A client taking amantadine (Symmetrel) approximately 2 weeks ago. The nurse determines that the medication is having a therapeutic effect if the client exhibits which finding?

- Decreased rigidity and Akinesia

F. Knowing the adverse effects of ranitidine (Zantac), the primary care provider's assistant should instruct the patient to watch for and report which of the following?

- Depression

E. The patient is going to take ranitidine (Zantac) in the form of effervescent tablets. Administration instructions for this drug formulation should include which of the following?

- Dissolve the tablets in water

A. You are about to administer ondansteron (Zofran) to a patient to prevent anesthesia induced nausea and vomiting. You prepare to monitor the patient for which of the following adverse effects of this drug?

- Dizziness, lightheadedness, sedation (may also cause headache)

B. A client is prescribed omeprazole, bismuth subsalicyclate, and metronidazole for the treatment of H. pylori. The nurse explains that combination therapy will accomplish which outcome?

- Eliminate the population of H. Pylori

A. The health care provider orders amantadine (Symmetrel) for a client with influenza. Which part of the clients health history would the nurse report to the health care provider prior to administering amantadine (Symmetrel)?

- Epilepsy

A. The parent of a child who is receiving chemotherapy asks the nurse why metoclopramide (Reglan) is not being used to treat suppress vomiting. The nurse will explain that, in children, this drug is more likely to cause which effect?

- Extrapyramidal symptoms

C. A client who has been receiving therapy with tetracycline reports itching and yellowish discoloration of the skin. The nurse knows these symptoms could be associated with which adverse effect of tetracycline?

- Fatty degeneration of the liver (Pruritis, or itching, and jaundice)

B. The health care provider has ordered 5 mg of intravenous valium to treat the client in status epilepticus. The clients IV bag is labeled "1,000 mL D5NS with 20,000 units Heparin." What nursing interventions are necessary to safely administer this diazepam (Valium)? Select all

- Flush the IV line with saline - Observe the IV tubing for cloudiness while administering the diazepam

C. Which generation of cephalosporins would be selected to treat complicated meningitis?

- Fourth (capable of crossing the Blood Brain Barrier)

D. The nurse reads that metoclopramide (Reglan) is prescribed for a client. Based on this prescription, the nurse expects to note that which diagnosis documented?

- Gastroparesis

A. Antibiotics classified as bacteriocidal protein synthesis inhibitors include?

- Gentamicin (Garamycin) (aminoglycosides such as gentamicin have a bactericidal effect; that is, they kill the bacteria).

B. First generation cephalosporins are the most effective of this class of antibiotics against?

- Gram-positive bacteria

K. A nurse preparing to administer carbamazepine (Tegretol) notices each of the following items on the client's breakfast tray. Which item should be a cause for concern and should be removed from the tray?

- Grapefruit juice

B. The nurse is collecting subjective and objective data from a client and notes that the client is taking zidovudine (Retrovir). The nurse determines that this medication has been prescribed to treat which condition?

- HIV

D. A client has been taking omeprazole (Prilosec) for 4 weeks. The ambulatory care nurse evaluates that the client is receiving the optimal intended effect of the medication if the client reports the absence of which symptom?

- Heartburn

E. A client has been taking omeprazole (Prilosec) for 4 weeks. The ambulatory care nurse evaluates medication effectiveness by asking the client if relief was obtained from which symptom?

- Heartburn

E. An older adult has been prescribed an aminoglycoside antibiotic. The nurse would immediately contact the physician if the client exhibits which symptoms?

- High pitched tinnitus - Vertigo - Nausea and vomiting

Ranitidine - CI/Pregnancy H2 Receptor antagonists

- Hypersensitivity - Acute porphyria: abnormality in RBC - metabolism → purple urine and stool category B

H. The nurse is providing teaching to a patient who will begin taking a cephalosporin to treat an infection. Which statement by the patient indicates a need for further teaching?

- I may stop taking the medication if my symptoms clear up

D. The nurse is reading the medication list for a postop client and notes that a PRN prescription for ondansetron was administered. Evaluation of the effectiveness of the medication is determined by the nurse if the client makes which statement?

- I no longer feel nauseous

B. The client who chronically uses NSAIDS has begun taking misoprostol (Cytotec). Which statement by the client indicates that the misoprostol is effective?

- I no longer have pain above my stomach

B. Effective client teaching regarding the treatment of H. pylori has been done for a client when the client states?

- I'll take all the meds exactly as prescribed

G. A female client has been prescribed ampicillin. What should the nurse emphasize when instructing the client about the medication?

- If taking oral contraceptives, use an alternate form of birth control - Ampicillin should be taken on an empty stomach - Contact the health care provider immediately if persistent diarrhea with fever occurs

1. The nurse is caring for a patient who is receiving an IV antibiotic. The patient has a serum drug trough of 1.5 mcg/mL. The normal trough for this drug is 1.7 mcg/mL to 2.2 mcg/mL. What will the nurse expect the patient to experience?

- Inadequate drug effects

H. The nurse understands that which is correct about tetracycline (Sumycin)?

- It is contraindicated in children younger than 8 years of age

C. A client is prescribed gentamicin (Garamycin) concurrently with acyclovir (Zovirax). Which assessment would be the priority for the nurse?

- Kidney function lab tests (concurrent use of gentamicin and acyclovir increases the risk of nephrotoxicity)

G. The nurse is planning care for a diabetic client prescribed an aminoglycoside antibiotic for a serious infection. Which nursing diagnoses would take priority?

- Knowledge deficit related to drug therapy - Risk for injury related to adverse drug effects - Infection

C. A client is scheduled to begin medication therapy with valproic acid (Depakene). The nurse looks for the results of which laboratory test before administering the first dose?

- Liver function tests

B. The nurse preparing to infuse vancomycin will monitor the client for? Select all

- Loss of hearing and balance - Reddening of the upper body with dizziness - Confusion or hallucinations - Fever and chills

Bismuth compounds (Kaopectate, pepto bismol) - S/E

- May cause black stool, can be result of medication but can also be from old blood. Should have stool checked for blood if experienced

A. A client with GERD must be cautioned against the overuse of antacids to avoid which syndrome?

- Metabolic ALKalosis

E. Which interventions would the nurse consider including in a plan of care for clients taking cephalosporins?

- Monitor kidney function in older adults - Monitor for persistent diarrhea in young children - Discuss the concurrent use of alcohol

D. The nurse is administering the first dose of ampicillin intramuscularly to a client with a severe infection. In addition to the six rights of medication administration, an important priority nursing action is to?

- Monitor the client closely for hypersensitivity with the first dose (the chance of hypersensitivity is greater with parenteral administration of ampicillin)

C. A client has a PRN prescription for ondansetron (Zofran). For which condition should the nurse administer this medication to the postoperative client?

- Nausea and vomiting

E. A nurse is providing instructions to a client beginning medication therapy with divalproex sodium (Depakote) for treatment of absence seizures. The nurse instructs the client that which represents the MOST frequent side effect of this medication?

- Nausea and vomiting

F. Prior to discharge of a client on cephalosporin therapy, the nurse discusses potentially adverse effects, including?

- Nausea, vomiting, Abdominal pain, Vaginal yeast infection

B. The nurse is caring for a client who has been taking a sulfonamide and should monitor for signs and symptoms of which side/adverse effects of the medication?

- Nephrotoxicity - Bone Marrow Depression - GI effects

E. A client admitted to the hospital is taking zidovudine (Retrovir). The nurse monitors the client for which adverse effect of the medication?

- Neurotoxicity

A. The nurse tells a client with pneumonia that the physician has prescribed a macrolide antibiotic because?

- Newer macrolides have a longer half-life, which makes less frequent dosing attractive to clients - Newer macrolides cause fewer GI symptoms - Macrolide antibiotics are considered one of the safest classes of antibiotics

4. H. Pylori Treatment

- Omeprazole (Prilosec), clarithromycin (Biaxin), amoxicillin (Amoxil)

A. A client with a diagnosis of peptic ulcer is prescribed Omeprazole (Prilosec) and asks the nurse where in the body this medication will work. The nurse correctly answers

- On the Surface of the parietal cells

A. A client with a gastric ulcer has a prescription for sucralfate (Carafate), 1 g by mouth four times daily. The nurse should schedule the medication for which times?

- One hour before meals and at bedtime

D. The nurse is obtaining a client's drug history prior to initiating therapy with gentamicin (Garamycin). The client takes diltiazem (Cardizem) and aspirin. Based on this information the nurse identifies the client at increased risk for?

- Ototoxicity

H. The nurse caring for a client who is taking an aminoglycoside should monitor the client for which adverse effects of the medication? Select all

- Ototoxicity - Renal toxicity - Dysrhythmias

D. The nurse caring for a client with an allergy to cephalosporins would be cautious in implementing an order for an anti-infective agent from which class?

- Pencillins (5-10 percent of clients who are allergic to penicillin also exhibit hypersensitivity to cephalosporins)

C. A client is prescribed omeprazole (Prilosec). The nurse prepares to perform client teaching based on the knowledge that omeprazole is a?

- Proton Pump Inhibitor

D. The nurse is managing care for a client prescribed tetracycline who is reporting frequent episodes of diarrhea. The nurse plans to monitor this client for?

- Pseudomembranous colitis

A. A side effect unique to the carbapenem antibiotics is the development of?

- Pseudomembranous colitis (the carbapenems can promote severe diarrhea and pseudomembranous colitis)

A. The nurse administering an infusion of vancomycin, will observe the client for which symptoms of red man syndrome? Select all

- Reddening of the upper body - Hypotension - Reflex tachycardia

A. A client is prescribed an H2 receptor antagonist. The nurse teaches this client that the purpose of the drug is to?

- Reduce gastric acid secretion in the stomach

A. A client who chronically uses nonsteroidal anti-inflammatory drugs (NSAIDS) has been taking misoprostol (Cytotec). The nurse determines that the medication is having the intended therapeutic effect if which finding is noted?

- Relief of epigastric pain

G. The nurse is preparing to give a dose of cephalosporin medication to a patient who has been receiving antibiotics for 2 weeks. The nurse notes ulcers on the patients tongue and buccal mucosa. Which action should the nurse take?

- Report a possible superinfection side effect of the cephalosporin

A. The health care provider has ordered IV diazepam (Valium) for the client in status epilepticus. During administration, it is most important for the nurse to assess for which result from this drug?

- Respiratory depression

Carbamazepine - Indication (Dibenzazepine, Neuronal Sodium Channel Moderator)

- Seizures (except absence) - acute mania - bipolar disorder - trigeminal neuralgia - periodic one side facial pain - neuropathic pain (Off label)

F. To prevent the most serious adverse effects of aminoglycosides in a diabetic client, the nurse will monitor which diagnostic lab reports? Select all

- Serum drug concentration of aminoglycoside (Prevent nephrotoxicity) - Serum creatinine (for potential nephrotoxicity) - BUN (Potential nephrotoxicity)

C. Zidovudine (Retrovir) has been prescribed for a client who asks the nurse about the action of the medication. The nurse responds that this medication performs which function?

- Slows the replication of HIV.

C. A client is taking a prescribed dose of phenytoin (Dilantin) to control seizures. Results of a phenytoin blood level study reveal a level of 35 mcg/mL. Which finding would be expected as a result of this laboratory result?

- Slurred speech

C. A client who has been diagnosed with pneumonia has been given a prescription for erythromycin (E-mycin). Client teaching about this medication should include which best instruction?

- Take the medication on an empty stomach

A. The client with AIDS has been prescribed raltegravir (Isentress). The nurse determines that the client may be experiencing an adverse effect related to this medication if which assessment finding is noted?

- Temperature of 101.2 F

F. The nurse is caring for a 7 year old patient who will receive oral antibiotics. Which antibiotic order will the nurse question for this patient?

- Tetracycline (Sumycin). Should not be given younger than 8 (irreversibly discolor the permanent teeth)

B. A client is prescribed ranitidine (Zantac). The nurse checks the clients BUN and serum creatinine levels prior to administering the drug for the first time. The rationale for checking these labs is?

- That the drug is primarily excreted by the kidneys

A. Bacterial enzymes participate in the construction of the bacterial cell wall. Penicillin targets these enzymes and interferes with?

- The addition of cross-links to the cell wall

B. The nurse has received an order to give imipenem cilastatin (Primaxin) IV to a client. Which assessments should alert the nurse to contact the health care provider? Select all

- The client is allergic to penicillin - The medication list includes anti-seizure medications - The client is an older adult with long-standing diabetes

C. A client receiving a dose of IV vancomycin (Vancocin) begins to experience chills, tachycardia, syncope, and flushing of the face and trunk. What is the nurse's best interpretation of these findings?

- The medication is infusing too rapidly

A. A client with AIDS is taking zidovudine (Retrovir) 200 mg orally three times daily has severe neutropenia noted on follow-up lab studies. The nurse interprets that which change is likely to occur at this point?

- The medication probably will be discontinued until lab results indicate bone marrow recovery

B. The home health nurse visits a client who is taking phenytoin (Dilantin) for control of seizures. During the assessment, the nurse notes that the client is taking birth control pills. Which information should the nurse include in the teaching?

