Saunders NCLEX Review Pharmacology Immunity Medications

4.That the client has developed another infection caused by leukopenic effects of the medication Rationale:Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Pneumocystis jiroveci pneumonia (PCP) is a fungal infection and is a common opportunistic infection. Pentamidine is an antimicrobial used to treat PCP. Frequent side and adverse effects of this medication include leukopenia, thrombocytopenia, and anemia. The client should be monitored routinely for signs and symptoms of infection. The remaining options are inaccurate interpretations.

The client with acquired immunodeficiency syndrome and Pneumocystis jiroveci infection has been receiving pentamidine. The client develops a temperature of 101º F (38.3º C). The nurse continues to assess the client, knowing that this sign most likely indicates which condition? 1.That the dose of the medication is too low 2.That the client is experiencing toxic effects of the medication 3.That the client has developed inadequacy of thermoregulation 4.That the client has developed another infection caused by leukopenic effects of the medication

4.Human immunodeficiency virus (HIV) infection Rationale:Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Abacavir is an antiviral medication and is used to treat HIV infection, in combination with other agents. It is not used to treat the conditions noted in the other options.

The nurse is collecting subjective and objective data from a client and notes that the client is taking abacavir. The nurse determines that this medication has been prescribed to treat which condition? 1.Otitis media 2.Heart failure 3.Urinary tract infection 4.Human immunodeficiency virus (HIV) infection

3.Bone marrow depression Rationale:Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Zidovudine is a nucleoside reverse transcriptase inhibitor that is used in combination with other antiretroviral agents to treat human immunodeficiency virus (HIV) infection. A contraindication to the medication is a history of hypersensitivity to this medication. Cautions include bone marrow suppression, renal and hepatic dysfunction, and conditions that cause decreased hepatic blood flow.

The primary health care provider (PHCP) writes a prescription for zidovudine for a client who was admitted to the hospital. The nurse should contact the PHCP to verify the prescription if which finding is noted in the assessment data? 1.History of renal calculi 2.Complaints of diarrhea 3.Bone marrow depression 4.Complaints of abdominal discomfort

1.A mask and pair of goggles Rationale:Ribavirin is administered via hood, face mask, or oxygen tent and is not administered by the IV or IM route. Some caregivers experience headaches, burning nasal passages and eyes, and crystallization of soft contact lenses as a result of administration of ribavirin. Specific to this medication is the use of goggles. A mask may be worn. A gown is not necessary. The medication used for the prevention of RSV is palivizumab, a monoclonal antibody, which is given monthly in an IM injection to prevent hospitalization associated with RSV.

Which supplies should the nurse obtain for the administration of ribavirin to a hospitalized child with respiratory syncytial virus (RSV)? 1.A mask and pair of goggles 2.Isolation gown and sterile gloves 3.An intravenous (IV) pole and hood 4.Intramuscular (IM) syringe and needle

3, 4, 5 Rationale:Sulfonamides (sulfa drugs) are a type of antibiotic. They work by disrupting the production of dihydrofolic acid, a form of folic acid that bacteria and human cells use for producing proteins. Adverse effects of sulfonamides include nephrotoxicity, bone marrow depression, GI effects, hepatotoxicity, dermatological effects, and some neurological symptoms, including headache, dizziness, vertigo, ataxia, depression, and seizures.

The nurse is caring for a client who has been taking a sulfonamide and should monitor for signs and symptoms of which adverse effects of the medication? Select all that apply 1.Ototoxicity 2.Palpitations 3.Nephrotoxicity 4.Bone marrow depression 5.Gastrointestinal (GI) effects 6.Increased white blood cell (WBC) count

4.Slows the replication of human immunodeficiency virus (HIV) Rationale:Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Zidovudine is a nucleoside reverse transcriptase inhibitor that is used in combination with other antiretroviral agents to treat HIV infection. It interferes with viral RNA-dependent DNA polymerase, an enzyme necessary for viral HIV replication. It slows HIV replication, reducing the progression of HIV infection. Zidovudine does not increase neutrophils, kill bacteria and fungi, or promote the function of natural killer cells.

