Saunders Immune Medications Evolve

Methenamine is prescribed for a client with a gram-positive urinary tract infection. The nurse questions the prescription if which preexisting disorder is noted in the client's record? 1. Cirrhosis 2. Hypothyroidism 3. Diabetes mellitus 4. Peripheral vascular disease

1. Cirrhosis Rationale: Methenamine is contraindicated in clients with renal or hepatic disease or those with severe dehydration. The nurse would question the health care provider's prescription for this medication in the client with cirrhosis.

Amikacin (Amikin) is prescribed for a client with a bacterial infection. The client should be instructed to contact the health care provider (HCP) immediately if which occurs? 1. Nausea 2. Lethargy 3. Hearing loss 4. Muscle aches

3. Hearing loss Rationale: Amikacin (Amikin) is an aminoglycoside. Adverse effects of aminoglycosides include ototoxicity (hearing problems), confusion, disorientation, gastrointestinal irritation, palpitations, blood pressure changes, nephrotoxicity, and hypersensitivity. The nurse instructs the client to report hearing loss to the HCP immediately. Lethargy and muscle aches are not associated with the use of this medication. It is not necessary to contact the HCP immediately if nausea occurs. If nausea persists or results in vomiting, the HCP should be notified.

A client who is prescribed metronidazole (Flagyl) calls the clinic nurse to report dark discoloration of the urine. The nurse interprets that the client's report warrants which nursing action at this time? 1. Instruct the client to increase oral fluid intake. 2. Inform the client that this is a common side effect. 3. Arrange for the client to speak with the health care provider. 4. Advise the client to immediately discontinue the medication.

1. Instruct the client to increase oral fluid intake. Rationale: Metronidazole can produce a variety of untoward effects, but they rarely require termination of treatment. Harmless darkening of the urine may occur, and the client should be told of this effect. It is not necessary to discontinue the medication or call the health care provider. Increasing fluid intake is a good health measure but will not prevent this side effect from occurring.

The nurse employed in a neighborhood health care clinic notes that the health care provider has prescribed oseltamivir (Tamiflu). The nurse reinforces teaching the client specific home care measures, knowing that this medication was prescribed for which condition? 1. Herpes simplex 2. Influenza virus 3. Herpes zoster 4. Varicella zoster

2. Influenza virus Rationale: Oseltamivir is an oral antiviral medication used to treat influenza A and B virus. It is not used to treat herpes simplex, herpes zoster, or varicella zoster.

Dapsone (DDS) is prescribed for a client with acquired immunodeficiency syndrome for the treatment of toxoplasmosis. The nurse reinforces medication instructions and determines that the client understands the instructions if the client makes which statement? 1. Discontinue the medication if nausea develops. 2. Report a sore throat to the health care provider. 3. Plan to take the medication every 4 hours around the clock. 4. Expect that abdominal pain and jaundice will occur as a normal side effect.

2. Report a sore throat to the health care provider. Rationale: Dapsone may be prescribed for the treatment of toxoplasmosis. The medication is taken orally on a daily basis. The medication suppresses bone marrow activity, and the complete blood count is monitored closely. If the client develops fever, sore throat, purpura, or jaundice, the HCP is notified because this could indicate infection. Medications are available to treat nausea and vomiting; the client should not discontinue the medication if these symptoms occur, but she should contact the HCP.

The nurse is assisting in caring for a client with a respiratory tract infection who is receiving intravenous tobramycin sulfate (Tobrex). The nurse is instructed to monitor for adverse effects of the medication. The nurse understands that which finding is indicative of an adverse effect of this medication? 1. Nausea 2. Vertigo 3. Vomiting 4. Hypotension

2. Vertigo Rationale: Ringing in the ears and vertigo are two symptoms that may indicate dysfunction of cranial nerve VIII. Ototoxicity is a frequent adverse effect of therapy with aminoglycosides and could result in permanent hearing loss. If this occurs, the health care provider should be notified. Nausea, vomiting, and hypotension are rare side effects of the medication.

A client with tuberculosis (TB) is prescribed rifampin (Rifadin). The nurse reinforces which information regarding this medication? 1. Yellow discoloration of the skin is common. 2. Wear glasses instead of soft contact lenses. 3. Take the medication on an empty stomach. 4. A negative sputum culture warrants stopping the therapy.

2. Wear glasses instead of soft contact lenses. Soft contact lenses may be permanently damaged by the orange discoloration that rifampin causes in body fluids. Any sign of jaundice should always be reported. If rifampin is not tolerated on an empty stomach, it may be taken with food. The client may be on the medication for 12 months even if cultures are negative.

Zidovudine (AZT) is prescribed for an adult client with human immunodeficiency virus (HIV). Which statement by the nurse provides the best instruction to the client about the medication? 1. "This medication must be taken with milk." 2. "Discontinue the medication if nausea occurs." 3. "Space the medication doses evenly around the clock." 4. "Aspirin can be taken to treat a headache if one occurs."

3. "Space the medication doses evenly around the clock." Rationale: Zidovudine interferes with HIV replication, slowing the progression of HIV infection. The client is instructed to space the doses of the medication evenly around the clock. Food or milk does not affect the gastrointestinal absorption of the medication. The client is instructed to continue therapy for the full length of treatment. The client also is instructed not to take any medication, including aspirin, without the health care provider's approval.

Cyclosporine (Sandimmune) is prescribed for a client following an allogenic kidney transplant. The nurse reinforces which instructions to the client regarding the medication? 1. There are no known adverse effects of the medication. 2. The medication will need to be taken for a period of 6 months. 3. Blood levels of the medication will need to be measured periodically. 4. The medication is administered by the intravenous route on a monthly basis.

3. Blood levels of the medication will need to be measured periodically. Rationale: Cyclosporine is an immunosuppressant. To avoid toxicity from high drug levels and to avoid organ rejection from low drug levels, blood levels of cyclosporine should be measured periodically. In the organ transplant client, an immunosuppressant will need to be taken for life. Oral administration is the route of choice; intravenous administration is reserved for clients who cannot take the medication orally. The most serious adverse effects are nephrotoxicity and infection.

A client with acquired immunodeficiency syndrome (AIDS) is receiving intravenous (IV) pentamidine isethionate (Pentam). The nurse assigned to care for the client monitors for signs of which toxic effect related to the administration of this medication? 1. Anorexia 2. Dizziness 3. Hypoglycemia 4. Hypertension

3. Hypoglycemia Rationale: Pentamidine isethionate causes severe hypoglycemia that may be fatal. Other toxic effects include hypotension, dysrhythmias, leukopenia, nephrotoxicity, Stevens-Johnson syndrome, hyperglycemia, and type 1 diabetes mellitus. Anorexia and dizziness are side effects that may occur with the administration of this medication, but they are not toxic effects. Hypertension is unrelated to the administration of this medication.

The nurse is reviewing the results of serum laboratory studies drawn on a client with acquired immunodeficiency syndrome who is receiving didanosine (Videx). The nurse interprets that the client may have the medication discontinued by the health care provider if which significantly elevated result is noted? 1. Serum protein 2. Blood glucose 3. Serum amylase 4. Serum creatinine

3. Serum amylase Rationale: Didanosine (Videx) can cause pancreatitis. A serum amylase level that is increased 1.5 to 2 times normal may signify pancreatitis in the client with acquired immunodeficiency syndrome and is potentially fatal. The medication may have to be discontinued. The medication is also hepatotoxic and can result in liver failure.