- There is the potential of decreased effectiveness of birth control pills while taking phenytoin

J. Teaching points for phenytoin (Dilantin)?

- Use a soft toothbrush - Alcohol should be avoided while on this medication - The medication may turn the client's urine pink, red, or brown

F. The nurse has given medication instructions to a client beginning anticonvulsant therapy with carbamazepine (Tegretol). The nurse determines that the client understands the use of the medication if he or she makes which statement?

- Use sunscreen outdoors

B. A client has a new prescription for metoclopramide (Reglan). On review of the chart, the nurse identifies that this medication can be safely administered with which condition?

- Vomiting following cancer chemotherapy.

C. A calcium carbonate antacid (tums) has been prescribed for a client, and the nurse provides instructions to the client, and the nurse provides instructions to the client about the medication. The nurse should tell the client that it is best to take with the antacid with which item?

- Water

D. A client with trigeminal neuralgia is being treated with carbamazepine (Tegretol) 400 mg orally daily. Which value indicates the client is experiencing an adverse effect to the medication?

- White blood cell count, 3,000 cells/mm

E. A client asks why the health care provider ordered penicillin for the client's infection. How should the nurse respond? Select all

- Your infection was caused by gram-positive bacteria - "Penicillin is a narrow-spectrum antibiotic that can be sued when the bacteria causing the infection is known" - "Penicillins are widely distributed to most body tissues"

Ranitidine - Adverse effects H2 Receptor antagonists

- blood dyscrasia (rare) - CNS - lethargy, restlessness, seizures (cimetidine) - confusion (elderly) - nausea, vomiting, diarrhea or constipation - gynecomastia, impotence - decrease libido (high doses on cimetidine)

Ranitidine - Interactions H2 Receptor antagonists

- decrease absorption of Kecanozol, tracranozole, some cephalosporins, delavirdine - antacids decrease absorption - Cimetidine increase levels of warfarin, phenytoin, lidocaine, and theophyline

Antacids - MOA

- neutralize gastric acid - some mildly stimulate prostaglandins (increase gastric mucosal lining) - Some mildly increase LES tone. Short acting (2hr) Need to be taken frequently.

Diazepam - Intervention (Benzodiazepines GABA receptor agonist)

- not used for chronic treatment due to significant s/e. but helpful of status epilepticus - Low TI: if given IV need monitoring, emergency equipment for resuscitation in the room if CV or resp system collapses

Ondansetron - Intervention (antiemetics)

-monitor persistent headache. - monitor for dizziness, diarrhea or dehydration

Vancomycin - Interventions Miscellaneous cell wall inhibitors

Assess for baseline hearing and monitor → notify HCP

Tetracycline - teaching

Avoid sun exposure avoid dairy products → drug/food interactions → inhibitors absorption of drug in GI tract

The nurse is performing a head-to-toe assessment on a client taking aluminum hydroxide. Why must the nurse closely assess for bowel changes? A. Hyperactive bowel sounds indicate imminent vomiting; suction should be made available. B. Hypoactive bowel sounds indicate duodenal ulcerations. C. Hematochezia is a sign that the medication is working. D. A distended abdomen could indicate constipation, a side effect of this medication.

A distended abdomen could indicate constipation, a side effect of this medication.

Valproic Acid - Indication (GABA agonists)

Absence or partial-complex seizures, migraines, bipolar-mania, behavioral disturbances (OL)

Ethosuximide - Indications Succinimides, Neuronal Calcium Channel moderator

Absence seizures

Omeprazole - Interactions (Proton Pump inhibitor)

Absorption decreases with atazanavir, ketoconozole, itraconazole. Incrase levels of warfarin, phenytoin, diazepam Food can reduce absorption decrease drug levels: ginkgo biloba and St. Johns worth

Acyclovir - Interventions (Nucleosides Analogs (Viruses))

Acutely ill requires IV, less acute PO, even less topical IV drug very toxic to system → must be administered very slowly and must have IV hydration Doesn't cure or kill of the virus, just decreases duration and severity Short 1/2 lives, given multiple times daily Monitor for severe skin reactions Monitor for severe GI, BUN, Creatinine levels Infuse IV slowly. Hydrate pt during and after infusion Monitor patency fo IV site and CNS effects

Nucleoside Analogs - prototype (viruses)

Acyclovir (Zovirax)

Enfurvirtide - CI/pregnancy (Entry Inhibitors - Fusion inhibitor)

Allergy pt infected with both HIV and hep B Severe liver disease Lactation Category B

Acyclovir - CI/Pregnancy (Nucleosides Analogs (Viruses))

Allergy to acyclovir or valacyclovir Caution with: -renal impairment - hydration -Neurologic disorder Category B/C

Efavirenz - CI/pregnancy (Non-nucleoside reverse transcriptase inhibitors (NNRTIs))

Allergy to delavidine Lactation Caution: childbearing yrs →birth control, liver dysfunction, achlorhydria, older pts Category D

Erytromycin -interventions (Macrolides)

Alternate drugs with penicillin allergy Rarely 1st line due to toxicity at high doses → ventricular tachycardia/vfib → sudden cardiac death

Viral replication inhibitors - prototype (Drugs for influenza)

Amantadine (Symmetrel)

Antacids - interactions

Decrease absorption of warfarin, digoxin, phenytoin, tetracycline, isoniazid, cimetidine, NSAIDs and ciprofloxacin

Ethosuximide - MOA Succinimides, Neuronal Calcium Channel moderator

Delays calcium influx into the neuron

Phenytoin - MOA (Hydantoins)

Delays the influx of sodium ions in neurons →decreases excitatory responses of brain cells

Diazepam - CI/Pregnancy (Benzodiazepines GABA receptor agonist)

Depressed VS Acute alcohol intoxication (already suppressed neurotransmitting system) Myasthenia gravis (already suppressed neurotransmitting system) Glaucoma Caution: Impaired renal, hepatic, respiratory Category D

Benzodiazepines GABA receptor agonist - Prototype

Diazepam (Valium)

Phenytoin - Teaching (Hydantoins)

Do not drive Notify if CNS effect occur. Provide regular dental check ups Report rash, do not stop abruptly

Intravenous vancomycin (Vancocin) has been prescribed to treat the meningitis. When administering this drug IV, which of the following actions should the health care professional take? (Select all that apply.) Do not mix it with other drugs. Administer it rapidly via IV bolus. Monitor the IV insertion site for phlebitis. Monitor vital signs during the infusion. Dilute the drug before administering it.

Do not mix it with other drugs. Monitor the IV insertion site for phlebitis. Monitor vital signs during the infusion. Dilute the drug before administering it. When administering vancomycin IV, the drug should be properly diluted and infused slowly over at least 1 hr. Vancomycin can cause phlebitis at the infusion site. It is essential, as it is for any other infusion, to infuse it through a patent IV line and to assess frequently for swelling, pain, or redness. Vancomycin is incompatible in solution with many other drugs. It is also essential, as it is when infusing any drug, to monitor vital signs to watch for any immediate adverse drug reactions.

Reversible Cholinesterase Inhibitor - prototype (Alzheimer's disease)

Donepezil (Aricept)

Non-nucleoside reverse transcriptase inhibitors (NNRTIs)

Efavirenz (Sustiva)

Entry Inhibitors - Fusion inhibitor - prototype

Enfuvirtide (Fuzeon)

Phenobarbital - MOA (Barbiturates)

Enhances GABA → suppresses neuronal discharge

Diazepam - MOA (Benzodiazepines GABA receptor agonist)

Enhances the actions of GABA in the brain

The health care provider orders amantadine (Symmetrel) for a client with influenza. Which part of the client's health history would the nurse report to the health care provider prior to administering amantadine (Symmetrel)? A. Epilepsy B. Chronic obstructive pulmonary disease (COPD) C. Diabetes mellitus D. Allergy to shellfish

Epilepsy

Because the patient is allergic to penicillin, which of the following drugs should be available in case the patient has a severe allergic reaction to the antibiotic that has been prescribed? Atropine Naloxone Epinephrine Neostigmine (Prostigmin)

Epinephrine

Succinimides, Neuronal Calcium Channel moderator - prototype (seizures medication)

Ethosuximide (Zarontin)

A patient is about to start taking ritonavir (Norvir) to treat HIV-1 infection. Which of the following instructions should you include when talking with the patient about taking this drug? (Select all that apply.) Expect periodic blood glucose testing. Take it on an empty stomach. Watch for and report jaundice. Increase weight-bearing activity. Expect periodic cholesterol testing.

Expect periodic blood glucose testing. Watch for and report jaundice. Increase weight-bearing activity. Expect periodic cholesterol testing Ritonavir, a protease inhibitor, can cause hyperglycemia and diabetes mellitus. Tell the patient to expect periodic blood glucose checks. Patients who already have diabetes should check their blood glucose levels frequently and report elevations as well as increased hunger, thirst, or urination. Tell the patient to take the drug with food to maximize absorption and minimize gastrointestinal upset. Ritonavir can cause liver toxicity, so tell the patient to watch for and report indications of liver toxicity, such as yellowed sclera and skin. Ritonavir can reduce bone density, so instruct the patient to increase weight-bearing activity and calcium and vitamin D intake. Tell the patient to expect periodic cholesterol checks.

Ranitidine - Interventions H2 Receptor antagonists

For impotence with cimetidine will prescribe ranitidine Monitor for severe vomiting or diarrhea

Ethosuximide - S/E Succinimides, Neuronal Calcium Channel moderator

GI CNS Hepatic Dermatologic Increased tonic-clonic seizures

Erytromycin - S/E (Macrolides)

GI Hepatic impairment toxicity

ampicillin - S/E (Penicillin)

GI - diarrhea, n/v allergy vaginal yeast anaphylactic reaction

Valproic Acid - S/E (GABA agonists)

GI - upset and indigestion CNS Decrease platelet aggregation (high doses) Pancreatitis → life threatening, monitor closely Bruising, bleeding, skin rash Liver toxicity (few months + children <2hrs)

Cefazotin - S/E (Cephalosporins)

GI effects

Antacids - CI

GI perforation or obstruction hypophosphatemia

Zidovudine - S/E Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

GI symptoms: Anorexia, nausea, diarrhea, abdominal pain Fatigue, Muscle aches (Myalgia), weakness, fever HA, CNS effects (insomnia, dizziness) *Lactic acidosis* *Hepatomegaly* *Bone marrow suppression → check CBC* Lipodystrophy → increases glucose and lipid levels

Vancomycin - S/E Miscellaneous cell wall inhibitors

GI, ototoxicity, nephrotoxicity, red man syndrome (not allergy but difficult to differentiate if it occurs, if med is infused too rapidly <1hr → head to toe rash, flush in, drop in BP, tachycardia)

Imipenem-cilastatin - S/E

GI, phleibitis (IV route)

Memantine - S/E (NMDA receptor blocker)

GI: N/V, diarrhea, anorexia Coughing Anemia Urinary Incontinence CNS Effects - dizziness, headache, increased confusion, constipation

GABA analog (agonist) - prototype

Gabapentin (Neurontin)

Raltegravir - S/E (integrase inhibitor)

Gastrointestinal symptoms: nausea, vomiting, diarrhea CNS symptoms: dizziness, headache, insomnia, fatigue High risk of myopathy and rhabdomyolysis

Lopinavir with ritonavir - SE (Protease inhibitor)

Gi: diarrhea, n/v, dyspepsia, abdominal pain, diarrhea or constipation, heartburn, Headache Hyperglycemia and diabetes Dyslipidemia Cardiac: Heart block Pancreatitis → metabolic disturbances Reduce bone density → osteoporsis liver toxicity Increased cholesterol and triglyceride levels → atherosclerosis and CV disease Fat distribution (thin extremities, face, and buttocks, increased abdominal fat, gynecomastia "buffalo hump" → fat accumulation between shoulder blades)

Cefazotin - MOA (Cephalosporins)

Gram negative infections Beta lactam ring (high resistance)

Carbamazepine - Interactions (Dibenzazepine, Neuronal Sodium Channel Moderator)

Grapefruit juice increase plasma level Decrease effectiveness of oral contraceptive and provide false negatives increase plasma levels: + antifungal, erythromyocin, isoniazed, MAOIs Decrease phenytoin, barbiturates, rifampin, cisplatin, and theophyline

Which statement by the nurse is true in regard to the development of a vaccine to prevent HIV? A. HIV has a low number of genetic variants. B. HIV has such a slow replication rate. C. HIV has an extremely rapid replication rate. D. There is a low mutation rate.

HIV has an extremely rapid replication rate.

Efavirenz - Indication (Non-nucleoside reverse transcriptase inhibitors (NNRTIs))

HIV infection (once daily dosing, penetrates CSF)

Zidovudine - Indication Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

HIV infection, post-exposure prophylaxis, reduce transmission from mother-fetus

F. A client in the ED experienced a severe allergic response to penicillin. The client tells the nurse this is the first time she has ever taken this particular drug. Which questions can the nurse ask to determine the reason for the allergic response? Select all

Have you ever been exposed to mold" - "Do you eat animal products that have been exposed to antibiotics such as penicillin" - "Have you ever had another allergic reaction to a group of antibiotics called cephalosporins?"