Zidovudine 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? 1.Increases neutrophils 2.Kills bacteria and fungi 3.Promotes the function of natural killer cells 4.Slows the replication of human immunodeficiency virus (HIV)

4.Blood urea nitrogen (BUN) level Rationale:Cyclosporine is an immunosuppressant. Nephrotoxicity is one of the most common adverse effects of cyclosporine. Nephrotoxicity is evaluated by monitoring the BUN and creatinine levels.

Blood work has been drawn on a client who has been taking cyclosporine following allogenic liver transplantation. The nurse should check the results of which test to determine the presence of an adverse effect related to this medication? 1.Hematocrit level 2.Cholesterol level 3.Hemoglobin level 4.Blood urea nitrogen (BUN) level

2.Phenytoin Rationale:Cyclosporine is an immunosuppressant medication used to prevent rejection following allogeneic organ transplantation. Medications known to lower cyclosporine levels include phenytoin (anticonvulsive medication), phenobarbital, rifampin, and trimethoprim-sulfamethoxazole. Cyclosporine levels should be monitored and the dosage adjusted in clients taking these medications.

Cyclosporine is prescribed for a client who received a kidney transplant. The nurse would be most concerned if a review of the medical record revealed that the client currently is taking which prescribed medication? 1.Digoxin 2.Phenytoin 3.Prednisone 4.Propranolol

4.Anorexia and abdominal pain Rationale:Itraconazole is an antifungal medication. Hepatitis is an adverse effect associated with the medication, and if anorexia of any degree, abdominal pain, unusual tiredness or weakness, dark urine, or jaundice develops, the health care provider should be notified.

Itraconazole is prescribed for a client to treat a fungal infection. The nurse monitors the client closely for which manifestation that is indicative of an adverse effect? 1.Diarrhea 2.Headache 3.Increased urine output 4.Anorexia and abdominal pain

2.Triglyceride level Rationale:Ritonavir is an antiretroviral (protease inhibitor) used in combination with other antiretroviral medications in the management of HIV infection. It can increase triglyceride levels; therefore, the client's triglyceride levels should be monitored.

The client who is seropositive for human immunodeficiency virus (HIV) has been taking ritonavir. The nurse tells the client that which follow-up laboratory study will be necessary while taking this medication? 1.Platelet count 2.Triglyceride level 3.Prothrombin time (PT) 4.International normalized ratio (INR)

4.Impaired balance while ambulating Rationale:Cytomegalovirus retinitis is an opportunistic viral infection of the eye. Foscarnet is an antiviral agent that is used to treat viral infections in the client with leukemia. Serious side and adverse effects, such as ototoxicity and nephrotoxicity, can occur as a result of this medication. Impaired balance while ambulating and impaired hearing are signs of ototoxicity. Intact hearing capacity, urine noted to be clear yellow, and a urinary output of 30 mL per hour are normal assessment findings.

The nurse is caring for a client who has cytomegalovirus retinitis and is receiving foscarnet. Which assessment finding, if reported by the client, indicates a need for follow-up? 1.Intact hearing capacity 2.Urine noted to be clear yellow 3.Urinary output of 30 mL per hour 4.Impaired balance while ambulating

2.Client complaint of ringing in the ears Rationale:Adverse effects of tobramycin sulfate include nephrotoxicity as evidenced by an increased BUN and serum creatinine; irreversible ototoxicity as evidenced by tinnitus, dizziness, ringing or roaring in the ears, and reduced hearing; and neurotoxicity as evidenced by headaches, dizziness, lethargy, tremors, and visual disturbances.

Tobramycin sulfate is prescribed. The nurse is administering the medication by intermittent intravenous infusion every 8 hours. The nurse monitors the client for signs of an adverse effect related to this medication and determines that which, if noted on assessment, would indicate its presence? 1.Client complaint of diarrhea 2.Client complaint of ringing in the ears 3.A white blood cell count of 6000 mm3 (6 × 109/L) 4.A blood urea nitrogen (BUN) of 10 mg/dL (3.6 mmol/L)

3.Neurotoxicity Rationale:Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Zidovudine is a nucleoside reverse transcriptase inhibitor that is used in combination with other antiretroviral agents to treat human immunodeficiency virus (HIV) infections. Adverse effects include anemia, granulocytopenia, and neurotoxicity as evidenced by ataxia, fatigue, lethargy, and nystagmus. Seizures can also occur.