The nurse is assigned to care for a client with cytomegalovirus retinitis and acquired immunodeficiency syndrome who is receiving foscarnet. The nurse should check the latest result of which laboratory study while the client is taking this medication? 1. CD4+ cell count 2. Serum albumin 3. Serum creatinine 4. Lymphocyte count

3. Serum creatinine Rationale: Foscarnet is toxic to the kidneys. Serum creatinine is monitored before therapy, two to three times per week during induction therapy and at least weekly during maintenance therapy. Foscarnet may also cause decreased levels of calcium, magnesium, phosphorus, and potassium. Thus, these levels are also measured with the same frequency.

A clinic nurse prepares to administer an MMR (measles, mumps, rubella) vaccine to a child. The nurse should administer this vaccine by which method? 1. Intramuscularly in the deltoid muscle 2. Subcutaneously in the gluteal muscle 3. Subcutaneously in the outer aspect of the upper arm 4. Intramuscularly in the anterolateral aspect of the thigh

3. Subcutaneously in the outer aspect of the upper arm Rationale: The MMR vaccine is administered subcutaneously in the outer aspect of the upper arm. The gluteal muscle is most often used for intramuscular injections. The MMR vaccine is not administered by the intramuscular route.

Lamivudine (Epivir) is prescribed for a client with human immunodeficiency virus (HIV) who is presently taking zidovudine (Retrovir). Which should the nurse reinforce in the medication instructions to the client? 1. That the medication must be taken with food 2. That numbness of the hands and feet is expected 3. To report vomiting or abdominal pain to the health care provider 4. To discontinue the zidovudine during the course of therapy with lamivudine

3. To report vomiting or abdominal pain to the health care provider Rationale: Lamivudine is an antiretroviral agent administered in combination with zidovudine to delay the appearance of zidovudine resistance. Lamivudine is well absorbed orally with or without food. Peripheral neuropathy can occur with its use, and the client is instructed to notify the health care provider if burning, numbness, or tingling of the hands, arms, feet, or legs occurs. Pancreatitis, evidenced by nausea, vomiting, and abdominal pain, is also an adverse effect of the medication and requires health care provider notification.

A client newly diagnosed with gout has been prescribed allopurinol (Zyloprim). The nurse should question the health care provider if the dose for which medication already prescribed has not changed? 1. Digoxin (Lanoxin) 2. Adenosine (Adenocard) 3. Ergonovine maleate (Ergotrate) 4. Warfarin sodium (Coumadin)

4. Warfarin sodium (Coumadin) Rationale: Allopurinol is an antigout medication that may increase the effect of oral anticoagulants. Warfarin sodium is an anticoagulant, and if this medication was prescribed for the client, the nurse should verify the prescription. The dose of warfarin sodium may need to be decreased. Adenosine is an antidysrhythmic. Digoxin is a cardiac glycoside. Ergonovine maleate is an antimigraine medication.

An oral powder form of nelfinavir (Viracept) is prescribed for a client with human immunodeficiency virus (HIV). The nurse reinforces instructions regarding the preparation of the medication and tells the client to mix the powder with which substance? 1. Milk 2. Applesauce 3. Orange juice 4. Grapefruit juice

1. Milk Rationale: Nelfinavir is an antiviral medication used in the treatment of HIV infection when antiretroviral therapy is warranted. It is available in tablet and powder form. The powder form is prepared by mixing the dose with a small amount of water, milk, formula, soy milk, or dietary supplements. The powder is not mixed with acidic foods or juices such as apple juice or applesauce, orange juice, or grapefruit juice.

Ketoconazole is prescribed for an assigned client. The nurse prepares to administer the medication in which manner? 1. With food 2. With an antacid 3. With 8 oz of water 4. On an empty stomach

3. With 8 oz of water Rationale: Ketoconazole is an antifungal medication. It should be administered with food to minimize gastrointestinal irritation. Options 2, 3, and 4 are incorrect. The medication requires acidity and should be administered at least 2 hours apart from an antacid.

A client who is human immunodeficiency virus (HIV) seropositive has been taking stavudine (Zerit XR). The nurse assesses which measure closely while the client is taking this medication? 1. Appetite 2. Level of consciousness 3. Gastrointestinal function 4. Presence of paresthesias

4. Presence of paresthesias Rationale: Stavudine is an antiretroviral (protease inhibitor) used in the management of HIV infection in clients who do not respond to or who cannot tolerate conventional therapy. The medication can cause peripheral neuropathy; the nurse should monitor closely the client's gait and ask the client about paresthesias. Options 1, 2 and 3 are not associated with this medication.

A client is receiving sulfisoxazole. Which measure should the nurse monitor to determine the effectiveness of the therapy? 1. Blood pressure 2. Blood glucose 3. Red blood cell count 4. White blood cell count

4. White blood cell count Rationale: Sulfisoxazole is an anti-infective used primarily to treat urinary tract infections. The effectiveness of the medication may be evaluated by monitoring the client's white blood cell count, which should decrease to within normal limits with therapy. The client should also experience relief of symptoms. This medication is not used as an antihypertensive (option 1), hypoglycemic agent (option 2), or to treat anemia (option 3).

A client has been receiving nitrofurantoin sodium (Macrodantin). The nurse determines that the therapy is effective if which result is noted? 1. Cessation of cough 2. Absence of dysuria 3. Relief of chest pain 4. Decreased urge for cigarettes

2. Absence of dysuria Rationale: Nitrofurantoin sodium is an antibacterial agent and is used to treat acute urinary tract infection or as chronic suppressive treatment of urinary tract infection. It is not effective with systemic bacterial infections. Because dysuria is a sign of a urinary tract infection, this is the only correct option.

The nurse is assigned to care for a client with a diagnosis of toxoplasmosis. The health care provider has prescribed sulfasalazine (Azulfidine). The nurse preparing to administer the medication understands that this medication is in which drug category? 1. Antibiotic 2. Sulfonamide 3. Opioid analgesic 4. Nonsteroidal anti-inflammatory

2. Sulfonamide Rationale: Sulfasalazine is a sulfonamide and produces anti-inflammatory and antibacterial effects. Options 1, 3, and 4 are incorrect.

The client with acquired immunodeficiency syndrome has begun therapy with zidovudine (Retrovir). The nurse should carefully monitor which laboratory result during treatment with this medication? 1. Blood culture 2. Blood glucose level 3. Blood urea nitrogen 4. Complete blood count

4. Complete blood count Rationale: A common side/adverse effect of therapy with zidovudine is leukopenia and anemia. The nurse monitors the complete blood count results for these changes. Options 1, 2, and 3 are unrelated to the use of this medication.

A client with a urinary tract infection is beginning medication therapy with nitrofurantoin (Macrodantin). The nurse realizes further instructions are necessary if the client states he will need to avoid which item? 1. Oranges 2. Prunes 3. Rhubarb 4. Cranberries

3. Rhubarb Rationale: When a client is taking nitrofurantoin, the urine pH must be maintained in an acid range. The client should consume an acid-ash diet. Rhubarb will reduce the acidity of the urine and should be avoided by the client taking this medication.

The nurse reinforces medication instructions to a client who had a kidney transplant about therapy with cyclosporine (Sandimmune). Which statement by the client indicates a need for further teaching? 1. "I need to obtain a yearly influenza vaccine." 2. "I need to have dental checkups every 3 months." 3. "I need to self-monitor my blood pressure at home." 4. "I need to call the health care provider (HCP) if my urine volume decreases or my urine becomes cloudy."