Patients receiving vancomycin should be closely monitored for which of the following? Visual disturbances Hearing loss Perioral numbness Metallic taste

Hearing loss Vancomycin can cause hearing loss. It is important to monitor peak blood vancomycin levels. Ototoxicity is less likely with blood vancomycin levels below 30 mcg/mL. Vancomycin is unlikely to cause visual disturbances, facial numbness, or a metallic taste, although it can cause generalized tingling. Systemic toxicity of some local anesthetics, such as lidocaine, may cause numbness of the lips or tongue and a metallic taste.

The nurse is caring for an adult male diagnosed with a peptic ulcer. The nurse states that the most likely etiology is: A. Acidic foods B. Stress C. Helicobacter pylori. D. Smoking

Helicobacter pylori.

Acyclovir - indication (Nucleosides Analogs (Viruses))

Herpeviruses

Lopinavir with ritonavir - Teaching (Protease inhibitor)

Hyperglycemia and diabetes: Advise patient to -Report increased thirst, hunger, urination Fat redistribution -Warn that fat redistribution may occur Compliance with having lipid profile drawn every few months Increase intake of calcium and vitamin D; weight-bearing exercises Avoid smoking Compliance with liver function testing Report increased abdominal pain, anorexia, jaundice Report persistent gastrointestinal symptoms Notify provider before taking any new drugs

Carbamazepine - CI/Pregnancy (Dibenzazepine, Neuronal Sodium Channel Moderator)

Hypersensitive Increased intraocular pressure (glaucoma) SLE CV disease Hepatic disease Category D

Valproic Acid - CI/Pregnancy (GABA agonists)

Hypersensitivity Bleeding disorders Cirrhosis Pancreatitis Caution: Low albumin and renal impairment Liver disease Trombocytopenia hyperammonenia other anticonvulsants Category D

ampicillin - CI/Pregnancy (Penicillin)

Hypersensitivity Caution renal impairment, oral contraceptives, DM Category B

Ethosuximide - CI/Pregnancy Succinimides, Neuronal Calcium Channel moderator

Hypersensitivity Caution: Renal and Hepatic disease Category C

Omeprazole - CI/Pregnancy (Proton Pump inhibitor)

Hypersensitivity Caution: hepatic impairment Category C

Gabapentin - CI/Pregnancy GABA analog (agonist)

Hypersensitivity Caution: status epilepticus, renal impairment, older adults. Category C

Phenytoin - CI/Pregnancy (Hydantoins)

Hypersensitivity, Seizures caused by hypoglycemia Caution: Hepatic, CV, heme Category D

While receiving vancomycin, the patient becomes flushed and warm. Which of the following additional adverse reactions to vancomycin should be expected? Muscle weakness Pupil change Ecchymosis Hypotension

Hypotension Rapid infusion of vancomycin may cause hypotension and flushing. Vancomycin should be infused slowly, over 1 hr, while monitoring vital signs, and assessing for a hypersensitivity reaction, such as hives and fever. Vancomycin infusion is unlikely to change pupillary reactions or cause ecchymosis or thrombocytopenia. Gentamicin may cause thrombocytopenia, which can manifest as ecchymosis.

Vancomycin - Route Miscellaneous cell wall inhibitors

IV only given PO in pts with PMC (local effect)

Imipenem-cilastatin - route, duration

IV only short 1/2 life

Phenytoin - Interaction (Hydantoins)

IV → incompatible with many other drugs and dextrose solutions. DIazepan, ionized, cimetidine and valproic acid increase levels of phenytoin. Alcohol can increase or decrease levels CNS increase sedative effects Phenobarbital and carbamazepine decrease levels it decreases effectiveness of oral contraceptives. Is a CYP450- it increases Warfarin dose.

Diazepam - Route, onset, Duration (Benzodiazepines GABA receptor agonist)

IV, IM, PO, rectal (for witnessed seizures at home) IV: 1-5m, IM: 15-30m, PO: 30-60m 1/2 life 20-50h

Zidovudine - Routes, Onset, Duration Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

IV, PO Peak 1-2h 1/2 life 1h

Carbapenems - prototype (antibiotics)

Imipenem-cilastatin (primaxin)

Which of the following interventions should you implement to prevent a serious adverse reaction in patients receiving IV acyclovir (Zovirax)? Premedicate the patient with an NSAID. Ambulate the patient after infusion. Increase the patient's fluid intake. Keep the patient supine for 2 hr after infusion.

Increase the patient's fluid intake. ​Acyclovir can cause renal toxicity due to accumulation of the drug in the renal tubules. It is essential to increase fluid intake during infusion and 2 hr after infusion to hydrate and flush the kidneys. Infuse this drug slowly and monitor urine output, BUN, and creatinine levels. Acyclovir may cause a rash or hives, but it is not necessary to premedicate with a nonsteroidal anti-inflammatory drug (NSAID). Unless patients have any contraindications to ambulation, there is no need to restrict it after infusion. However, ambulation will not prevent any serious reactions to the drug. It is not necessary for patients to remain flat for 2 hr after infusion, as this drug is unlikely to cause headache or other CNS effects that lying supine would prevent.

Amantadine - Indication (Viral replication inhibitors - Drugs for influenza)

Influenza infections, parkinson's disease

ciprofloxacin -MOA (Fluoroquinolones)

Inhibit bacterial DNA synthesis → effective against gram negative and gram positive

Lopinavir with ritonavir - MOA (Protease inhibitor)

Inhibits HIV protease → assembly of virion is prevented

Vancomycin - MOA Miscellaneous cell wall inhibitors

Inhibits cell wall and interferes with bacterial RNA synthesis Identified as being most effective for pt's with MRSA

Carbamazepine - MOA (Dibenzazepine, Neuronal Sodium Channel Moderator)

Inhibits sodium channels Similar to phenytoin - decrease discharge of neurons around areas of increase activities

Amantadine - MOA (Viral replication inhibitors - Drugs for influenza)

Inhibits viral replication

Enfurvirtide - interventions (Entry Inhibitors - Fusion inhibitor)

Injection site reactions -Monitor for and report injection site reactions and infection -Instruct patient and/or caregiver in correct subcutaneous administration (rotate sites, avoid giving by deep injection) Monitor temperature and for signs of pneumonia Monitor for and report signs of hypersensitivity very expensive

Enfurvirtide - s/e (Entry Inhibitors - Fusion inhibitor)

Injection site skin reactions - severe pain, pruritus, erythema, abscesses, cellulitis Pneumonia: cough shortness of breath, fever Allergic reactions: chills and fever, rash, nausea, hypotension, elevated liver enzymes, diarrhea, fatigue

Omeprazole - Patient education (Proton Pump inhibitor)

Instruct pt to perform weight bearing exercises. Supplement calcium and Vit D. Report signs of bleeding symptom resolution in 4-8 weeks.

When talking with a patient about starting antituberculosis treatment with rifampin (Rifadin), be sure to instruct the patient to report which of the following possible indications of a serious adverse effect of this drug? Tremor Jaundice Sweating Insomnia

Jaundice ​Rifampin can cause liver toxicity and hepatitis, so be sure to monitor liver enzymes during therapy and instruct patients to report abdominal pain, nausea, and jaundice. Rifampin can cause lethargy, drowsiness, and confusion. It is unlikely to cause insomnia. Rifampin can cause a red-orange discoloration of urine, saliva, tears, and sweat, but it is unlikely to cause sweating. Rifampin can cause ataxia, but it is unlikely to cause tremors.

Zidovudine - CI/Precautions Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

Life threatening allergy Lactic acidosis Caution: anemia, neutropenia, renal and hepatic impairment, alcoholism, anticancer treatments, bone marrow suppression Category C

Protease inhibitors - prototype

Lopinavir with ritonavir (Kaletra)

Phenytoin - S/E (Hydantoins)

Low TI CNS: nystagmus, confusion, coma CV: bradycardia, vfib GI: gingival hyperplasia, hepatic toxicity, hematologic, effect on bone marrow (check CBCs) Abrupt D/C can induce status epilepticus

Zidovudine - Interactions Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

Many drugs increase risk for bone marrow suppression, including ganciclovir (Cytovene), trimethoprim/sulfamethoxazole (Septra), and several anticancer drugs Probenecid increases zidovudine levels by decreasing elimination Rifampin (Rifadin) and some other HIV drugs (nelfinavir and ritonavir) decrease zidovudine levels

Entry inhibitor - CCR5 antagonist - prototype

Maraviroc (Selentyr)

NMDA receptor blocker - prototype (Alzheimers disease)

Memantine (Namenda)

A client with GERD must be cautioned against the overuse of antacids to avoid which syndrome? A. Respiratory alkalosis B. Metabolic acidosis C. Metabolic alkalosis D. Respiratory acidosis

Metabolic alkalosis

Efavirenz - Interventions (Non-nucleoside reverse transcriptase inhibitors (NNRTIs))

Monitor and report rash (usually seen 1 to 3 wks after starting delavirdine) - Rash that occurs along with fever, lesions in the mouth or eyes, blisters, or muscles pain requires discontinuation of the drug Monitor for and report persistent GI effects Monitor pts weight -Report significant decrease Monitor periodic liver function tests (transaminase levels) - Report elevations Older drug, some resistance developing If take with high fat meal, drug absorption is decreased → can lead to toxicity -not given with meals

Maraviroc - Interventions (Entry inhibitor - CCR5 antagonist)

Monitor for and report persistent CNS symptoms Monitor for persistent musculoskeletal symptoms Monitor for respiratory symptoms Monitor for and report rash, abdominal pain, jaundice Monitor lab values for increase in eosinophils or elevated immunoglobulin E

Phenytoin - Intervention (Hydantoins)

Monitor for excessive drowsiness, other CNS effect. Increase levels = nystagmus, ataxia, sedation, blurred vision Look out at children's gums Monitor for rashes, monitor plasma levels (therapeutic level 10-20mcg/ml monitor vital signs. In childhood seizures and adults with treatable primary abnormality of the brain, may not need lifelong treatment with with this drug if seizure free for 3 yrs with the drug.

Trimethropin-sulfamethoxazole - interventions (Sulfonamides)

Most commonly used for UTIs but need C&S first Resistance

Amantadine - Interventions (Viral replication inhibitors - Drugs for influenza)

Most effective against influenza A and B Does not cure the virus, but does shorten the duration by 30% Must be taken within 48hr of onset of symptoms to be effective Some anticholinergic effects Reserved for high risk pts who could become severely ill from flue due to toxicities

Ethosuximide - Interventions Succinimides, Neuronal Calcium Channel moderator

Not commonly prescribed Monitor for abnormalities in GI, CNS, hepatic, dermatologic Monitor for tonic clonic seizures and put seizure precautions in place.

Zidovudine - Interventions Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

Obtain baseline hemoglobin and neutrophil counts monthly Plan to interrupt therapy for: -Hemoglobin <5gm per dL or down 50% of baseline (administer Epogen) - Neutrophil count <750 cells per mL or down 25% of baseline (administer Filgrastim) Transfuse packed red blood cells as needed Monitor and report GI symptoms; weight loss Monitor CNS effects, fever, myalgia, and treat with mild analgesics Not the first drug of choice due to resistance When given to pregnant females, give oral dose 5 times daily from 14 weeks gestation until delivery; during delivery administer IV infusion until neonate is delivered and cord is clamped For other patients, administer oral dose 2 to 3 times daily, usually without regard for meals.

Proton pump inhibitor Prototype

Omeprazole (prilosec)

Antiemetics - Prototype

Ondansetron (Zofran)

Maraviroc - MOA (Entry inhibitor - CCR5 antagonist)

Only works with CCR5-tropic HIV strains Blocks coreceptor CCR5 needed for entry into host cell

Tetracycline - S/E

PMC Hepatoxicitu photo-sensitivity discoloration of teeth in children

Gabapentin - Routes, Onset, Duration GABA analog (agonist)

PO 1hr 1/2 life: 5-6hrs

Amantadine - Route, Onset, Duration (Viral replication inhibitors - Drugs for influenza)

PO 48h 1/2 life 20-50h

Ethosuximide - Routes, Onset, Duration Succinimides, Neuronal Calcium Channel moderator

PO 4hrs 1/2 life: 60hrs

Lopinavir with ritonavir - Route, Onset, Duration (Protease inhibitor)

PO Peak 3-4h 1/2 life 5-6h take with food for best absorption take twice daily

Efavirenz - Routes, Onset, Duration (Non-nucleoside reverse transcriptase inhibitors (NNRTIs))

PO Peak 3-5h 1/2 life 52-76h

Raltegravir - Administration (integrase inhibitor)

PO must be combined with other HIV drugs

Carbamazepine - routes, Onset, duration (Dibenzazepine, Neuronal Sodium Channel Moderator)

PO (won't help in emergency) Slow and variable 1/2 life: 14-26h

Tetracycline - administration

PO on empty stomach

Omeprazole - Route, onset duration (Proton Pump inhibitor)

PO, IV 0.5-3.5 H 3-4 days Given one time a day 30min before 1st meal of the day.