A client admitted to the hospital is taking zidovudine. The nurse monitors the client for which adverse effect of the medication? 1.Colitis 2.Ototoxicity 3.Neurotoxicity 4.Visual disturbances

1.Avoid exposure to sunlight. Rationale:Ketoconazole is an antifungal medication. The client should avoid exposure to sunlight because the medication increases photosensitivity. Antacids should be avoided for 2 hours after ketoconazole is taken because gastric acid is needed to activate the medication; however, it should be taken with food. The client should avoid concurrent use of alcohol because the medication is hepatotoxic.

A client has a prescription for ketoconazole. Which instruction should the nurse include in the client's teaching plan? 1.Avoid exposure to sunlight. 2.Take the medication with an antacid. 3.Take the medication on an empty stomach. 4.Limit alcohol consumption to 2 oz per day.

1.WBC count of 8000 mm3 (8 × 109/L) and a creatinine level of 0.9 mg/dL (79.5 mcmol/L) Rationale:Tobramycin is an antibiotic (aminoglycoside) that causes nephrotoxicity and ototoxicity. The medication is working if the WBC count drops back into the normal range and kidney function remains normal. A WBC count of 15,000 mm3 (15 × 109/L) is elevated, indicating that infection is still present. The sodium, chloride, and potassium levels are all normal values and are unrelated to the effectiveness of this medication.

A client is receiving tobramycin. The nurse evaluates that the medication therapy is effective if which laboratory test result is noted? 1.WBC count of 8000 mm3 (8 × 109/L) and a creatinine level of 0.9 mg/dL (79.5 mcmol/L) 2.Sodium level of 145 mEq/L (145 mmol/L) and chloride level of 106 mEq/L (106 mmol/L) 3.Sodium level of 140 mEq/L (140 mmol/L) and potassium level of 3.9 mEq/L (3.9 mmol/L) 4.White blood cell (WBC) count of 15,000 mm3 (15 × 109/L) and a blood urea nitrogen level of 38 mg/dL (13.7 mmol/L)

1.The medication is infusing too rapidly. Rationale:Vancomycin is an antibiotic. The client is experiencing manifestations of what is called "red neck syndrome." This is a response due to histamine release that occurs with rapid or bolus injection of this medication. The client may experience chills, fever, flushing of the face or trunk, tachycardia, syncope, tingling, and an unpleasant taste in the mouth. The corrective action is to administer the medication more slowly. An antihistamine such as diphenhydramine may be administered as well. Although the client can experience an allergic reaction to the medication, the manifestations in the question best describe "red neck syndrome." There is no indication that the client is experiencing an upper airway obstruction. In addition, there are no data in the question that indicate that the client is taking another medication.

A client receiving a dose of intravenous vancomycin begins to experience chills, tachycardia, syncope, and flushing of the face and trunk. What is the nurse's best interpretation of these findings? 1.The medication is infusing too rapidly. 2.The client is allergic to the medication. 3.The client is experiencing upper airway obstruction. 4.The medication has interacted with another medication the client is receiving.

1.Inhalation Rationale:Ribavirin is an antiviral medication and is active against RSV, influenza virus types A and B, and herpes simplex virus. It is administered by oral inhalation. The medication is absorbed from the lungs and achieves high concentrations in respiratory tract secretions and erythrocytes.

A pediatric nurse has obtained ribavirin in powder form from the pharmacy to administer to a child with respiratory syncytial virus (RSV) infection. After preparing the medication, the nurse should administer it by which route? 1.Inhalation 2.Intravenous 3.Subcutaneous 4.Oral, in the child's formula

4.Plan for a skin test dose to identify hypersensitivity. Rationale:Antithymocyte globulin is an immunosuppressant used to prevent rejection after kidney, heart, liver, and bone marrow transplantation. The nurse should plan for a skin test dose before IV administration of antithymocyte globulin to identify hypersensitivity to the medication. Options 1 and 2 are not specific to this medication. The client would not be premedicated with acetylsalicylic acid (aspirin). Premedication with acetaminophen or diphenhydramine, or both, may be prescribed to prevent reaction to the medication.