1. "I need to obtain a yearly influenza vaccine." Rationale: Cyclosporine is an immunosuppressant medication. Because of the medication's effects, the client should not receive any vaccinations without first consulting the HCP. The client should report decreased urine output or cloudy urine, which could indicate kidney rejection or infection, respectively. The client must be able to self-monitor blood pressure to check for the side effect of hypertension. The client needs meticulous oral care and dental cleaning every 3 months to help prevent gingival hyperplasia.

A client is receiving tacrolimus (Prograf) to prevent organ rejection. The nurse expects to administer the dose with which medication that is also normally prescribed? 1. Prednisone 2. Erythromycin 3. Fluconazole 4. Carbamazepine

1. Prednisone Rationale: Prograf is used for the prevention of organ rejection in clients receiving an organ transplant. Concurrent use of glucocorticoids is recommended during administration of this medication. Prednisone is a glucocorticoid. Fluconazole is an antifungal agent. Carbamazepine is an anticonvulsant. Erythromycin is an antibiotic.

A 15-year-old child is scheduled to receive a series of the hepatitis B vaccine. The child arrives at the clinic for the first dose. The nurse collects data on the child before administering the vaccine and asks the child about a history of an allergy to which product? 1. Eggs 2. Penicillin 3. Baker's yeast 4. Sulfonamides

3. Baker's yeast Rationale: A contraindication to receiving the hepatitis B vaccine is a previous anaphylactic reaction to common baker's yeast. An allergy to eggs, penicillin, and sulfonamides is unrelated to the contraindication to receiving this vaccine.

A client who is human immunodeficiency virus (HIV) seropositive has been taking zalcitabine (ddC) as a component of treatment. The nurse tells the client that which laboratory test will need to be monitored while taking this medication? 1. Glucose level 2. Platelet count 3. Red blood cell count 4. Liver function studies

4. Liver function studies Rationale: Zalcitabine is an antiretroviral (nucleoside reverse transcriptase inhibitor) used in the management of HIV infection with other antiretrovirals. It also has been used as a single agent in clients who are intolerant of or who progress on other regimens. It can cause serious liver damage, and liver function studies should be monitored closely. Options 1, 2, and 3 are not specifically associated with the use of this medication.

The nurse is reviewing instructions to a client with otitis media who is receiving amoxicillin (Amoxil) 500 mg orally every 8 hours. Which statement by the client would indicate an understanding of the adverse effects related to the medication? 1. "If I get diarrhea, I need to call the doctor." 2. "I may become dizzy from the medication." 3. "Constipation means that the medication needs to be stopped." 4. "A headache may mean that I need to discontinue the medication."

1. "If I get diarrhea, I need to call the doctor." Rationale: Amoxicillin is a penicillin. Adverse reactions include superinfections such as potentially fatal antibiotic-associated colitis, which results from altered bacterial balance. Symptoms include abdominal cramps, severe watery diarrhea, and fever. Options 2, 3, and 4 are incorrect. The medication does not cause dizziness. The client should not independently stop the medication.

Efavirenz (Sustiva), an antiviral medication, is prescribed for a client with human immunodeficiency virus (HIV) infection. Which time should the nurse tell the client is best to take this medication? 1. At bedtime 2. With lunch 3. With dinner 4. Before breakfast

1. At bedtime Rationale: Because the medication causes temporary nervous system side effects during the first 2 to 4 weeks of therapy, the client is instructed to take the medication at bedtime. Because of the nervous system effects, options 2, 3, and 4 are not recommended administration times.

Which report indicates to the nurse that the client is experiencing a toxicity-related reaction to kanamycin sulfate (Kantrex)? 1. Difficulty hearing 2. Gastrointestinal disturbances 3. An elevated white blood cell count 4. A decreased blood urea nitrogen (BUN)

1. Difficulty hearing Rationale: Adverse reactions associated with kanamycin sulfate include nephrotoxicity evidenced by an increased BUN and creatinine and decreased creatinine clearance. Irreversible ototoxicity as evidenced by tinnitus, dizziness, ringing in the ears, and reduced hearing, and neurotoxicity as evidenced by headache, dizziness, lethargy, and visual disturbances can occur. Gastrointestinal disturbances can occur as a frequent side effect of the medication. An elevated white blood cell count may occur as a result of the respiratory infection.

A client who received a kidney transplant is taking azathioprine (Imuran), and the nurse reinforces instructions about the medication. Which statement by the client indicates a need for further teaching? 1. "I need to watch for signs of infection." 2. "I need to discontinue the medication after 14 days of use." 3. "I can take the medication with meals to minimize nausea." 4. "I need to call the health care provider (HCP) if more than one dose is missed."

2. "I need to discontinue the medication after 14 days of use." Rationale: Azathioprine is an immunosuppressant medication that is taken for life. Because of the effects of the medication, the client must watch for signs of infection, which are reported immediately to the HCP. The client should also call the HCP if more than one dose is missed. The medication may be taken with meals to minimize nausea.

The nurse is caring for a client with a skin infection who is receiving amoxicillin (Amoxil) 500 mg every 8 hours. Which sign/symptom indicates to the nurse that the client is experiencing a frequent side effect related to the medication? 1. Fever 2. Vaginal drainage 3. Severe watery diarrhea 4. Severe abdominal cramps

2. Vaginal drainage Rationale: Amoxicillin is a type of penicillin. Frequent side effects include mild gastrointestinal disturbances, headache, and oral or vaginal candidiasis. A less common but more harmful adverse effect that can occur includes superinfection, such as potentially fatal antibiotic-associated colitis, which results from altered bacterial balance. Symptoms include severe abdominal cramps, severe watery diarrhea, and fever.

The nurse has reinforced discharge instructions to a mother of a child who is taking tetracycline (Sumycin) to treat Rocky Mountain spotted fever (RMSF). Which statement by the mother indicates an understanding regarding the administration of the medication? 1. "I need to give the medication with milk." 2. "I need to give the medication with a sip of water." 3. "I need to use a straw when I give the medication." 4. "I need to mix the medication in a Styrofoam cup with water."

3. "I need to use a straw when I give the medication." Rationale: Because tetracycline hydrochloride can cause staining of the teeth, straws should be used, and the mouth should be rinsed after administration. Option 4 is not necessary. The medication should be administered 1 hour before or 2 hours after the administration of milk. A full glass of water rather than a sip should be taken with the medication.

The licensed practical nurse employed in the ambulatory clinic is assisting a registered nurse with preparing to administer a dose of intravenous immune globulin (IVIG). The licensed practical nurse ensures that which medication is readily available before the medication is administered? 1. Protamine sulfate 2. Phytonadione (vitamin K) 3. Epinephrine (Adrenalin) 4. Acetylcysteine (Mucomyst)

3. Epinephrine (Adrenalin) Rationale: IVIG is an immune serum that increases antibody titer and antigen-antibody reaction, providing passive immunity against infection. Anaphylactic reactions, although rare, can occur, and the nurse ensures that epinephrine is readily available when administering this medication. Protamine sulfate is the antidote for heparin. Vitamin K is the antidote for oral anticoagulants. Acetylcysteine is used to treat acetaminophen overdose.