Valproic Acid - Routes, Onset, Duration (GABA agonists)

PO, IV 15-30 mins 1/2 life: 5-20hrs

Ranitidine - Routes. Onset, Duration H2 Receptor antagonists

PO, IV 30-60min 6-12hrs Give with/without food, administer slowly. No antacid within of 1hr administration

Phenytoin - Route, Onset, Duration (Hydantoins)

PO, IV PO: 30 - 120m 1/2 life: 24h

Acyclovir - Route, Onset, Duration (Nucleosides Analogs (Viruses))

PO, IV, Topical Peak 1.5-2h 4-8h

Ranitidine - Indications H2 Receptor antagonists

PUD Heartburn GERD

Omeprazole - Indication (Proton Pump inhibitor)

PUD, heartburn (OTC), GERD, H. pylori (combined with antibiotics)

Gabapentin - Indication GABA analog (agonist)

Partial seizures Postherpetic neuralgia Restless leg syndrome Diabetic neuropathy (off-label) ALS, MS

Maraviroc - CI/pregnancy (Entry inhibitor - CCR5 antagonist)

Patient who do not have CCR5 tropic HIV 1 Pts just beginning first time treatment for HIV Current symptoms of hepatitis Allergy Children <16yrs Category B

The nurse caring for a client with an allergy to cephalosporins would be cautious in implementing an order for an anti-infective agent from which class? A. Aminoglycosides B. Fluoroquinolones C. Sulfonamides D. Penicillins

Penicillins

Barbiturates - prototype (Seizures)

Phenobarbital

Hydantoins - Prototype (Seizures)

Phenytoin (Dilantin)

Gabapentin - Indications GABA analog (agonist)

Prescribed more for DM neuropathy than for seizures Fewer drug/drug interactions than other categories of seizure drugs.

Memantine - MOA (NMDA receptor blocker)

Prevents glutamate from causing excitatory actions → slows nerve degeneration Blocks excess glutamate from NMDA receptors -decrease overstimulation of NMDA receptors -intracellular calcium and neuronal damage. -decrease progression of Alzheimers disease

Acyclovir - MOA (Nucleosides Analogs (Viruses))

Prevents viral DNA synthesis (inserted into DNA chain)

Acyclovir - Interactions (Nucleosides Analogs (Viruses))

Probenecid increases blood levels. Zidovudine increases CNS effects. Nephrotoxic drugs increase risk for renal toxicity.

Phenobarbital - S/E (Barbiturates)

Profound CNS depression Respiratory depression Decreased HR/BP Dependence

A client diagnosed with Barrett esophagus might require the most efficient pharmacologic therapy of GERD. This would include the use of which class of drug? A. Proton pump inhibitor B. Antacid C. Magnesium citrate D. H2-receptor antagonist

Proton pump inhibitor

Raltegravir - CI/pregancy (integrase inhibitor)

Pt who are just beginning HIV treatment for the 1st time Children <16yrs Severe hepatic disorders category C

Integrase inhibitors - prototype

Raltegravir (Isentress)

H2 Receptor antagonists - prototype (GI disorder)

Ranitidine (zantac)

Omeprazole - SE (Proton Pump inhibitor)

Rare when taken as directed: Headache, N/V, diarrhea, rash, abdominal pain Long term: bone loss

A patient is about to start taking amoxicillin (Amoxil) to treat an ear infection. You instruct the patient to monitor and report which of the following? Rash Blurred vision Constipation Hypertension

Rash

Memantine - CI (NMDA receptor blocker)

Renal failure (nephrotoxic) Caution with renal insufficiency

Maraviroc - teaching (Entry inhibitor - CCR5 antagonist)

Report dizziness, insomnia, numbness or tingling of extremities to provider Avoid hazardous activities, such as driving, until effects are known Report persistent musculoskeletal discomfort to provider Report cough, fever, upper respiratory symptoms, such as sinus infection Report onset of itchy rash, abdominal pain, loss of appetite to provider Notify provider before taking any new over-the-counter or prescribed drug Multiple drug interactions Need to change dosage based on other drugs being taken

ampicillin - Teachings (Penicillin)

Report immediately (stool watery or bloody diarrhea), vaginal discharge, mouth pain, call 911 severe symptoms.

A patient is prescribed oral tetracycline for treatment of acne vulgaris. When telling the patient about taking tetracycline, which of the following instructions should you include? (Select all that apply.) Increase weight-bearing activity. Report mouth pain. Take it 1 hr before meals. Wear sunscreen and protective clothing. Swallow the pill with 8 oz of milk.

Report mouth pain. Take it 1 hr before meals. Wear sunscreen and protective clothing.

Raltegravir - Teaching (integrase inhibitor)

Report persistent nausea, vomiting, or diarrhea to provider Report dizziness or headache to provider Take analgesic prescribed by provider for headache Avoid hazardous activities, such as driving, until effects are known

Efavirenz - Teaching (Non-nucleoside reverse transcriptase inhibitors (NNRTIs))

Report rash and pruritus of skin to provider Report persistent nausea, vomiting, and diarrhea Notify provider before taking any new over-the-counter or prescribed drug due to multiple drug interactions S/E may diminish over time (after 1 month)

Valproic Acid - Teaching (GABA agonists)

Report → rash, n/v, abdominal pain, jaundice, anorexia, bruising, confusion, decrease LOC

Lopinavir with ritonavir - CI/Pregnancy (Protease inhibitor)

Resistance to any protease inhibitor pancreatitis Lactation Caution: Liver impairment, DM, Elevated cholesterol, renal insufficiency , Hemophilia Category C

The health care provider has ordered intravenous (IV) diazepam (Valium) for the client in status epilepticus. It is most important for the nurse to assess for which result? A. Tachycardia B. Level of consciousness C. Hypotension D. Respiratory depression

Respiratory depression

Prior to administering donepezil (Aricept) to a client with Alzheimer disease, the nurse reviews the client's medical history for which disease processes? Select all that apply. A. Respiratory disorders B. Liver dysfunction C. Kidney failure D. Atrial fibrillation E. Arthritis

Respiratory disorders Liver dysfunction Kidney failure Atrial fibrillation

Raltegravir - Interactions (integrase inhibitor)

Rifampin (Rifadin) and tipranavir (Aptivus) combined with ritonavir (Norvir) to treat HIV, cause a decrease in blood levels of raltegravir Atazanavir (Reyataz) increases blood levels of raltegravir

Zidovudine - Teaching Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

Risk for bone marrow suppression - Report increase in fatigue, pallor, fever, or onset of infection to provider -Adhere to monthly blood sampling Report to provider: persistent gastrointestinal symptoms, headache, insomnia, or dizzines, fever and myalgia Notify provider before takin any new over-the-counter or prescribed drug to multiple drug interactions

Enfurvirtide - Teaching (Entry Inhibitors - Fusion inhibitor)

Risk for injection site reaction: -Rotate sites and be sure to avoid injecting into any area with reddened, -abraded or scarred skin -Report tenderness, redness, swelling, hardened areas, itching, or other skin reactions to provider Report cough, fever, or shortness of breath to provider Report any symptom of hypersensitivity to enfuvirtide to provider

Enfurvirtide - routes (Entry Inhibitors - Fusion inhibitor)

SQ administration only requires 2x daily

Be sure to administer imipenem-cilastatin (Primaxin) cautiously with patients who have which of the following? Seizure disorder Thyroid disease Diabetes mellitus Immunosuppression

Seizure disorder

Ondansetron - MOA (antiemetics)

Serotonin receptor (%-HT3) antagonist → blocks stimulation of portion of brain in medulla known as vomiting center (triggered by various stimuli from inside/outside of body)

A patient is about to start taking trimethoprim/sulfamethoxazole (Bactrim) to treat a urinary tract infection. You should instruct the patient to report which of the following possible indications of serious adverse effect of this drug? Dry mouth Sore throat Urinary frequency Frontal headache

Sore throat

Lopinavir with ritonavir - Interactions (Protease inhibitor)

St. John's wort, and antiseizure drugs such as phenobarbital, phenytoin, and carbamazepine decrease levels of protease inhibitors All protease inhibitors inhibit P450 Ritonavir - decreases levels of oral contraceptives

Diazepam - Indication (Benzodiazepines GABA receptor agonist)

Status epilepticus (IV), anxiety, pre-procedure, muscle relaxant, respiratory seizures with other AEDs

Misoprostol (Cytotec) - MOA

Synthetic prostaglandin, stimulates gastric mucosal lining

what is the target of pharmacotherapy for viruses?

Targets some point of the viral replication process to kill of the virus, or boost the pt's own immune system against the virus (vaccine or immunomodulatory drug categories)

Tetracycline - prototype

Tetracycline (Sumycin)

Which instruction should take priority in client teaching for any antibiotic therapy? A. The full course of prescribed drug therapy must be completed. B. Maintain adequate food intake C. Maintain an adequate fluid intake D. Report symptoms of secondary infection, such as vaginal yeast infections

The full course of prescribed drug therapy must be completed.

The nurse teaches clients with acquired immune deficiency syndrome (AIDS) about the importance of taking their medications as prescribed. What does the nurse recognize as the primary factor for medication nonadherence in the AIDS population? A. The lack of vailability of medications to treat AIDS B. A lack of understanding for the reason to take medications C. The necessity of having to take multiple medications throughout the day D. The unpleasant side effects associated with the medications

The necessity of having to take multiple medications throughout the day

You are administering gentamicin for treatment of a respiratory tract infection. Instruct the patient to monitor and report which of the following adverse effects of gentamicin? Blurred vision Tremor Sweating Tinnitus

Tinnitus

Phenytoin - Indications (Hydantoins)

Tonic and Partial Seizures Except absence

Acyclovir - S/E (Nucleosides Analogs (Viruses))

Topical form: - burning, itching (at application site, usually temporary) Oral form: -GI symptoms (n/v, diarrhea) - Headache - Vertigo - anorexia - Elevated hepatic enzymes IV: - Renal toxicity (nephrotoxicity) - CNS toxicity (rare; pts with renal impairment at most risk) symptoms: restlessness, tremors, psychosis, seizures - Thrombophlebitis at IV site; IV infiltration causes tissue damage.

Acyclovir - Teaching (Nucleosides Analogs (Viruses))

Topical: -Avoid: scratching application site, putting the ointment in eyes (wear gloves or finger cots. -Report persistent skin symptoms Oral: -Take with food if GI occur -Report persistant GI or CNS symptoms IV: -hydration occurs during and after infusion -Report symptoms of CNS toxicity (restlessness, tremors) -Report burning pain at IV site

Carbamazepine - S/E (Dibenzazepine, Neuronal Sodium Channel Moderator)

Transient and diminish: - Drowsiness - Dizziness - N/V - Rare hepatic impairment

Gabapentin - MOA GABA analog (agonist)

Unclear, possibly, calcium channels

Maraviroc - Administration (Entry inhibitor - CCR5 antagonist)

Use oral only Must be combined with other HIV drugs Dosage ranges from 150-600mg 2x daily

GABA agonists - prototype

Valproic acid (Depakote)

Miscellaneous Cell Wall Inhibitors - prototype

Vancomycin (Vancocin)

​Because the patient is allergic to penicillin, which of the following antibiotics is appropriate to prescribe for the meningitis? Cephalexin (Keflex) Amoxicillin (Amoxil) Cefotetan (Cefotan) Vancomycin (Vancocin)

Vancomycin (Vancocin) Cephalexin is a first-generation cephalosporin. Cefotetan is a second-generation cephalosporin. Cephalosporins are similar in structure to penicillins, so patients who are allergic to penicillins may also be allergic to cephalosporins. Amoxicillin is a penicillin; therefore, patients allergic to penicillin should not take this drug. Vancomycin is an appropriate choice for treating a bacterial infection in patients with penicillin allergies.

Phenobarbital - Implications (Barbiturates)

Very old drug, but very low TI and high potential for a drug dependence → rarely used in adults, primarily used in pediatric population for emergencies

Enfurvirtide - MOA (Entry Inhibitors - Fusion inhibitor)

Viral entry and replication is prevented blocks virus from getting across host membrane

You're caring for a patient who is pregnant and is HIV-positive. Which of the following drugs helps prevent the transfer of HIV to the fetus? Anastrozole Zidovudine (Retrovir) Tamoxifen (Soltamox) Trastuzumab (Herceptin

Zidovudine (Retrovir) Zidovudine prevents the transmission of HIV to the fetus. The patient should take the drug orally five times daily from 14 weeks of gestation until delivery. During delivery, the patient should receive the drug via IV infusion until the birth attendant clamps the newborn's cord. Anastrozole (Arimidex), an aromatase inhibitor and a pregnancy risk category D drug, treats early or advanced estrogen receptor-positive breast cancer in postmenopausal women. Tamoxifen, an estrogen receptor blocker and a pregnancy risk category D drug, treats metastatic estrogen receptor-positive breast cancer and prevents it in high-risk women. Trastuzumab, a monoclonal antibody and a pregnancy risk category D drug, treats metastatic breast cancer with tumors that overexpress human epidural growth factor receptor 2 (HER2).