Intravenous (IV) antithymocyte globulin is prescribed to a client for treatment of transplant rejection. Which intervention is the priority in planning the administration of this medication? 1.Assess bowel sounds. 2.Assess the neurovascular status. 3.Premedicate the client with acetylsalicylic acid. 4.Plan for a skin test dose to identify hypersensitivity.

1.With food Rationale:Ketoconazole is an antifungal medication. It should be administered with food to minimize gastrointestinal irritation. The remaining options are incorrect. The medication requires acidity and should be administered at least 2 hours apart from an antacid.

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

3.Epinephrine Rationale:Cyclosporine is an immunosuppressant medication used to prevent rejection following allogeneic organ transplantation. Because of the risk of anaphylaxis during administration of cyclosporine by the IV route, epinephrine and oxygen must be immediately available for use. An oral airway or a suction machine is not the priority item. A code cart should be available, but it is not the priority item.

The nurse is preparing to administer a prescribed dose of cyclosporine by intravenous (IV) administration. Which priority item would the nurse have available during administration of this medication? 1.A code cart 2.Oral airway 3.Epinephrine 4.A suction catheter

2.Two nucleoside analogues and one protease inhibitor Rationale:Pneumocystis jiroveci pneumonia (PCP) is a fungal infection and is a common opportunistic infection in the client with acquired immunodeficiency syndrome. HAART consists of the combination of 2 nucleoside analogues, which target viral replication during the reverse transcription phase of the cell cycle, and a protease inhibitor, which targets viral replication at a different phase. The remaining options are incorrect descriptions of combination therapies.

A 2-year-old with Pneumocystis jiroveci pneumonia is to begin treatment with highly active antiretroviral therapy (HAART). The nurse anticipates that the primary health care provider will prescribe which combination? 1.One immunoglobulin and one nucleoside analogue 2.Two nucleoside analogues and one protease inhibitor 3.Two protease inhibitors and one broad-spectrum antibiotic 4.One nucleoside reverse transcriptase inhibitor and one non-nucleoside reverse transcriptase inhibitor

4.Infection Rationale:Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Pneumocystis jiroveci pneumonia (PCP) is a fungal infection and is a common opportunistic infection. Pentamidine is an anti-infective medication. Adverse effects of pentamidine include leukopenia, thrombocytopenia, and anemia. The client should be monitored routinely for signs and symptoms of infection. The client also should have ongoing monitoring of a number of parameters because of the nature and side effects of the medication, including complete blood cell count; liver function; blood glucose; blood urea nitrogen; and serum creatinine, calcium, and magnesium levels. The items in the remaining options are not associated with an adverse effect of this medication.

The client with acquired immunodeficiency syndrome (AIDS) and Pneumocystis jiroveci infection has been receiving pentamidine. The nurse caring for the client should monitor the client most closely for signs of which adverse effect of the medication? 1.Nausea 2.Fatigue 3.Vomiting 4.Infection

4.Temperature of 101.2º F (38.4º C) Rationale:Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Raltegravir is classified as an integrase inhibitor and acts by inhibiting human immunodeficiency virus (HIV) replication. Insomnia, dizziness, and indigestion are some side effects of the mediation. A temperature of 101.2º F is indicative of potential opportunistic infection, which is an adverse effect of this medication.

The client with acquired immunodeficiency syndrome (AIDS) has been prescribed raltegravir. The nurse determines that the client may be experiencing an adverse effect related to this medication if which assessment finding is noted? 1.Insomnia 2.Dizziness 3.Indigestion and belching 4.Temperature of 101.2º F (38.4º C)

1, 2, 3, 4, 5 Rationale:Options 1 through 5 are correct. Oseltamivir is an antiviral medication that reduces complications of the flu and is effective for all flu types. Treatment must begin early, no later than 2 days after symptom onset, and preferably much sooner, even during the first 12 hours, because benefits decline greatly when treatment is delayed. It has no reported interactions with other medications. The only major side effects are nausea and vomiting. It is not toxic to the liver.

The nurse is presenting information on treatment of influenza and the use of oseltamivir. The nurse should provide which information on the use of oseltamivir? Select all that apply. 1.The incidence of flu complications is reduced. 2.Oseltamivir is effective for all types of influenza. 3.Dosing must begin within 2 days after symptom onset. 4.No interactions with other medications have been reported. 5.It is best to begin dosing within the first 12 hours after symptom onset. 6.Oseltamivir is highly toxic to the liver, and liver function studies must be performed.