A client has been prescribed oral erythromycin. The nurse reinforces which information regarding the administration of this medication? 1. Take with juice. 2. Schedule at bedtime. 3. Take on an empty stomach. 4. Ingest just before performing an activity.

3. Take on an empty stomach. Rationale: Oral erythromycin should be administered on an empty stomach with a full glass of water. Administration is not dependent on physical activity or a specific time of day.

A client with acquired immunodeficiency syndrome (AIDS) has a low T4 count. The nurse initiates prophylactic treatment as prescribed with aerosolized pentamidine isethionate (NebuPent) and monitors for which expected outcome? 1. The client shows no weight loss. 2. Strict standard precautions were maintained. 3. The client has a respiratory rate and depth within normal limits for activity level. 4. The client maintains serum sodium, potassium, calcium, and chloride values within normal ranges.

3. The client has a respiratory rate and depth within normal limits for activity level. Rationale: Aerosolized pentamidine is given prophylactically to clients with a T4 count below 200 to prevent Pneumocystis jiroveci pneumonia, which is the most common opportunistic infection that occurs in clients with AIDS. A respiratory rate and depth within normal limits for activity level would indicate that the client was not experiencing the respiratory difficulty that is associated with pneumonia. Standard precautions are always maintained on all clients. Although weight loss and electrolyte imbalance can occur in the client with AIDS, these options are not related to this medication.

Saquinavir (Invirase) is prescribed for the client who is human immunodeficiency virus (HIV) seropositive. The nurse reinforces medication instructions and determines that the client needs further teaching if the client makes which statement? 1. "I will eat high-calorie foods." 2. "I will avoid sun exposure." 3. "I will eat foods that are high in fat." 4. "I will take the medication on an empty stomach."

4. "I will take the medication on an empty stomach." Rationale: Saquinavir is an antiretroviral (protease inhibitor) used in combination with other antiretroviral medications in the management of HIV infection. It is administered with meals and is best absorbed if the client consumes high-calorie, high-fat meals. It can cause photosensitivity, and the client is instructed to avoid sun exposure.

Itraconazole (Sporanox) is prescribed for a client with a fungal infection of the hands. Which statement by the client indicates an understanding of the medication? 1. "I should take the medication on an empty stomach." 2. "I should decrease my fluid intake while taking the medication." 3. "I may become unusually fatigued while taking this medication." 4. "If my urine becomes very dark, I should contact my health care provider."

4. "If my urine becomes very dark, I should contact my health care provider." Rationale: Itraconazole is an antifungal medication. The client should be instructed to take the medication with food because it increases the absorption of the medication. Fluids should be increased to prevent constipation, which can occur as a side effect. Hepatitis is an adverse reaction associated with the medication, and if the client develops any anorexia, abdominal pain, unusual tiredness or weakness, dark urine, or jaundice, the health care provider should be notified.

A client with human immunodeficiency virus (HIV) who has contracted tuberculosis (TB) asks the nurse how long the medication therapy lasts. Which duration of treatment should the nurse explain to the client? 1. 6 total months and at least 1 month after cultures convert to negative 2. 6 total months and at least 3 months after cultures convert to negative 3. 9 total months and at least 3 months after cultures convert to negative 4. 9 total months and at least 6 months after cultures convert to negative

4. 9 total months and at least 6 months after cultures convert to negative Rationale: The client with TB who is coinfected with HIV requires that antitubercular therapy last longer than usual. The prescription is usually for a total of 9 months and at least 6 months after sputum cultures convert to negative.

The nurse is admitting a client to the nursing unit who is scheduled for several diagnostic tests. When obtaining a medication history, the nurse discovers that the client is taking tacrolimus (Prograf) daily. On further data collection, which should the nurse expect to note in the client history? 1. Hypertension 2. Ileal conduit created 3. Coronary artery disease 4. Allogenic liver transplant

4. Allogenic liver transplant Rationale: Tacrolimus is an immunosuppressant medication used in the prophylaxis of organ rejection in clients receiving allogenic liver transplants. It should be used concurrently with adrenal corticosteroids. It may also be used in clients receiving kidney, bone marrow, heart, pancreas, and small bowel transplants. Options 1, 2, and 3 are not associated with this use of this medication.

The nurse is reinforcing medication instructions to a client with human immunodeficiency virus (HIV) who will be taking saquinavir (Invirase). What instruction does the nurse provide the client in regard to taking the medication? 1. At bedtime 2. On an empty stomach 3. Two hours before breakfast 4. Within 2 hours after a full meal

4. Within 2 hours after a full meal Rationale: Saquinavir is an antiviral medication. It is administered within 2 hours after a full meal. If the medication is taken without food in the stomach, it may result in no antiviral activity.

The nurse is reinforcing dietary instructions to a client who has been prescribed cyclosporine (Sandimmune). Which food item should the nurse instruct the client to avoid? 1. Red meats 2. Orange juice 3. Grapefruit juice 4. Green, leafy vegetables

3. Grapefruit juice

he nurse notes that zidovudine (AZT) has recently been prescribed for a client. The client states, "I've been getting a little nauseated, and I've had a couple of headaches since I started the AZT. Does this mean I can't take the medicine?" The nurse makes which response to the client? 1. "These symptoms may become more tolerable as you adjust to ongoing therapy." 2. "I do not see the need for you to worry because your neutrophil counts are well over 100." 3. "I know you're worried that you won't be able to take AZT, but you only have a slight neutropenia." 4. "Don't worry. There are so many other medications these days that the health care provider can give you."

1. "These symptoms may become more tolerable as you adjust to ongoing therapy." Rationale: The initial adverse effects of zidovudine include headache, malaise, insomnia, rash, diarrhea, and fever. As AZT therapy proceeds, these symptoms become more tolerable. If anemia or neutropenia occurs, the medication will be discontinued or the therapy will be temporarily interrupted. Options 2, 3, and 4 do not address the client's concerns.

The nurse notes that a client is receiving lamivudine (Epivir). The nurse determines that this medication has been prescribed to treat which condition? 1. Pancreatitis 2. Pharyngitis 3. Tonic-clonic seizures 4. Human immunodeficiency virus (HIV) infection

4. Human immunodeficiency virus (HIV) infection Rationale: Lamivudine is a nucleoside reverse transcriptase inhibitor and antiviral medication. It slows HIV replication and reduces the progression of HIV infection. It also is used to treat chronic hepatitis B and is used for prophylaxis in health care workers at risk of acquiring HIV after occupational exposure to the virus. This medication is not used to treat pancreatitis, pharyngitis, or seizures.

A child is diagnosed with tinea capitis of the scalp. Oral griseofulvin (Gris-PEG) has been prescribed for the child, and the nurse provides instructions regarding the administration of the medication. Which instructions should the nurse provide to the mother? 1. Administer the medication with milk. 2. Administer the medication with water. 3. Administer the medication at bedtime. 4. Administer the medication on an empty stomach.

1. Administer the medication with milk. Rationale: Griseofulvin (topical and oral) is the treatment of choice for tinea capitis. For topical treatment to be effective, topical medication must penetrate the hair follicles. Topical therapy alone is not effective, and oral medication is prescribed. Because the medication is insoluble in water, absorption of the medication is improved if it is taken with a high-fat meal or with milk.

Saquinavir (Invirase) is prescribed for the client who is human immunodeficiency virus seropositive. The nurse reinforces medication instructions and should provide the client with which health care measure? 1. Avoid sun exposure. 2. Eat low-calorie foods. 3. Eat foods that are low in fat. 4. Take the medication on an empty stomach.