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

Zidovudine (Retrovir, AZT)

The nurse is preparing to administer the first dose of intravenous ceftriaxone (Rocephin) to a patient. When reviewing the patients chart, the nurse notes that the patient previously experienced a rash when taking amoxicillin. What is the nurses next action? a. Administer the drug and observe closely for hypersensitivity reactions. b. Ask the provider whether a cephalosporin from a different generation may be used. c. Contact the provider to report drug hypersensitivity. d. Notify the provider and suggest an oral cephalosporin.

a. Administer the drug and observe closely for hypersensitivity reactions.

The nurse is providing teaching for the family of a patient who has been newly diagnosed with Alzheimers disease (AD). Which statement by the family member indicates understanding of the teaching? a. Alzheimers disease is a chronic, progressive condition. b. Alzheimers disease affects memory but not personality. c. The onset of Alzheimers disease is usually between 65 and 75 years. d. With proper treatment, symptoms of this disease can be arrested.

a. Alzheimers disease is a chronic, progressive condition.

A patient who is receiving chemotherapy will be given dronabinol (Marinol) to prevent nausea and vomiting. The nurse will tell the patient that this drug will be given at which time? a. Before and after the chemotherapy b. During chemotherapy c. Immediately prior to chemotherapy d. 24 hours prior to chemotherapy

a. Before and after the chemotherapy

The nurse is caring for a patient who is receiving a high dose of tetracycline (Sumycin). Which laboratory values will the nurse expect to monitor while caring for this patient? a. Blood urea nitrogen (BUN) and creatinine levels b. Complete blood counts c. Electrolytes d. Liver enzyme levels

a. Blood urea nitrogen (BUN) and creatinine levels High doses of tetracyclines can lead to nephrotoxicity, especially when given along with other nephrotoxic drugs. Renal function tests should be performed to monitor for nephrotoxicity.

A patient is receiving high doses of a cephalosporin. Which laboratory values will this patients nurse monitor closely? a. Blood urea nitrogen (BUN), serum creatinine, and liver function tests b. Complete blood count and electrolytes c. Serum calcium and magnesium d. Serum glucose and lipids

a. Blood urea nitrogen (BUN), serum creatinine, and liver function tests Cefazolin will produce an increase in the patients BUN, creatinine, AST, ALT, ALP, LDH, and bilirubin.

A patient will begin taking the protease inhibitor combination Kaletra (lopinavir/ritonavir). What information will the nurse include when teaching the patient about dietary changes? a. Consume a low-cholesterol diet. b. Consume more acidic foods. c. Take the pill on an empty stomach. d. Take the pill with fatty foods.

a. Consume a low-cholesterol diet. Protease inhibitors generally cause elevations of cholesterol and triglycerides, so patients should be counseled to consume a low-fat diet.

The nurse is caring for a patient who takes low-dose erythromycin as a prophylactic medication. The patient will begin taking cefaclor for treatment of an acute infection. The nurse should discuss this with the provider because taking both of these medications simultaneously can cause which effect? a. Decreased effectiveness of cefaclor. b. Increased effectiveness of cefaclor. c. Decreased effectiveness of erythromycin. d. Increased effectiveness of erythromycin.

a. Decreased effectiveness of cefaclor. The interaction of cefaclor and erythromycin will produce a decrease in the action of the cefaclor.

The nurse is teaching a patient who is about to take a long car trip about using dimenhydrinate (Dramamine) to prevent motion sickness. What information is important to include when teaching this patient? a. Do not drive while taking this medication. b. Dry mouth is a sign of toxicity with this mediation. c. Take the medication 1 to 2 hours prior to beginning the trip. d. Take 100 mg up to 6 times daily for best effect.

a. Do not drive while taking this medication. Drowsiness is a common side effect of dimenhydrinate, so patients should be cautioned against driving while taking this drug. Dry mouth is a common side effect and not a sign of toxicity. The drug should be taken 30 minutes prior to travel. The maximum recommended dose is 400 mg per day.

Which actions can contribute to bacterial resistance to antibiotics? (Select all that apply.) a. Frequent use of antibiotics b. Giving large doses of antibiotics c. Skipping doses d. Taking a full course of antibiotics e. Treating viral infections with antibiotics

a. Frequent use of antibiotics c. Skipping doses e. Treating viral infections with antibiotics

The nurse is providing teaching to a patient who will begin taking a cephalosporin to treat an infection. Which statement by the patient indicates a need for further teaching? a. I may stop taking the medication if my symptoms clear up. b. I should eat yogurt while taking this medication. c. I should stop taking the drug and call my provider if I develop a rash. d. I will not consume alcohol while taking this medication.

a. I may stop taking the medication if my symptoms clear up.

The nurse provides home care instructions for a patient who will take a high dose of azithromycin after discharge from the hospital. Which statement by the patient indicates understanding of the teaching? a. I may take antacids 2 hours before taking this drug. b. I should take acetaminophen for fever or mild pain. c. I should expect diarrhea to be a common, mild side effect. d. I should avoid dairy products while taking this drug.

a. I may take antacids 2 hours before taking this drug. Azithromycin peak levels may be reduced by antacids when taken at the same time so patients should be cautioned to take antacids 2 hours before or 2 hours after taking the drug. High-dose azithromycin carries a risk for hepatotoxicity when taken with other potentially hepatotoxic drugs such as acetaminophen. Diarrhea may indicate pseudomembranous colitis and should be reported. There is no restriction for dairy products when taking azithromycin.

The nurse is caring for a patient who is receiving an intravenous antibiotic. The patient has a serum drug trough of 1.5 mcg/mL. The normal trough for this drug is 1.7 mcg/mL to 2.2 mcg/mL. What will the nurse expect the patient to experience? a. Inadequate drug effects b. Increased risk for superinfection c. Minimal adverse effects d. Slowed onset of action

a. Inadequate drug effects Low peak levels may indicate that the medication is below the therapeutic level. They do not indicate altered risk for superinfection, a decrease in adverse effects, or a slowed onset of action.

The health care professional instructs the patient to watch for and report which of the following adverse reactions to the aluminum hydroxide (Amphojel) she will start taking? (Select all that apply.) a. Muscle weakness b. Tremors c. Difficulty swallowing d. Whitish stools e. Constipation

a. Muscle weakness b. Tremors c. Difficulty swallowing e. Constipation Aluminum hydroxide, an antacid, can cause hypophosphatemia and hypomagnesemia. The health care professional should monitor phosphate and magnesium levels and instruct the patient to watch for and report muscle weakness, muscle cramps, difficulty swallowing, and tremors. Aluminum hydroxide can cause constipation, so the patient should increase her fluid and fiber intake and increase exercise and activity. The patient should expect whitish or white-speckled stools but should report bloody or black, tarry stools, as they indicate gastrointestinal bleeding.

A patient is admitted to the hospital for treatment of pneumonia after complaining of high fever and shortness of breath. The patient was not able to produce sputum for a culture. The nurse will expect the patients provider to order a. a broad-spectrum antibiotic. b. a narrow-spectrum antibiotic. c. multiple antibiotics. d. the pneumococcal vaccine.

a. a broad-spectrum antibiotic.

he nurse is caring for a patient who has recurrent urinary tract infections. The patients current infection is not responding to an antibiotic that has been used successfully several times in the past. The nurse understands that this is most likely due to a. acquired bacterial resistance. b. cross-resistance. c. inherent bacterial resistance. d. transferred resistance.

a. acquired bacterial resistance.

A patient who is newly diagnosed with HIV infection after a recent exposure calls to report fever, sore throat, myalgia, and night sweats. The nurse will notify the provider that this patient is most likely experiencing a. acute retroviral syndrome. b. AIDS. c. an increased viral load. d. an opportunistic infection

a. acute retroviral syndrome. Acute retroviral syndrome often occurs 2 to 12 weeks after exposure and is caused by rapid viral replication that triggers an immune response, resulting in CD4 cell replacement and HIV antibody production that causes the viral load to drop. This patient is experiencing symptoms of this syndrome. AIDS is a diagnosis that indicates advanced disease. Opportunistic infection symptoms are related to the type of infection.

A patient who is HIV-infected takes 800 mg of indinavir (Crixivan), a protease inhibitor medication. The provider has ordered adding ritonavir (Norvir) to the regimen. The nurse will teach the patient that the addition of ritonavir a. allows decreasing the dosing from 3 times daily to twice daily. b. can lead to increased cholesterol and triglycerides. c. may worsen insulin resistance. d. will require increased dietary restrictions.

a. allows decreasing the dosing from 3 times daily to twice daily. Ritonavir boosting is a mainstay of protease inhibitor therapy and can reduce dosing frequency and pill burden as well as overcome viral resistance. It does not increase the likelihood of elevated cholesterol and triglycerides or insulin resistance and does not lead to increased dietary restrictions.

The nurse is teaching a group of nursing students about the use of antipsychotic drugs for antiemetic purposes. The nurse will explain that, when given as antiemetics, these drugs are given a. in smaller doses. b. less frequently. c. with anticholinergics. d. with antihistamines.

a. in smaller doses. Antipsychotic medications have antiemetic properties in smaller doses.

antibiotic resistance

acquired resistance, becoming major problem in global clinical settings; ability of an organism to become resistant or unresponsive to anti infective (antibiotics) drugs.

Antacids

aluminum (amphojel) sodium Magnesium (milk of magnesia) calcium (tums) bicarbonate magnesium + aluminum (magaldrate)

Penicillins - prototype

ampicillin (Principen)

What others are medications can be use instead of antiemetics?

anticholinergics/antihistamines, dopamine antagonists-phenothiazines, benzodiazepines, cannabinoids, corticosteroids.

The nurse is caring for an 80-year-old patient who has Alzheimers disease who will begin taking rivastigmine (Exelon). What will the nurse include in the plan of care for this patient? a. Administer the drug once daily. b. Assist the patient to stand and walk. c. Give the drug with food to increase absorption. d. Use nonsteroidal anti-inflammatory drugs (NSAIDs) instead of acetaminophen for pain.

b. Assist the patient to stand and walk. Patients taking rivastigmine for Alzheimers disease are at risk for falls and loss of balance. Caregivers should assist with standing and walking. The drug is taken twice daily, and it should be taken on an empty stomach. NSAIDs increase gastrointestinal side effects.

A patient is about to start taking aluminum hydroxide (Amphojel) to reduce gastric acid. Which of the following instructions should you include when talking with the patient about taking this drug? (Select all that apply.) a. Take it with a large meal. b. Chew the tablets thoroughly. c. Drink 4 oz of water after taking it. d. Increase fluid and fiber intake. e. Take it once daily.

b. Chew the tablets thoroughly. c. Drink 4 oz of water after taking it. d. Increase fluid and fiber intake. instruct patients to chew aluminum hydroxide tablets thoroughly (not swallow them whole) and follow the tablets or the liquid suspension with water to make sure it gets to the stomach promptly. This type of antacid can cause constipation, so make sure patients increase fluid and fiber intake and exercise more. Patients can take this drug up to four times a day.

Knowing the adverse effects of ranitidine (Zantac), the primary care provider's assistant should instruct the patient to watch for and report which of the following? a. Blurred vision b. Depression c. Paresthesias d. Bone pain

b. Depression Ranitidine, a histamine2-receptor antagonist, can cause CNS depression, manifesting as lethargy, depression, restlessness, and even seizures. The patient should watch for and report any of these effects, as they might require adjustments in her drug therapy or possibly additional therapy. Ranitidine is unlikely to cause blurred vision, although it can cause vertigo and hallucinations. It is unlikely to cause paresthesias, but it can cause other CNS effects such as somnolence and agitation. The drug is also unlikely to cause bone pain, although it can cause headaches.

You are about to administer ondansetron (Zofran) to a patient to prevent anesthesia-induced nausea and vomiting. You prepare to monitor the patient for which of the following adverse effects of this drug? a. Bronchospasm b. Dizziness c. Hypertension d. Anxiety

b. Dizziness Ondansetron, a serotonin antagonist, can cause dizziness, lightheadedness, and sedation. It is unlikely to cause bronchospasm, hypertension, or anxiety. However, it can cause a headache, so recommend an over-the-counter analgesic for headache pain. This drug can also cause tachycardia and angina in patients who have a history of coronary artery disease.

The parent of a child who is receiving chemotherapy asks the nurse why metoclopramide (Reglan) is not being used to suppress vomiting. The nurse will explain that, in children, this drug is more likely to cause which effect? a. Excess sedation b. Extrapyramidal symptoms c. Paralytic ileus d. Vertigo

b. Extrapyramidal symptoms

The parent of an 18-month-old toddler calls the clinic to report that the child has vomited 5 times that day. The nurse determines that the child has had three wet diapers in the past 6 hours. What will the nurse recommend for this child? a. Administering an OTC antiemetic medication such as diphenhydramine b. Giving frequent, small amounts of Pedialyte c. Keeping the child NPO until vomiting subsides d. Taking the child to the emergency department for IV fluids

b. Giving frequent, small amounts of Pedialyte The child is not dehydrated as evidenced by adequate wet diapers, so nonpharmacologic measures, such as oral fluids, are recommended. Antiemetics are not recommended unless dehydration occurs. Intravenous fluids are given when dehydration is present.