1.Diarrhea Rationale:Tacrolimus is an immunosuppressant medication used in the prophylaxis of organ rejection in clients who receive allogenic liver transplants. Frequent side effects include headache, tremors, insomnia, paresthesia, diarrhea, nausea, constipation, vomiting, abdominal pain, and hypertension. Toxic effects include nephrotoxicity and pleural effusion, which can occur frequently. Nephrotoxicity is characterized by increasing serum creatinine and a decrease in urine output. Thrombocytopenia, leukocytosis, anemia, and atelectasis occur occasionally. Neurotoxicity, including tremor, headache, and mental status changes, also can occur. It is imperative for the nurse to assess laboratory results, particularly renal function tests, and to monitor intake and output closely.

The nurse is providing discharge instructions to a client who will be taking tacrolimus daily following allogenic liver transplantation. The nurse instructs the client that which is a frequent side effect related to this medication? 1.Diarrhea 2.Confusion 3.Loss of memory 4.A decrease in urine output

4.Use a straw when giving the medication. Rationale:Tetracycline is an antibiotic. Because tetracycline can cause staining of the teeth, straws should be used and the mouth rinsed after administration. The medication should be administered 1 hour before or 2 hours after the administration of milk, which would eliminate the options of giving the medication with milk or ice cream. Mixing the medication in a Styrofoam cup is unnecessary.

A child has been prescribed tetracycline hydrochloride. The nurse providing medication information to the mother should plan to emphasize which instruction about giving this medication to the child? 1.Give the medication with milk. 2.Give the medication with ice cream. 3.Mix the medication in a Styrofoam cup. 4.Use a straw when giving the medication.

2.The child's skin is pale and he is feeling tired. Rationale:Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Zidovudine effectively interferes with HIV replication but can cause bone marrow suppression. Anemia occurs most commonly after 4 to 6 weeks of therapy. Hematology studies need to be monitored for anemia and granulocytopenia. Tiredness and a pale color could indicate that the child is anemic. Complaints of pain is not associated with the medication but can be associated with the diagnosis; swelling is not usually a characteristic of the infection but could be an indication of an underlying problem. If the child is clinging to the parents, this could indicate fear but is not associated with an adverse effect of the medication.

A child with human immunodeficiency virus (HIV) infection is receiving zidovudine. Which finding indicates to the nurse that the child may be experiencing an adverse effect from the medication? 1.The child complains of pain in his lower legs. 2.The child's skin is pale and he is feeling tired. 3.The child has some swelling in the hands and around the ankles. 4.The child is clinging to his parents and won't allow them to leave.

3.Hypotension Rationale:Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Abacavir is an antiretroviral agent that is used in combination with other medications to treat human immunodeficiency virus infection. Adverse effects include hypersensitivity, hypotension, lactic acidosis, and severe hepatomegaly.

A client admitted to the hospital is taking abacavir. The nurse should monitor the client for which adverse effect of the medication? 1.Insomnia 2.Diarrhea 3.Hypotension 4.Decreased appetite

1.Slow IV infusion over 1 hour Rationale:Acyclovir is an antiviral medication. It is dispensed as a powder to be reconstituted for IV administration and is administered by slow IV infusion over 1 hour.

A client is receiving acyclovir by the intravenous (IV) route for treatment of cytomegalovirus (CMV) infection. After reconstituting the powder dispensed by the pharmacy, the nurse should administer this medication via which method? 1.Slow IV infusion over 1 hour 2.Rapid IV bolus over 5 minutes 3.Continuous IV infusion over 24 hours 4.Continuous IV infusion over 12 hours

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

A client is receiving amoxicillin orally every 8 hours. Which finding would indicate to the nurse that the client is experiencing a frequent minor side effect related to the medication? 1.Fever 2.Vaginal drainage 3.Severe watery diarrhea 4.Severe abdominal cramps

2.Decreased urine output Rationale:Amphotericin B is an antifungal medication and can cause side and adverse effects such as chills, fever, headache, vomiting, and impaired renal function. A decreased urine output is an indication of impaired renal function. Changes in the pulse and temperature are not related to impaired renal function. The blood urea nitrogen level would be elevated if renal function was impaired. The nurse monitors for these side and adverse effects and also carefully assesses the IV site because of the irritating effects of the medication.