1. Avoid sun exposure. Rationale: Saquinavir (Invirase) is an antiretroviral (protease inhibitor) used with other antiretroviral medications to manage human immunodeficiency virus infection. Saquinavir is administered with meals and is best absorbed if the client consumes high-calorie, high-fat meals. Saquinavir can cause photosensitivity, and the nurse should instruct the client to avoid sun exposure.

The nurse is reviewing the laboratory results for a client receiving tacrolimus (Prograf). Which laboratory result should indicate to the nurse that the client is experiencing an adverse effect of the medication? 1. Blood glucose of 200 mg/dL 2. Potassium level of 3.8 mEq/L 3. Platelet count of 300,000 cells/mm3 4. White blood cell count of 6000 cells/mm3

1. Blood glucose of 200 mg/dL Rationale: A blood glucose level of 200 mg/dL is elevated above the normal range of 70 to 110 mg/dL and suggests an adverse effect. Other adverse effects include neurotoxicity evidenced by headache; tremor; insomnia; gastrointestinal (GI) effects such as diarrhea, nausea, and vomiting; hypertension; and hyperkalemia.

The nurse plans to emphasize which statement when reinforcing instructions about the use of indinavir (Crixivan) to a client? 1. Take the medication with a large meal. 2. Store the medication in the refrigerator. 3. Take the medication with a high-protein snack. 4. Moisture can affect the potency of the medication.

4. Moisture can affect the potency of the medication. Rationale: To maximize absorption, the medication should be administered with water but on an empty stomach. It is not to be administered with a large meal or a high-protein snack. The medication should be stored at room temperature and protected from moisture because moisture can degrade the medication and affect its potency.

The nurse is emphasizing discharge instructions to the mother of a child who has been prescribed tetracycline hydrochloride. The nurse stresses the importance of which instruction? 1. Give the medication in combination with milk. 2. Administer the medication 1 hour before bedtime. 3. Mix the medication with water in a glass container. 4. Use a straw when the child is taking the medication.

4. Use a straw when the child is taking the medication. Rationale: Because tetracycline hydrochloride can stain the teeth, straws should be used and the mouth should be rinsed after administration. The medication should be administered 1 hour before or 2 hours after the administration of milk. The remaining options are unnecessary.

The client who is human immunodeficiency virus seropositive has been taking stavudine (d4t, Zerit). Which should the nurse monitor closely while the client is taking this medication? 1. Gait 2. Appetite 3. Level of consciousness 4. Hemoglobin and hematocrit blood levels

1. Gait Rationale: Stavudine (d4t, Zerit) is an antiretroviral used to manage human immunodeficiency virus infection in clients who do not respond to or who cannot tolerate conventional therapy. The medication can cause peripheral neuropathy, and the nurse should monitor the client's gait closely and ask the client about paresthesia. Options 2, 3, and 4 are unrelated to the use of this medication.

Moxifloxacin (Avelox) is prescribed for a client with a diagnosis of community-acquired pneumonia. The client needs to take the medication for 10 days, and the nurse reinforces instructions to the client about the medication. Which statement by the client indicates an understanding of the medication instructions? 1. "I need to limit my daily fluid intake." 2. "I need to wear sunscreen and protective clothing when outdoors." 3. "I need to take the medication with a magnesium-containing antacid." 4. "Joint swelling and tendon pain are expected while I am taking the medication."

2. "I need to wear sunscreen and protective clothing when outdoors." Rationale: Moxifloxacin is a fluoroquinolone. Increased sensitivity of the skin to sunlight can occur, and the client is instructed to avoid excessive sunlight and artificial ultraviolet light. The client should wear sunscreen and protective clothing when outdoors. The client should also drink fluids liberally and avoid the use of antacids because antacids will decrease absorption of the medication. The medication can cause inflamed and ruptured tendons, and the client is instructed to notify the health care provider if inflammation or tendon pain occurs.

The nurse is reinforcing instructions to a client about the use of ceftriaxone, an antibiotic, for treating cervical gonorrhea. There is a need for further teaching if the client makes which statement? 1. "I can expect to get this one shot." 2. "I will take the pills for 20 full days." 3. "I may experience some discomfort at the injection site." 4. "If I have a penicillin allergy, I may be allergic to this medication too."

2. "I will take the pills for 20 full days." Rationale: If the client indicates she will be taking pills for 20 days, further teaching is needed. Cervical gonorrhea is treated with one (125 mg) injection of ceftriaxone or one (400 mg) oral dose of cefixime (Suprax). Allergies to penicillin may contraindicate giving ceftriaxone, and slight discomfort at the injection site is common

Nalidixic acid is prescribed for the client with a urinary tract infection. Reviewing the client's record, the nurse notes that the client is taking warfarin (Coumadin) on a daily basis. Which prescription should the nurse anticipate because the client is taking this oral anticoagulant? 1. An increase in the anticoagulation dosage 2. A reduction in the anticoagulation dosage 3. The need to discontinue the warfarin during therapy 4. The need to administer an alternative medication to treat the urinary tract infection

2. A reduction in the anticoagulation dosage Rationale: Nalidixic acid can intensify the effects of oral anticoagulants. When an oral anticoagulant is combined with nalidixic acid, a reduction in the anticoagulant dosage may be needed.

A client with acquired immunodeficiency syndrome and Pneumocystis jiroveci infection has been receiving pentamidine isethionate (Pentam 300). The nurse assisting in caring for the client monitors the client most closely for which adverse effect? 1. Nausea 2. Anemia 3. Restlessness 4. Gastrointestinal discomfort

2. Anemia Rationale: Pentamidine isethionate is an anti-infective medication. Adverse effects of this medication include leukopenia, thrombocytopenia, and anemia. The client should be monitored routinely for signs and symptoms of these adverse effects. The client also should have ongoing monitoring of a number of parameters because of the nature and side effects of the medication, including blood glucose, blood urea nitrogen, serum creatinine, complete blood cell count, liver function studies, and serum calcium and magnesium levels.

A client has been given a prescription for trimethoprim (Proloprim). The nurse determines that the client understands how to use the medication properly if the client states an intention to perform which action? 1. Restrict fluids while taking the medication. 2. Drink extra fluids while taking the medication. 3. Discontinue the medication once symptoms subside. 4. Call the health care provider if the urine becomes brown.

2. Drink extra fluids while taking the medication. Rationale: Trimethoprim is a sulfonamide used to treat urinary tract infections. Each dose of trimethoprim should be taken with a full glass of water, and the client should maintain a high fluid intake. The client should not be instructed to discontinue the medication. Some forms of sulfonamides cause the urine to turn dark brown or red. This is an expected effect, and the client does not need to notify the health care provider.

The nurse is caring for a client diagnosed with tuberculosis (TB). Rifampin (Rifadin), 600 mg by mouth daily is prescribed for the client. The nurse reinforces instructions to the client regarding the administration of this medication. Which statement by the client indicates an understanding of the instructions? 1. "I need to limit alcohol intake." 2. "I need to take the medication with meals." 3. "I will need to take the medication for months." 4. "I need to call the health care provider if the color of my urine turns red-orange."