The nurse is caring for a patient who has unexplained, recurrent vomiting and who is unable to keep anything down. Until the cause of the vomiting is determined, the nurse will anticipate administering which medications? a. Antibiotics and antiemetics b. Intravenous fluids and electrolytes c. Non-prescription antiemetics d. Prescription antiemetics

b. Intravenous fluids and electrolytes Antiemetics can mask the underlying cause of vomiting and should not be used until the cause is determined unless vomiting is so severe that dehydration and electrolyte imbalance occurs. Nonpharmacologic measures, such as fluid and electrolyte replacement, should be used. Antibiotics are only used if an infectious cause is determined.

A patient who is HIV-positive begins therapy with the fixed-dose combination nucleoside reverse transcriptase inhibitor (NRTI) Combivir (lamivudine/zidovudine) twice daily. The patient is in the clinic for follow-up 1 week after initiation of therapy and reports having nausea. The patients creatinine clearance is 40 mL/minute. Based on these findings, the nurse will perform which action? a. Instruct the patient to take the medication 60 minutes prior to meals. b. Notify the provider to discuss single-dose NRTI products. c. Request an order for once-daily dosing of this medication. d. Suggest that the patient increase fluid intake.

b. Notify the provider to discuss single-dose NRTI products. Patients should have dosage adjustments of NRTIs if creatinine clearance is less than 50 mL/min. The patient will need single-dose medications so that adjustments can be made. Taking the medication prior to meals improves absorption of didanosine but does not alter the side effect of nausea for Combivir, which should subside in the next week or so. This combination product is not given once daily. Increasing fluid intake will not affect this patients symptoms.

The nurse assumes care for a patient who is currently receiving a dose of intravenous vancomycin (Vancocin) infusing at 20 mg/min. The nurse notes red blotches on the patients face, neck, and chest and assesses a blood pressure of 80/55 mm Hg. Which action will the nurse take? a. Request an order for IV epinephrine to treat anaphylactic shock. b. Slow the infusion to 10 mg/min and observe the patient closely. c. Stop the infusion and obtain an order for a BUN and serum creatinine. d. Suspect Stevens-Johnson syndrome and notify the provider immediately.

b. Slow the infusion to 10 mg/min and observe the patient closely. When vancomycin is infused too rapidly, red man syndrome may occur; the rate should be 10 mg/min to prevent this. This is a toxic reaction, not an allergic one, so epinephrine is not indicated. Stevens-Johnson syndrome is characterized by a rash and fever. Red man syndrome is not related to renal function.

A patient with HIV infection has been receiving antiretroviral therapy for 2 months. At the initiation of treatment, the patient had a viral load (VL) of 60 copies/mL and a CD4 count of 450 cells/mm3. Todays lab results reveal a VL of 20 copies/mL and a CD4 cell count of 800 cells/mm3. How will the nurse interpret the patients results? a. A drug-resistant strain is likely. b. The patient is progressing as expected. c. The patients treatment goals have been met. d. Treatment failure has occurred.

b. The patient is progressing as expected. The treatment goal would be a VL of < 20 copies/mL and a CD4 cell count between 800 and 1200 cells/mm3. This goal should be achieved in 16 to 24 weeks. Since this patient has shown improvement, progress has been made, and treatment should continue. A drug-resistant strain is not likely to respond to therapy. Treatment failure is not evident.

The nurse caring for a patient who will receive penicillin to treat an infection asks the patient about previous drug reactions. The patient reports having had a rash when taking amoxicillin (Amoxil). The nurse will contact the provider to a. discuss giving a smaller dose of penicillin. b. discuss using erythromycin (E-mycin) instead of penicillin. c. request an order for diphenhydramine (Benadryl). d. suggest that the patient receive cefuroxime (Ceftin)

b. discuss using erythromycin (E-mycin) instead of penicillin. Erythromycin is the drug of choice when penicillin is not an option. Giving smaller doses of penicillin does not prevent hypersensitivity reactions. Benadryl is useful when a hypersensitivity reaction has occurred. A small percentage of patients allergic to penicillins may be hypersensitive to cephalosporins.

The nurse would explain that Augmentin is a combination drug containing the antibiotic amoxicillin and clavulanate, which is a(n): A. secondary antibiotic. B. beta-lactamase inhibitor to prevent the breakdown of beta lactam ring. C. anti-inflammatory to prevent allergic response. D. antiviral to prevent superinfection.

beta-lactamase inhibitor to prevent the breakdown of beta lactam ring.

Metoclopramide (Reglan) - MOA

blocks nausea trigger zone in brain and increase peristalsis Faster emptying = lower pressure/GERD/acid in stomach Used if PPI or H2 receptor blockers aren't relieving symptoms

The nurse is teaching a nursing student about the minimal effective concentration (MEC) of antibiotics. Which statement by the nursing student indicates understanding of this concept? a. A serum drug level greater than the MEC ensures that the drug is bacteriostatic. b. A serum drug level greater than the MEC broadens the spectrum of the drug. c. A serum drug level greater than the MEC helps eradicate bacterial infections. d. A serum drug level greater than the MEC increases the therapeutic index.

c. A serum drug level greater than the MEC helps eradicate bacterial infections. The MEC is the minimum amount of drug needed to halt the growth of a microorganism. A level greater than the MEC helps eradicate infections. Drugs at or above the MEC are usually bactericidal, not bacteriostatic. Raising the drug level does not usually broaden the spectrum or increase the therapeutic index of a drug.

A patient who experiences motion sickness when flying asks the nurse the best time to take the medication prescribed to prevent motion sickness for a 0900 flight. The nurse will instruct the patient to take the medication at which time? a. As needed, at the first sign of nausea b. At 0700, before leaving for the airport c. At 0830, just prior to boarding the plane d. When seated, just prior to takeoff

c. At 0830, just prior to boarding the plane Motion sickness medication has its onset in 30 minutes. The patient should be instructed to take the medication a half hour prior to takeoff. It is not used as needed.

The nurse is preparing to administer amoxicillin (Amoxil) to a patient and learns that the patient previously experienced a rash when taking penicillin. Which action will the nurse take? a. Administer the amoxicillin and have epinephrine available. b. Ask the provider to order an antihistamine. c. Contact the provider to discuss using a different antibiotic. d. Request an order for a beta-lactamase resistant drug.

c. Contact the provider to discuss using a different antibiotic. Patients who have previously experienced manifestations of allergy to a penicillin should not use penicillins again unless necessary. The nurse should contact the provider to discuss using another antibiotic from a different class. Epinephrine and antihistamines are useful when patients are experiencing allergic reactions, depending on severity.

The patient is going to take ranitidine (Zantac) in the form of effervescent tablets. Administration instructions for this drug formulation should include which of the following? a. Swallow the tablets whole. b. Chew the tablets before swallowing them. c. Dissolve the tablets in water. d. Place the tablets under the tongue.

c. Dissolve the tablets in water. The patient should dissolve effervescent ranitidine tablets completely in water and then drink the solution. The health care professional should make sure she understands that she should not chew them, swallow them whole, or dissolve them on or under her tongue. Additional instructions for patients taking this drug include eating six small meals per day and not smoking or drinking alcohol.

A female patient who is allergic to penicillin will begin taking an antibiotic to treat a lower respiratory tract infection. The patient tells the nurse that she almost always develops a vaginal yeast infection when she takes antibiotics and that she will take fluconazole (Diflucan) with the antibiotic being prescribed. Which macrolide order would the nurse question for this patient? a. Azithromycin (Zithromax) b. Clarithromycin (Biaxin) c. Erythromycin (E-Mycin) d. Fidaxomicin (Dificid)

c. Erythromycin (E-Mycin) When erythromycin is given concurrently with fluconazole, erythromycin blood concentration and the risk of sudden cardiac death increase.

A patient is diagnosed with mycoplasma pneumonia. Which antibiotic will the nurse expect the provider to order to treat this infection? a. Azithromycin (Zithromax) b. Clarithromycin (Biaxin) c. Erythromycin (E-Mycin) d. Fidaxomicin (Dificid)

c. Erythromycin (E-Mycin) Erythromycin is the drug of choice for treating mycoplasma pneumonia.

The nurse is caring for several patients who are receiving antibiotics. Which order will the nurse question? a. Azithromycin (Zithromax) 500 mg IV in 500 mL fluid b. Azithromycin (Zithromax) 500 mg PO once daily c. Erythromycin 300 mg IM QID d. Erythromycin 300 mg PO QID

c. Erythromycin 300 mg IM QID Erythromycin and other macrolides should not be given intramuscularly because they cause painful tissue irritation.

The nurse is preparing to give a dose of oral clindamycin (Cleocin) to a patient who is being treated for a skin infection caused by Staphylococcus aureus. The patient has had several doses of the medication and reports having nausea. Which action will the nurse take next? a. Administer the next dose when the patient has an empty stomach. b. Hold the next dose and contact the patients provider. c. Instruct the patient to take the next dose with a full glass of water. d. Request an order for an antacid to give along with the next dose

c. Instruct the patient to take the next dose with a full glass of water. Clindamycin should be taken with a full glass of water to minimize gastronintestinal (GI) irritation such as nausea, vomiting, and stomatitis. Giving the medication on an empty stomach will increase the likelihood of GI upset. It is not necessary to hold the next dose or to give an antacid.

A pregnant patient is HIV-positive. Which antiretroviral agent will the nurse expect the patients provider to order? a. Abacavir/lamivudine/zidovudine (Trizivir) b. Efavirenz/emtricitabine/tenofovir (Atripla) c. Lamivudine/zidovudine (Combivir) d. Rilpivirine/emtricitabine/tenofovir (Complera)

c. Lamivudine/zidovudine (Combivir) Antiretroviral therapy is strongly recommended for all pregnant HIV-infected patients. The preferred dual nucleoside reverse transcriptase inhibitor is Combivir.

The nurse is caring for a patient who is receiving a high dose of intravenous azithromycin to treat an infection. The patient is also taking acetaminophen for pain. The nurse should expect to review which lab values when monitoring for this drugs side effects? a. Complete blood counts b. Electrolytes c. Liver enzymes d. Urinalysis

c. Liver enzymes High doses of macrolides, when taken with other, potentially hepatotoxic drugs such as acetaminophen may cause hepatotoxicity, so liver enzymes should be carefully monitored.

A nursing student asks the nurse to differentiate the pathology of Alzheimers disease from that of Parkinsons disease. Which description is correct? a. Alzheimers disease involves a possible excess of acetylcholine and neuritic plaques. b. Alzheimers disease is caused by decreased amounts of dopamine and degeneration of cholinergic neurons. c. Parkinsons disease is characterized by an imbalance of dopamine and acetylcholine. d. Parkinsons disease involves increased dopamine production and decreased acetylcholine.

c. Parkinsons disease is characterized by an imbalance of dopamine and acetylcholine. Parkinsons disease (PD) is characterized by an imbalance of dopamine (DA) and acetylcholine (ACh) caused by an unexplained degeneration of the dopaminergic neurons allowing the excitatory response of acetylcholine to exceed the inhibitory response of dopamine. Alzheimers disease (AD) may result from decreased ACh, degeneration of cholinergic neurons, and neuritic plaques. Dopamine does not appear to play a role in Alzheimers disease.

The nurse is helping to develop a plan of care for a patient who has advanced Alzheimers disease. The patient will be taking a new medication. Which is a realistic goal for this patient? a. Demonstrate improved cognitive function. b. Exhibit improved ability to provide self-care. c. Receive appropriate assistance for care needs. d. Show improved memory for recent events.

c. Receive appropriate assistance for care needs.

The nurse is reviewing a patients chart prior to administering gentamycin (Garamycin) and notes that the last serum peak drug level was 9 mcg/mL and the last trough level was 2 mcg/mL. What action will the nurse take? a. Administer the next dose as ordered. b. Obtain repeat peak and trough levels before giving the next dose. c. Report possible drug toxicity to the patients provider. d. Report a decreased drug therapeutic level to the patients provider.

c. Report possible drug toxicity to the patients provider. Gentamycin peak values should be 5 to 8 mcg/mL, and trough levels should be 0.5 to 2 mcg/mL. Peak levels give information about whether or not a drug is at toxic levels, while trough levels indicate whether a therapeutic level is maintained. This drug is at a toxic level, and the next dose should not be given.

The nurse is preparing to administer clarithromycin to a patient. When performing a medication history, the nurse learns that the patient takes warfarin to treat atrial fibrillation. The nurse will perform which action? a. Ask the provider if azithromycin may be used instead of clarithromycin. b. Obtain an order for continuous cardiovascular monitoring. c. Request an order for periodic serum warfarin levels. d. Withhold the clarithromycin and notify the provider.

c. Request an order for periodic serum warfarin levels. Macrolides can increase serum levels of other drugs such as warfarin. If these drugs are used with macrolides, serum drug levels should be monitored. All macrolides have this drug interaction. Cardiovascular monitoring is not indicated. The drug may be given as long as serum drug levels are monitored.