3. "I will need to take the medication for months." Rationale: The client needs to avoid alcohol while taking this medication. The medication should be taken on an empty stomach with 8 ounces of water 1 hour before or 2 hours after meals. The client should be told that urine, feces, sweat, and tears may turn red-orange. The client should also be instructed that doses should not be skipped and that the medication needs to be taken as prescribed for the full length of therapy, which may range from 6 to 9 months up to 1 year. The nurse should note any elevation of the alkaline phosphatase, which would indicate possible hepatotoxicity.

The nurse is caring for a postrenal transplant client taking cyclosporine (Sandimmune). The nurse notes an increase in one of the client's vital signs, and the client is complaining of a headache. Which is the vital sign that is most likely increased? 1. Pulse 2. Respirations 3. Blood pressure 4. Temperature

3. Blood pressure Rationale: Hypertension can occur in a client taking cyclosporine (Sandimmune), and because this client is also complaining of a headache, the blood pressure is the vital sign to be monitoring most closely. Other adverse effects include infection, nephrotoxicity, and hirsutism. Options 1, 2, and 4 are unrelated to the use of this medication.

A client taking metronidazole for the treatment of Trichomonas vaginalis calls the nurse employed in the health care provider's office and is concerned because the color of the urine is very dark. Which information should the nurse provide to the client? 1. Increase fluid intake. 2. Discontinue the medication. 3. The darkening of the urine is a harmless side effect. 4. Report to the clinic to see the health care provider immediately.

3. The darkening of the urine is a harmless side effect. Rationale: Metronidazole can produce a variety of untoward effects, but these rarely require termination of treatment. Harmless darkening of the urine may occur, and the client should be forewarned of this effect. The nurse would not instruct the client to discontinue the medication. It is not necessary for the client to see the health care provider. Increasing fluid intake is a good health measure but will not prevent this side effect from occurring.

Vancomycin has been prescribed. The nurse plans to monitor which item associated with effectiveness of this medication? 1. Hearing acuity 2. Kidney function studies 3. Therapeutic serum levels 4. Heart rate and blood pressure

3. Therapeutic serum levels Rationale: Vancomycin is classified as a tricyclic glycopeptide antibiotic and acts by producing a bactericidal effect. Therapeutic serum levels are drawn on a regular basis to ensure effectiveness of this medication. The nurse should monitor hearing acuity, kidney function studies, and heart rate and blood pressure because this medication can be ototoxic, nephrotoxic, and cardiotoxic; however, these findings are not associated specifically with the effectiveness of this medication.

The nurse is assigned to care for a client with herpes simplex virus (HSV) who is receiving acyclovir (Zovirax). The nurse is monitoring for adverse effects of the medication. Which laboratory result should the nurse specifically monitor to identify an adverse effect associated with the use of this medication? 1. Platelet count 2. Red blood cell count 3. White blood cell count 4. Blood urea nitrogen (BUN)

4. Blood urea nitrogen (BUN) Rationale: The most common reaction related to the administration of this medication is phlebitis and inflammation at the intravenous site of infusion. Reversible nephrotoxicity manifested as elevations in serum creatinine and blood urea nitrogen also occurs in some clients. The cause of nephrotoxicity is the deposition of acyclovir in the renal tubules. The risk of renal injury is increased by dehydration and by the use of other nephrotoxic medications.

A client with acquired immunodeficiency syndrome has been started on therapy with zidovudine (Retrovir). The nurse reviews the health care provider's prescription, expecting to note that which laboratory test has been prescribed? 1. Blood culture 2. Blood glucose level 3. Blood urea nitrogen 4. Complete blood count (CBC)

4. Complete blood count (CBC) Rationale: Zidovudine is a nucleoside-nucleotide reverse transcriptase. An adverse effect of this medication therapy is granulocytopenia and anemia. The nurse carefully monitors the CBC results for these changes. With early human immunodeficiency virus infection or in the client who is asymptomatic, CBC levels are monitored monthly for 3 months, then every 3 months thereafter. In clients with advanced disease, these levels are monitored every 2 weeks for the first 2 months, and then once a month if the medication is tolerated well. Options 1, 2, and 3 are not specifically associated with this medication.

Mycophenolate mofetil (CellCept) is prescribed for a client as prophylaxis for organ rejection following an allogeneic renal transplant. Which instruction does the nurse reinforce regarding administration of this medication? 1. Administer medication after meals. 2. Take the medication with a magnesium-type antacid. 3. Open the capsule and mix with food for administration. 4. Contact the health care provider (HCP) if a sore throat occurs.

4. Contact the health care provider (HCP) if a sore throat occurs. Rationale: Mycophenolate mofetil should be administered on an empty stomach. The capsules should not be opened or crushed. The client should contact the HCP if unusual bleeding or bruising, sore throat, mouth sores, abdominal pain, or fever occurs because these are adverse effects of the medication. Antacids containing magnesium and aluminum may decrease the absorption of the medication and therefore would not be taken with the medication. The medication may be given in combination with corticosteroids and cyclosporine.

The nurse is assisting in preparing a plan of care for a client with acquired immunodeficiency syndrome (AIDS) who will be receiving ganciclovir (Cytovene). Which intervention should be included in the plan of care? 1. Monitor for signs of hyperglycemia. 2. Administer the medication without food. 3. Administer the medication with an antacid. 4. Instruct the client to use an electric razor for shaving.

4. Instruct the client to use an electric razor for shaving. Rationale: Ganciclovir causes neutropenia and thrombocytopenia as the most frequent side effects. For this reason, the nurse monitors the client for signs and symptoms of bleeding and implements the same precautions that are used for a client receiving anticoagulant therapy. Thus, the client should be instructed to use an electric rather than a straight razor for shaving. The medication does not have to be taken on an empty stomach or without food. Additionally, the medication does not have to be taken with an antacid; in fact, an antacid may affect absorption. The medication may cause hypoglycemia but not hyperglycemia.

The client with acquired immunodeficiency syndrome and Pneumocystis jiroveci infection has been receiving pentamidine isethionate (Pentam 300). The client develops a temperature of 101° F. The nurse should do further monitoring of the client, knowing that this sign would most likely indicate which? 1. The dose of the medication is too low. 2. The client is experiencing toxic effects of the medication. 3. The client has developed inadequacy of thermoregulation. 4. This is the result of another infection caused by the leukopenic effects of the medication.

4. This is the result of another infection caused by the leukopenic effects of the medication. Rationale: Frequent side/adverse effects of this medication include leukopenia, thrombocytopenia, and anemia. The client should be monitored routinely for signs and symptoms of infection. Options 1, 2, and 3 are inaccurate interpretations.

Stavudine (d4T) is prescribed for a client with advanced human immunodeficiency virus (HIV). The nurse reinforces medication instructions to the client and tells the client that it is important to report which to the health care provider 1. Fatigue 2. Headache 3. Constipation 4. Tingling in the extremeties

4. Tingling in the extremeties Rationale: Peripheral neuropathy, characterized by numbness, tingling, or pain in the hands or feet, can occur frequently with this medication and is an adverse effect. Headache, diarrhea (not constipation), and fatigue are side effects of the medication.

The nurse has a routine prescription to instill erythromycin ointment into the eyes of a newborn. The nurse explains to the parents that this medication is used for which purpose? 1. To help the newborn to see more clearly 2. To ensure the sterility of the conjunctiva in the newborn 3. To guard against infection acquired during intrauterine life 4. To protect the newborn from contracting an eye infection from the birth process

4. To protect the newborn from contracting an eye infection from the birth process Rationale: The use of eye prophylaxis with an agent such as erythromycin protects the newborn from contracting a conjunctival infection during birth. This infection, called ophthalmia neonatorum, results from maternal vaginal infection with chlamydia or gonorrhea. This prophylaxis is mandatory in the United States.