The nurse is teaching a patient who will be discharged home from the hospital to take amoxicillin (Amoxil) twice daily for 10 days. Which statement by the nurse is correct? a. Discontinue the antibiotic when your temperature returns to normal and your symptoms have improved. b. If diarrhea occurs, stop taking the drug immediately and contact your provider. c. Stop taking the drug and notify your provider if you develop a rash while taking this drug. d. You may save any unused antibiotic to use if your symptoms recur.

c. Stop taking the drug and notify your provider if you develop a rash while taking this drug. Patients who develop signs of allergy, such as rash, should notify their provider before continuing medication therapy. Patients should be counseled to continue taking their antibiotics until completion of the prescribed regimen even when they feel well. Diarrhea is an adverse effect but does not warrant cessation of the drug. Before deciding to stop taking a medication due to a side effect, encourage the patient to contact the provider first. Patients should discard any unused antibiotic.

A woman who is 2 months pregnant reports having morning sickness every day and asks if she can take any medications to treat this problem. The nurse will recommend that the patient take which action first? a. Contact the provider to discuss a possible need for intravenous fluids. b. Contact the provider to discuss a prescription antiemetic. c. Use nonpharmacologic measures such as saltines. d. Take over-the-counter antiemetics such as diphenhydramine.

c. Use nonpharmacologic measures such as saltines.

The nurse is providing discharge teaching for a patient who will receive oral levofloxacin (Levaquin) to treat pneumonia. The patient takes an oral hypoglycemic medication and uses over-the-counter (OTC) antacids to treat occasional heartburn. The patient reports frequent arthritis pain and takes acetaminophen when needed. Which statement by the nurse is correct when teaching this patient? a. You may take antacids with levofloxacin to decrease gastrointestinal upset. b. You may take nonsteroidal anti-inflammatory medications (NSAIDs) for arthritis pain. c. You should monitor your serum glucose more closely while taking levofloxacin. d. You should take levofloxacin on an empty stomach to improve absorption.

c. You should monitor your serum glucose more closely while taking levofloxacin. Levofloxacin may increase the effects of oral hypoglycemic medications, so patients taking these should be advised to monitor their serum glucose levels closely. Antacids decrease the absorption of levofloxacin. NSAIDs taken with levofloxacin can cause central nervous system reactions, including seizures.

The nurse is caring for a patient who is HIV-positive and has been receiving antiretroviral therapy for several months. The nurse experiences a needlestick injury resulting in exposure to the patients blood. The nurse asks the Occupational Health nurse if treatment is necessary. How will the Occupational Health nurse respond? a. No treatment is necessary since the patient is receiving antiretroviral therapy. b. We will treat you if the patients VL is > 20 copies/mL. c. You will require 4 weeks of antiretroviral therapy. d. You will undergo HIV testing and will be treated if you are positive.

c. You will require 4 weeks of antiretroviral therapy. Persons exposed to the blood of HIV-infected patients should receive 4 weeks of antiretroviral therapy.

The nurse is teaching a family member about an elderly parents new prescription for tacrine (Cognex) to treat Alzheimers disease (AD). The family member asks what to expect from this drug. The nurse will respond that the patient will a. demonstrate improved ambulation. b. have reversal of all symptoms. c. have decreased deterioration of cognition. d. show improved communication ability.

c. have decreased deterioration of cognition.

The nurse is caring for a 70-kg patient who is receiving gentamicin (Garamycin) 85 mg 4 times daily. The patient reports experiencing ringing in the ears. The nurse will contact the provider to discuss a. decreasing the dose to 50 mg QID. b. giving the dose 3 times daily. c. obtaining a serum drug level. d. ordering a hearing test.

c. obtaining a serum drug level. Aminoglycosides can cause ototoxicity. Any changes in hearing should be reported to the provider so that serum drug levels can be monitored. The dose is correct for this patients weight (5 mg/kg/day in 4 divided doses). A hearing test is not indicated unless changes in hearing persist.

A patient who has HIV infection will begin treatment with efavirenz. The nurse expects this agent to be given in the combination product Atripla in order to a. avoid development of psychiatric comorbidities. b. prevent dizziness, sedation, and nightmares. c. reduce viral resistance. d. prevent severe rash and hepatotoxicity.

c. reduce viral resistance. Efavirenz is optimally given as a component of Atripla. The primary reason for using combination products is to reduce viral resistance. Efavirenz should not be given to patients who have psychiatric histories. Efavirenz may cause dizziness, sedation, nightmares, rash, and hepatotoxicity, but this is not minimized with combination therapy.

The nurse is caring for a patient who will begin taking doxycycline to treat an infection. The nurse should plan to give this medication a. 1 hour before or 2 hours after a meal. b. with an antacid to minimize GI irritation. c. with food to improve absorption. d. with small sips of water.

c. with food to improve absorption. Doxycycline is a lipid-soluble tetracycline and is better absorbed when taken with milk products and food. It should not be taken on an empty stomach. Antacids impair absorption of tetracyclines. Small sips of water are not necessarily indicated.

ciprofloxacin - S/E (Fluoroquinolones)

cartilage toxicity, GI toxicity, hypersensitivity, cardiotoxicity, CNIS toxicity, phototoxicity, hepatoxicity spontaneous rupture of tendons and tendonitis

Fluoroquinolones - prototype

ciprofloxacin (Cipro)

Omeprazole - Interventions (Proton Pump inhibitor)

consider dose and length of time on the drug. Monitor for bone loss.

Antacids - S/E

constipation (aluminum and calcium) diarrhea, ventricular dysrhythmias (magnesium) fluid retention, exacerbation of HF or HTN (sodium) metabolic alkalosis (bicarbonate) hypophosphatimia, hypomagnesimia

Trimethropin-sulfamethoxazole - S/E (Sulfonamides)

crystaluria, blood dyscrasias, hypersensitivity, (including thiazide diuretics) Steven-Johnson syndrome, photosensitivity

A patient will begin taking amoxicillin. The nurse should instruct the patient to avoid which foods? a. Green leafy vegetables b. Beef and other red meat c. Coffee, tea, and colas d. Acidic fruits and juices

d. Acidic fruits and juices Acidic fruits and juices should be avoided while the client is being treated with amoxicillin because amoxicillin can be irritating to the stomach. Stomach irritation will be increased with the ingestion of citrus and acidic foods. Amoxicillin may also be less effective when taken with acidic fruit or juice.

The patient will begin taking penicillin G procaine (Wycillin).The nurse notes that the solution is milky in color. What action will the nurse take? a. Call the pharmacist and report the milky color. b. Add normal saline to dilute the medication. c. Call the physician and report the milky appearance. d. Administer the medication as ordered by the physician.

d. Administer the medication as ordered by the physician. Penicillin G procaine (Wycillin) has a milky appearance; therefore, the appearance should not concern the nurse.

The nurse is caring for a patient who is receiving an intravenous antibiotic. The nurse notes that the provider has ordered serum drug peak and trough levels. The nurse understands that these tests are necessary for which type of drugs? a. Drugs with a broad spectrum b. Drugs with a narrow spectrum c. Drugs with a broad therapeutic index d. Drugs with a narrow therapeutic index

d. Drugs with a narrow therapeutic index Medications with a narrow therapeutic index have a limited range between the therapeutic dose and a toxic dose. It is important to monitor these medications closely by evaluating regular serum peak and trough levels.

The nurse is preparing to administer intravenous gentamicin to an infant through an intermittent needle. The nurse notes that the infant has not had a wet diaper for several hours. The nurse will perform which action? a. Administer the medication and give the infant extra oral fluids. b. Contact the provider to request adding intravenous fluids when giving the medication. c. Give the medication and obtain a serum peak drug level 45 minutes after the dose. d. Hold the dose and contact the provider to request a serum trough drug level.

d. Hold the dose and contact the provider to request a serum trough drug level. Gentamicin can cause nephrotoxicity. When changes in urine output occur, the provider should be notified, and serum trough levels should be obtained to make sure the drug is not at a toxic level. If the drug level is determined to be safe, giving extra fluids either orally or intravenously may be indicated. Serum peak levels give information about therapeutic levels but are not a substitution for avoiding nephrotoxicity in the face of possible oliguria.

The nurse is preparing to administer the first dose of an antibiotic to a patient admitted for a urinary tract infection. Which action is most important prior to administering the antibiotic? a. Administering a small test dose to determine whether hypersensitivity exists b. Having epinephrine available in the event of a severe hypersensitivity reaction c. Monitoring baseline vital signs, including temperature and blood pressure d. Obtaining a specimen for culture and sensitivity

d. Obtaining a specimen for culture and sensitivity To obtain the most accurate culture, the specimen should be obtained before antibiotic therapy begins. It is important to obtain cultures when possible in order to correctly identify the organism and help determine which antibiotic will be most effective. Administering test doses to determine hypersensitivity is sometimes done when there is a strong suspicion of allergy when a particular antibiotic is needed. Epinephrine is kept close at hand when there is a strong suspicion of allergy.

A patient who will begin antiretroviral therapy reports having trouble sticking with drug regimens in the past. Which action will the nurse take? a. Ask the patients family members to administer the medications. b. Avoid discussing adverse effects to prevent focus on negative aspects of ART. c. Give a detailed list of medications and stress the need to adhere to the schedule. d. Offer written and verbal information about each drugs purpose.

d. Offer written and verbal information about each drugs purpose.

The nurse is preparing to give a dose of a cephalosporin medication to a patient who has been receiving the antibiotic for 2 weeks. The nurse notes ulcers on the patients tongue and buccal mucosa. Which action will the nurse take? a. Hold the drug and notify the provider. b. Obtain an order to culture the oral lesions. c. Gather emergency equipment to prepare for anaphylaxis. d. Report a possible superinfection side effect of the cephalosporin.

d. Report a possible superinfection side effect of the cephalosporin. The patients symptoms may indicate a superinfection and should be reported to the physician so it can be treated; however, the drug does not need to be held. It is not necessary to culture the lesions. The symptoms do not indicate impending anaphylaxis.

The nurse is preparing to administer an antibiotic to a patient who has been receiving the antibiotic for 2 days after a culture was obtained. The nurse notes increased erythema and swelling, and the patient has a persistent high fever of 39 C. What is the nurses next action? a. Administer the antibiotic as ordered. b. Contact the provider to request another culture. c. Discuss the need to add a second antibiotic with the provider. d. Review the sensitivity results from the patients culture.

d. Review the sensitivity results from the patients culture. The sensitivity results from the patients culture will reveal whether the organism is sensitive or resistant to a particular antibiotic. The patient is not responding to the antibiotic being given, so the antibiotic should be held and the provider notified. Another culture is not indicated. Antibiotics should be added only when indicated by the sensitivity.

The nurse is preparing to begin a medication regimen for a patient who will receive intravenous ampicillin and gentamicin. Which is an important nursing action? a. Administer each antibiotic to infuse over 15 to 20 minutes. b. Order serum peak and trough levels of ampicillin. c. Prepare the schedule so that the drugs are given at the same time. d. Set up separate tubing sets for each drug labeled with the drug name and date.

d. Set up separate tubing sets for each drug labeled with the drug name and date. Intravenous aminoglycosides can be given with penicillins and cephalosporins but should not be mixed in the same container. The IV line should be flushed between antibiotics, or separate tubing sets may be set up. Gentamicin must be infused over 30 to 60 minutes. It is not necessary to measure ampicillin peak and trough levels. Giving the drugs at the same time increases the risk of mixing them together.

The nurse is caring for a 7-year-old patient who will receive oral antibiotics. Which antibiotic order will the nurse question for this patient? a. Azithromycin (Zithromax) b. Clarithromycin (Biaxin) c. Clindamycin (Cleocin) d. Tetracycline (Sumycin)

d. Tetracycline (Sumycin) Tetracyclines should not be given to children younger than 8 years of age because they irreversibly discolor the permanent teeth.

A patient who has recently begun antiretroviral therapy with a combination drug develops immune reconstitution inflammatory syndrome (IRIS) with mild symptoms. What does the nurse expect that the provider will order? a. Administration of a high dose of corticosteroids b. Changing the regimen to a single antiretroviral drug c. Temporarily discontinuing the antiretroviral therapy d. Treating an underlying opportunistic infection

d. Treating an underlying opportunistic infection IRIS is related to specific opportunistic infections that must be treated. Anti-inflammatory medications, such as corticosteroids, may be used if indicated after the underlying infection is treated. Changing or discontinuing the antiretroviral therapy regimen is not indicated.

A female patient will receive doxycycline to treat a sexually transmitted illness (STI). What information will the nurse include when teaching this patient about this medication? a. Nausea and vomiting are uncommon adverse effects. b. The drug may cause possible teratogenic effects. c. Increase intake of dairy products with each dose of this medication. d. Use a backup method of contraception if taking oral contraceptives.

d. Use a backup method of contraception if taking oral contraceptives. The desired action of oral contraceptives can be lessened when taken with tetracyclines, so patients taking oral contraceptives should be advised to use a backup contraception method while taking tetracyclines. Nausea and vomiting are common adverse effects. Doxycycline should not be taken with dairy products. Tetracycline may cause teratogenic effects.

The nurse is caring for a 55-year-old patient who has been HIV-infected for 15 years. The nurse understands that this patient a. has an increased risk of transmitting the HIV infection. b. is less likely to develop AIDS than younger persons with HIV infection. c. is less likely to respond to antiretroviral agents. d. may have comorbid illnesses that can complicate HIV.

d. may have comorbid illnesses that can complicate HIV. Older HIV-infected patients may have age-related comorbid illness that can complicate management of HIV infection.

When is the peak for antibiotics drawn?

drawn 30 min - 1/1.5hrs after dose (depends on oral or IV, IVPB) - Highest level of drug in bloodstream.

When is the trough for antibiotics drawn?

drawn 30 min prior to next dose due. - lowest level of drug molecules in the bloodstream

Ondansetron - teaching (antiemetics)

drink fluids, report, dizziness, and headache.

Macrolides - prototype

erythromycin (Erythrocin)

Enfurvirtide - indication (Entry Inhibitors - Fusion inhibitor)

for pts who have become resistant to other drugs

Maraviroc - indication (Entry inhibitor - CCR5 antagonist)

for pts who have developed resistance to other drugs Not all HIV strains have CCR5 → draw blood prior to verify strain of HIV has receptor using assay or drug will be useless

Ondansetron - administration antiemetics)

give orally or IV IV → chemo → start 30 min before and then also do afterwards

Pre-exposure prophylaxis (PrEP)

given to someone who is HIV negative but at high risk fro transmission IV drug abuser who shares needles, high risk for sexual transmission

Anticholinergics

helpful, but have systemic PNS and adverse effects that aren't tolerated well, not commonly used

Imipenem-cilastatin - CI/Pregnancy

hypersensitivity (allergic reaction) renal impairment Category C

Antacids - Teaching

increase activity and fluid intake. Report abdominal pain and diarrhea with milk of magnesia Report muscle weakness, cramps, difficult swallowing tremors (aluminum antacids) Tell pts to report signs of gastrointestinal bleeding.

Valproic Acid - Interactions (GABA agonists)

increase levels of phenytoin and phenobarbital + topiramate increase the risk for hyperammonenia

Memantine - Teaching (NMDA receptor blocker)

increased fluid and fiber → PRN supplements Report CNS effects Include caregivers

Sucralfate (Carafate) - MOA

increases mucosal lining and increase bicarbonate and prostaglandin release → neutralizes gastric acid and protects stomach wall

Valproic Acid - MOA (GABA agonists)

increases the concentration of GABA in the brain (suppresses excitatory actions) Inhibits the influx sodium through channels inhibits the influx of calcium through calcium channels

Trimethropin-sulfamethoxazole - MOA (Sulfonamides)

inhibits synthesis of folic acid in bacteria (required for DNA/RNA synthesis)

Ondansetron - S/E (antiemetics)

mild, headaches, dizziness, and diarrhea

Antacids - interventions

monitor bowel function → constipation or diarrhea administer stool softeners monitor phosphorus and magnesium levels

Memantine - Intervention (NMDA receptor blocker)

monitor for CNS effects keep pt safe monitor for constipation Keep in mind that SE effects are difficult with pts, they can't understand why are experiencing them.

ampicillin - Interventions (Penicillin)

monitor for gastrointestinal symptoms, report bloody stools, monitor and report candida infections, treatment with an anti-fungal agent. monitor and report allergy. cross hypersensitivity with cephalosporins treat broad spectrum infections.

Valproic Acid - Interventions (GABA agonists)

monitor for s/e, blood ammonia level, serum amylase, liver function. Obtain baseline of liver, observe for s/s of hepatitis

for what are the peak and trough used?

monitoring blood levels of antibiotics in patients - antibiotics often have low TI, can become toxic Drug will be either be given at higher, lower doses or given closer or farther apart depending on these.

Erytromycin - administration (Macrolides)

must be taken on an empty stomach for best absorption, but may be taken with food to be able to tolerate it → very irritating to stomach, cause nausea and stomach pain

Antacids - administration

orally 4x a day, chew tablet thoroughly and drink 4ox of water. Do not give within 2hr of administering drugs that interact with them.

Post-exposure prophylaxis (PEP)

potential exposure through unsafe sex or blood transfer (sharing needles, health care workers needle sticks) Start within 24-36h of exposure and taken for 4 wks, monitored intermittently Facilities require consent from pt to test for HIV, if pt does not consent, will start PEP, can discontinue if determined negative.

ampicillin - interactions (Penicillin)

probenecid increases penicillin blood levels + tetracyclines decrease therapeutic levels.

The nurse is managing care for a client prescribed tetracycline who is reporting frequent episodes of diarrhea. The nurse plans to monitor this client for: A. intestinal obstruction. B. paralytic ileus. C. pseudomembranous colitis. D. impaired biliary function

pseudomembranous colitis.

Antiepileptic durgs (AED) - MOA

reduces excitability of brain cells to prevent seizures - blocking sodium channels to reduce transmission of impulses - stimulating GABA receptors to decrease exhibitory actions - blocking calcium channels that potentiate neuromuscular activity - blocking glutamate a stimulating neurotransmitter

Status epilepticus

repeated seizure activity with no recovery in between, usually lasting more than 10 min or >3 seizures in a row without interruption - medical emergency: respiratory muscles dramatically contract reducing ventilation → hypoxia → lactic acidosis → necrosis and toxicity to organ system

Ranitidine - Teaching H2 Receptor antagonists

report changes in sexual desire as well as lethargy, depression, restlessness or seizures, vomiting and diarrhea. Drink plenty of fluids report signs of gastrointestinal bleeding.

Bismuth compounds (Kaopectate, pepto bismol) - MOA

stimulate mucosal production and prostaglandins

Antiepileptic durgs (AED)

suppress neuron discharge to prevent seizure activity

E. A clinic nurse is teaching a group of teens taking tetracycline for acne. Which teaching points should take priority? Select all

teaching points should take priority? Select all - Take tetracycline on an empty stomach to increase absorption - Tetracycline may cause photosensitivity, making the skin susceptible to sunburn - Tetracycline may cause vaginal yeast infection in women who are using oral contraceptives.

Zidovudine - MOA Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

terminates DNA chain and creates defective DNA strand

Goal of HIV/AIDS treatment

to reduce morbidity, prolong survival, improve QOL, restore/preserve immune system function

Lopinavir with ritonavir - Indication (Protease inhibitor)

treat both HIV-1 and HIV-2 with at least 1 reverse transcriptase inhibitor to prevent resistance Increase therapeutic effects of other antiretroviral drugs HIV infection (prolonged 1/2 life, 1-2x daily dosing)

Sulfonamides - prototype

trimethorpin-sulfamethoxasole (Bactrim)

Memantine - Indication (NMDA receptor blocker)

used in combo with cholinesterase inhibitors to slow progression of moderate-severe AD

Antacids - indications

usually tried initially during first symptoms of PUD or GERD

Carbamazepine - Intervention (Dibenzazepine, Neuronal Sodium Channel Moderator)

Begin with low dose and increase gradually Give larger dose at bedtime Monitor CBC, mainly WBC. Monitor and report skin rash. Protect pt from sun exposure. Do not mix oral suspension, maintain therapeutic levels. Less potentially toxic effects than Hydantoins but does require plasma drug level monitoring (TI 4-12mcg/ml) May be given for ptsd without seizures but with peripheral neuropathy due to OIL uses found in post market surveillance. Adverse effects are transient and diminish as treatment progresses, should resolve quickly

ampicillin - MOA (Penicillin)

Beta-Lactam ring weakens and destroy cell wall. Inhibits enzyme necessary for cell wall formation no effect on human cell wall Penicillin G is the active constituent

Omeprazole - MOA (Proton Pump inhibitor)

Binds irreversibly with H, K, ATPase and inhibits acid secretion. Inhibits pump that pumps HCl into stomach, blocks it, lower levels of HCl = less irritation to stomach lining and esophagus. Does not prevent reflux, just decreases acid amount

Efavirenz - MOA (Non-nucleoside reverse transcriptase inhibitors (NNRTIs))

Binds to reverse transcriptase and prevents DNA synthesis

Ranitidine - MOA H2 Receptor antagonists

Blocks H2 receptors on parietal cells and decreases acid production.

Raltegravir - MOA (integrase inhibitor)

Blocks insertion of viral DNA strand into host cell

Imipenem-cilastatin - MOA

Broadest antimicrobial spectrum Beta-lactam ring differs from penicillin and cephalosporin → less resistance Cilastatin part is not an active ingredient, causes drug/drug interaction to prolong the effect of the antibiotic → remains active in blood longer → only a couple doses a day required

A patient is about to start taking omeprazole (Prilosec) to treat a duodenal ulcer. Which of the following instructions should you include when talking with the patient about taking this drug? a. Take it with food. b. Avoid using aluminum-based antacids. C. Consume adequate vitamin D and calcium. d. Do not drink with grapefruit juice.

C. Consume adequate vitamin D and calcium. Omeprazole, a proton pump inhibitor, can cause bone loss with long-term use, so instruct patients to increase weight-bearing activities and consume sufficient amounts of calcium and vitamin D to help prevent osteoporosis. Food can reduce the absorption of omeprazole, so instruct patients to take this drug 1 hr before a meal. Antacids are unlikely to interfere with the absorption of omeprazole and might help reduce gastric distress. Grapefruit juice interacts with many different drugs, including cyclosporine (Sandimmune), midazolam (Versed), and lovastatin (Mevacor), but it is unlikely to affect the metabolism of omeprazole

Gabapentin - S/E GABA analog (agonist)

CNS Behavioral

Amantadine - S/E (Viral replication inhibitors - Drugs for influenza)

CNS effects Worsens psychiatric disorders Toxicity in renal impairment; visual and auditory hallucinations, seizures, coma, dysrhythmias

Carbamazepine - Teaching (Dibenzazepine, Neuronal Sodium Channel Moderator)

CNS effects- visual disturbances, do not drive. Precautions with falls. Instruct pt to report urine output. Shortness of breath, instruct sunscreen use

Efavirenz - S/E (Non-nucleoside reverse transcriptase inhibitors (NNRTIs))

CNS effects: sleep disorders, dizziness, decreased concentration Rash (frequent)- may develop into SJ syndrome or erythema multiform *Teratogen* GI symptoms: n/v, diarrhea Elevated liver enzymes (transaminase levels)

Maraviroc - S/E (Entry inhibitor - CCR5 antagonist)

CNS symptoms: dizziness, sleep disorders, paresthesias Musculoskeletal pain Cough and upper respiratory infections Liver damage: symptoms of allergic reaction, such as rash, are often seen before liver damage occurs (elevated immunoglobulin E and eosinophil counts) Increased risk for Myocardial ischemia and infarction Hepatoxicity

A priority system of assessment in a client recently started on efavirenz (Sustiva) includes: A. pulmonary. B. CNS. C. GI. D. cardiac.

CNS.

Diazepam - S/E (Benzodiazepines GABA receptor agonist)

CV collapse CNS effects Urinary retention Laryngeal spasm Cough Substance abuse (Schedule IV)

Maraviroc - Interaction (Entry inhibitor - CCR5 antagonist)

CYP3A4 inhibitors raise maraviroc blood levels CYP3A4 inducer decrease maraviroc blood levels

Ondansetron - Indication (antiemetics)

Cancer pt receiving chemotherapy for treatment (targets rapidly replicating cells in the body and destroys them) - GI tract cells are rapidly replicating, so chemo drugs often affect GI tract → N/V - Helps avoid f/e abnormalities in already sick pt's

Dibenzazepine, Neuronal Sodium Channel Moderator - Protype (Seizures)

Carbamazepine (Tegretol)

Vancomycin - CI/Pregnancy Miscellaneous cell wall inhibitors

Category C

Misoprostol (Cytotec) - Pregnancy

Category X - use for medical abortion → miscarriage

Cefazotin - CI/Pregnancy (Cephalosporins)

Caution in renal impairments, anticoagulants (drug/drug), alcohol (drug/drug) Category B

Erytromycin - CI/Pregnancy (Macrolides)

Caution with warfarin (hepatic inhibitor) Category B

Amantadine - CI/Pregnancy (Viral replication inhibitors - Drugs for influenza)

Caution: CNS disease, psychiatric disorders, renal impairment Edema, HF Category C

Trimethropin-sulfamethoxazole - CI/Pregnancy (Sulfonamides)

Caution: hyperkalemia, renal impairment Category C

tetracycline - CI/pregnancy

Caution: oral contraceptives Category D

Cephalosporins

Cefazolin (ancef)

Lopinavir with ritonavir - Interventions (Protease inhibitor)

Counsel pt on dietary and activity management of hyperglycemia and dyslipidimia -avoid anti-hyperglycemic and anti-dyslipidemic drugs to decrease drug/drug interactions, cost, s/e, etc Monitor Hyperglycemia and diabetes -determine baseline; periodically monitor blood glucose -give prescribed anti-diabetic drugs Monitor for fat redistribution Monitor cholesterol and triglyceride levels Monitor bone density Monitor for liver toxicity Monitor GI symptoms Keep viral load down and CD4 high Ritonavir is not active, prevents liver from breaking down lopinavir → longer duration of action in blood stream → better therapeutic effect and prolonged 1/2 life.

It is crucial for the nurse to monitor which laboratory test when a client is taking acyclovir (Zovirax)? A. Fasting blood glucose B. White blood count (WBC) C. Creatinine D. Viral culture

Creatinine