A client with human immunodeficiency virus (HIV) who is taking an oral solution of ritonavir (Norvir) complains about the taste of the solution. Which response by the nurse is accurate? "Try refrigerating the solution." 2. "Take the medication at bedtime." 3. "Mix the oral solution with chocolate milk." 4. "You need to notify the health care provider."

3. "Mix the oral solution with chocolate milk." Rationale: Ritonavir oral solution is preferably administered with a food substance. It may be mixed with chocolate milk or a dietary supplement to improve the taste. The client also is instructed to consume the dose within 1 hour of mixing. It is not necessary to notify the health care provider. Taking the medication at bedtime or refrigeration of the medication will not have an effect on the taste of the oral solution.

A client taking fexofenadine (Allegra) is scheduled for allergy skin testing and tells the nurse in the health care provider's office that a dose was taken this morning. Which should the nurse anticipate? 1. A lower dose of allergen will need to be injected. 2. A higher dose of allergen will need to be injected. 3. The client will need to reschedule the appointment. 4. The client should have the skin test read a day later than usual.

3. The client will need to reschedule the appointment. Rationale: Fexofenadine is an antihistamine, which provides relief of symptoms caused by allergy. Antihistamines should be discontinued for at least 3 days (72 hours) before allergy skin testing to avoid false-negative readings. This client should have the appointment rescheduled for 3 days after discontinuing the medication.

The nurse reinforces instructions to the client prescribed to take cyclosporine (Sandimmune) oral solution. Which instruction should the nurse provide? 1. Mix the concentration with chocolate milk. 2. Mix the concentration with grapefruit juice. 3. Avoid diluting the concentrate for administration. 4. Dilute the medication in a Styrofoam cup before administration.

1. Mix the concentration with chocolate milk. Rationale: To improve palatability, the client should be taught to mix the concentrated medication solution with chocolate milk or orange juice just before administration. Grapefruit juice can raise cyclosporine levels. The client is instructed to dispense the oral liquid into a glass container using a specially calibrated pipette; mix it well and drink it immediately; fill the container with a diluent such as water and drink it to ensure ingestion of the complete dose; dry the outside of the pipette and return to its cover for storage.

The nurse is preparing to administer ribavirin (Virazole) to a child with respiratory syncytial virus (RSV). The pharmacy dispenses the medication as a powder. Which action does the nurse perform to prepare to administer the medication? 1. Mixing the medication as prescribed and administering by inhalation 2. Mixing the medication in formula and administering it orally to the child 3. Mixing the medication in sterile saline and administering it by subcutaneous injection 4. Mixing the medication in sterile water and administering it by intramuscular injection

1. Mixing the medication as prescribed and administering by inhalation Rationale: Ribavirin is active against RSV, influenza virus types A and B, and herpes simplex virus. It is administered by inhalation, and the medication is absorbed from the lungs and achieves high concentrations in respiratory tract secretions and erythrocytes. It is not administered orally, subcutaneously, or intramuscularly

The nurse is assisting in caring for a client who is receiving amphotericin B intravenously (IV) to treat disseminated candidiasis. The nurse reviews the plan of care and implements which action during the administration of the medication? 1. Monitors urinary output 2. Monitors blood pressure 3. Monitors for hypothermia 4. Monitors for hyperglycemia

1. Monitors urinary output Rationale: Amphotericin B is a toxic medication that can produce symptoms during administration such as chills, fever, headache, vomiting, and impaired renal function. The medication is also very irritating to the IV site, commonly causing thrombophlebitis. The nurse administering this medication watches for all of these problems. Options 2, 3, and 4 are not specifically related to the administration of this medication.

A client with human immunodeficiency virus is taking nevirapine (Viramune). The nurse should monitor for which side/adverse effects of the medication? Select all that apply. 1. Rash 2. Hepatotoxicity 3. Hyperglycemia 4. Peripheral neuropathy 5. Reduced bone mineral density

1. Rash 2. Hepatotoxicity Rationale: Nevirapine (Viramune) is a nonnucleoside reverse transcriptase inhibitor that is used to treat HIV infection. It is used in combination with other antiretroviral medications to treat HIV. Adverse effects include rash, Stevens-Johnson syndrome, hepatitis, and increased transaminase levels. Hyperglycemia, peripheral neuropathy, and reduced bone density are not side/adverse effects of this medication.

The nurse working in a pediatric clinic is preparing to administer childhood vaccinations to a 15-month-old child. Which vaccine should be added to the child's routine immunizations at this time because the child is older than 12 months of age? 1. Varicella 2. Hepatitis B 3. Hepatitis A 4. Pneumococcal vaccine (PVC)

1. Varicella Rationale: Varicella vaccine is recommended at any visit at or after age 12 months for susceptible children (i.e., children who lack a reliable history of chickenpox and have not been vaccinated). The other vaccines are administered on or before age 1 year.

A client with diabetes mellitus has a foot infection and is to be started on antibiotic therapy with an aminoglycoside. The nurse collects data from the client and notes that the client has a hearing loss. The nurse should take which action next? 1. Give the medication but at half the prescribed dose. 2. Inform the registered nurse (RN) about the hearing loss. 3. Have the client drink extra water to avoid toxic side effects. 4. Suggest a peak and trough to ensure safe medication administration.

2. Inform the registered nurse (RN) about the hearing loss. Rationale: A preexisting hearing loss is a contraindication for the administration of aminoglycosides because these medications can cause ototoxicity and irreversible hearing loss. The nurse should report the findings to the RN to protect the client's safety. The RN will in turn notify the health care provider. Options 3 and 4 are not beneficial because hearing loss has already occurred in this client. Nurses do not change medication prescriptions independently.

Ketoconazole is prescribed for a client with a diagnosis of candidiasis. Which interventions should the nurse include in the plan of care regarding this medication? Select all that apply. 1. Restrict fluid intake. 2. Instruct the client to avoid alcohol. 3. Monitor hepatic and liver function studies. 4. Administer the medication with an antacid. 5. Instruct the client to avoid exposure to the sun. 6. Administer the medication on an empty stomach.

2. Instruct the client to avoid alcohol. 3. Monitor hepatic and liver function studies. 5. Instruct the client to avoid exposure to the sun. Rationale: Ketoconazole is an antifungal medication. It is administered with food (not on an empty stomach), and antacids are avoided for 2 hours after taking the medication to ensure absorption. The medication is hepatotoxic, and the nurse monitors liver function studies. The client is instructed to avoid exposure to the sun because the medication increases photosensitivity. The client is also instructed to avoid alcohol. There is no reason for the client to restrict fluid intake. In fact, this could be harmful to the client.

The nurse is caring for a client taking an oral hypoglycemic agent (sulfonylurea) has just been diagnosed with a urinary tract infection. The health care provider plans to treat the infection with sulfamethoxazole. The nurse expects that because of medication interactions, the health care provider will prescribe a prescription in which manner? 1. Higher dose of the oral hypoglycemic 2. Lower dose of the oral hypoglycemic 3. Lower dose of the sulfamethoxazole 4. Higher dose of the sulfamethoxazole

2. Lower dose of the oral hypoglycemic Rationale: Sulfonamide antibiotics such as sulfamethoxazole can intensify the effects of warfarin, phenytoin, and oral hypoglycemics. Many oral hypoglycemic agents are classified as sulfonylureas. When combined with sulfonamides, these medications may require a reduction in dosage. Therefore, options 1, 3, and 4 are incorrect.

A client who is receiving infliximab (Remicade) via intravenous (IV) injection is complaining of difficulty swallowing. Which is the initial nursing action? 1. Notify the health care provider. 2. Notify the registered nurse (RN). 3. Have the client take deep breaths and try to relax. 4. Obtain a prescription for diphenhydramine (Benadryl) 50 mg by mouth.

2. Notify the registered nurse (RN). Rationale: Infliximab is a monoclonal antibody and gastrointestinal anti-inflammatory. Allergic reactions and anaphylaxis can occur from this medication and can be fatal. This complaint could be the first sign of an anaphylactic reaction. The RN must be notified, and it is imperative that the infusion be shut off as soon as possible. Then the health care provider must be notified. An antihistamine such as diphenhydramine then may be prescribed. Instructing the client to take deep breaths and relax is not a helpful intervention in this situation.

A client is beginning to take trimethoprim-sulfamethoxazole (Bactrim) for a recurrent urinary tract infection (UTI). The nurse should reinforce which instructions to the client regarding this medication? 1. "Expect rashes or skin changes as a result of therapy." 2. "Discontinue the medication once symptoms subside." 3. "Take most doses early in the day when fluid intake is largest." 4. "Take each dose with 8 oz of water, and drink extra water each day."

3. "Take most doses early in the day when fluid intake is largest." Rationale: Trimethoprim-sulfamethoxazole is a sulfonamide. The client takes each dose with 8 oz of water and drinks several extra glasses of water each day. The client should space doses evenly around the clock for stable blood levels and should take medication for the full course of therapy. The client should report rashes or other skin changes, which could indicate an allergy to sulfa.

The nurse is providing vaccine information to a second-day postpartum client who received a rubella vaccine. The nurse reminds the client to avoid which action after receiving this vaccine? 1. Sustaining injury to the injection site 2. Eating highly acidic foods for a week 3. Becoming pregnant for 2 to 3 months 4. Having sexual relations for 2 to 3 months

3. Becoming pregnant for 2 to 3 months Rationale: Rubella vaccine is a live attenuated virus that provides active immunity for 15 years. Because rubella is a live vaccine, it is potentially teratogenic during the organogenesis phase of fetal development. To avoid this risk, the nurse advises the client to avoid becoming pregnant for 2 to 3 months after receiving the vaccine. Abstinence from sexual intercourse is unnecessary, but an effective form of contraception should be used. The vaccine may cause local or systemic reactions that are mild and self-limiting. Options 1 and 2 are not significant or related to this vaccine.

The nurse is preparing to administer pentamidine isethionate (Pentam 300) to an assigned client by the intramuscular route. The nurse plans to monitor which parameter closely after administering this medication? 1. Capillary refill 2. Peripheral pulses 3. Blood pressure (BP) 4. Level of consciousness

3. Blood pressure (BP) Rationale: Pentamidine isethionate is an anti-infective medication. Life-threatening and fatal hypotension can occur following the administration of this medication. The client must be in a supine position with frequent BP checks following administration. Options 1, 2, and 4 are not associated with the administration of this medication.

A client has been prescribed amikacin (Amikin). Which priority baseline function should be monitored? 1. Apical pulse 2. Liver function 3. Hearing acuity 4. Blood pressure

3. Hearing acuity Rationale: Amikacin (Amikin) is an antibiotic. This medication can cause ototoxicity and nephrotoxicity; therefore, hearing acuity tests and kidney function studies should be performed before the initiation of therapy. Apical pulse, liver function studies, and blood pressure are not specifically related to the use of this medication.

Indinavir (Crixivan) is prescribed for a client with a diagnosis of human immunodeficiency virus (HIV). Which medication instruction should the nurse reinforce to the client? 1. Expect the urine to turn red. 2. Take the medication with a large meal. 3. Increase fluid intake to at least 1.5 L/day. 4. Expect a significant amount of unexplained weight loss.

3. Increase fluid intake to at least 1.5 L/day. Rationale: Indinavir is an antiretroviral agent. This medication can cause kidney stones; therefore, the client is instructed to increase fluid intake to at least 1.5 L/day. The client is also instructed to report sharp back pain or the presence of blood in the urine. The client is instructed to take the medication 1 hour before or 2 hours after a large meal. If the medication needs to be taken with food, the client should consume a light meal, such as dry toast, juice, or a bowl of cereal with milk. Unexplained weight loss must be reported to the health care provider.

Tacrolimus (Prograf) is prescribed for a client. Which disorder, noted on the client's record, indicates that the medication needs to be administered with caution? 1. Ulcerative colitis 2. Diabetes insipidus 3. Renal insufficiency 4. Coronary artery disease

3. Renal insufficiency Rationale: Tacrolimus is used with caution in immunosuppressed clients and those with renal or hepatic function impairment. It is contraindicated in clients with hypersensitivity to this medication or hypersensitivity to cyclosporine. The disorders in options 1, 2, and 4 are not a concern with the use of this medication.

A client with an infected leg wound that is draining purulent material has a prescription for sodium hypochlorite (Dakin solution) to be used in the care of the wound. The nurse should perform which action while using this solution? 1. Pour onto sterile sponges and pack in the wound. 2. Let the solution run freely over normal skin tissue. 3. Rinse off the solution immediately following irrigation. 4. Use each bottle of solution for 1 month before replacing.

3. Rinse off the solution immediately following irrigation. Rationale: Dakin solution is a chloride solution used for irrigating and cleaning either necrotic or purulent wounds. It cannot be used to pack purulent wounds because the solution is inactivated by copious pus. (It can be used to pack necrotic wounds, however.) It should not come into contact with healing or normal tissue, and it should be rinsed off immediately if used for irrigation. The solution is unstable and must be prepared on a regular basis (per agency and pharmacy procedures).

A client with acquired immunodeficiency syndrome (AIDS) has an opportunistic respiratory fungal infection and is receiving intravenous amphotericin B. The nurse assisting in caring for the client monitors for which sign that indicates an adverse effect of the medication? 1. Jaundice 2. Pale stools 3. Orange urine 4. Decreased urine output

4. Decreased urine output Rationale: Clients receiving amphotericin B may develop nephrotoxicity. Clients should be monitored for oliguria, hematuria, cloudy urine, decreased urine output, and elevated renal function laboratory values. Amphotericin B does not cause the urine to turn orange. Pale stools indicate hepatotoxicity as does jaundice; hepatotoxicity is not an adverse effect.

The nurse is taking a health history on a client seen in the health care clinic for the first time. When the nurse asks the client about current prescribed medications, the client tells the nurse that amprenavir (Agenerase) is taken twice daily. Based on this finding, the nurse elicits data from the client regarding the presence of which condition? 1. Peptic ulcer disease 2. Inflammatory bowel disease 3. Coronary artery disease (CAD) 4. Human immunodeficiency virus (HIV)

4. Human immunodeficiency virus (HIV) Rationale: Amprenavir is an antiretroviral agent, classified as a protease inhibitor, used to treat HIV infection. It is not used to treat peptic ulcer disease, inflammatory bowel disease, or CAD.