A client is receiving amphotericin B by the intravenous (IV) route. During ongoing therapy with this medication, the nurse should most closely assess the client for which finding that indicates a complication? 1.Decreased pulse 2.Decreased urine output 3.Decreased body temperature 4.Decreased blood urea nitrogen level

2.Elevated serum creatinine Rationale:Amphotericin B is an antifungal medication. It exerts direct toxicity on cells of the kidneys and causes renal impairment in most clients. To evaluate renal injury, tests of kidney function should be performed weekly, and intake and output should be monitored. If the serum creatinine level rises above 3.5 mg/dL (309 mcmol/L), the dose of amphotericin B should be reduced. The laboratory abnormalities in the remaining options are unrelated to the use of this medication.

A client is receiving amphotericin B by the intravenous (IV) route. The nurse determines that the client is having an adverse effect to the medication if which laboratory study result is noted? 1.Elevated platelet count 2.Elevated serum creatinine 3.Low white blood cell count 4.Lowered hemoglobin and hematocrit

4.Providing the client with a soft toothbrush and an electric razor Rationale:Ganciclovir is an antiviral medication. Common adverse effects of ganciclovir are neutropenia and thrombocytopenia. For this reason, the nurse implements the same precautions that are used for a client receiving anticoagulant therapy. These include providing a soft toothbrush and an electric razor to minimize risk of trauma that could result in bleeding. The medication may cause hypoglycemia, but not hyperglycemia. The medication does not have to be taken on an empty stomach. Pressure on venipuncture sites should be held for approximately 10 minutes.

A client is receiving ganciclovir. Which nursing action is appropriate during the time the client is receiving this medication? 1.Monitoring blood glucose levels for elevation 2.Administering the medication on an empty stomach only 3.Applying pressure to venipuncture sites for at least 1 minute 4.Providing the client with a soft toothbrush and an electric razor

4.Elevated blood urea nitrogen (BUN) level Rationale:Cyclosporine is an immunosuppressant. The use of cyclosporine can cause nephrotoxicity. This complication is detected by assessing for elevated levels of BUN and serum creatinine. Decreased hemoglobin level and WBC count are incorrect because cyclosporine does not depress the bone marrow.

A client who has undergone renal transplantation is receiving ongoing therapy with cyclosporine. The nurse would be sure to immediately report which abnormal finding? 1.Decreased creatinine level 2.Decreased hemoglobin level 3.Decreased white blood cell (WBC) count 4.Elevated blood urea nitrogen (BUN) level

2.Vertigo Rationale:Tobramycin sulfate is an aminoglycoside. Ringing in the ears and vertigo are symptoms of ototoxicity that may indicate dysfunction of the eighth cranial nerve. This is a frequent adverse effect of therapy with the use of aminoglycosides and could result in permanent hearing loss. In clients with these symptoms, the nurse should withhold the dose of the medication and notify the primary health care provider. Nausea, vomiting, and hypotension are rare side effects of the medication.

A client with a respiratory tract infection is receiving intravenous tobramycin sulfate. The nurse should assess for which adverse effect of this medication? 1.Nausea 2.Vertigo 3.Vomiting 4.Hypotension

4.Take the medication with water on an empty stomach. Rationale:Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Indinavir is a protease inhibitor. To maximize absorption, the medication should be administered with water on an empty stomach. The medication may be taken 1 hour before a meal or 2 hours after a meal, or it may be administered with skim milk, coffee, tea, or a low-fat meal. It is not administered with a large meal. The medication should be stored at room temperature and protected from moisture because moisture can degrade the medication.

A client with human immunodeficiency virus infection is taking indinavir. The nurse plans to provide the client with which direction when providing instructions about the use of this medication? 1.Store the medication in the refrigerator. 2.Take the medication with a high-fat snack. 3.Take the medication with the large meal of the day. 4.Take the medication with water on an empty stomach.

3.Serum amylase level Rationale:Didanosine can cause pancreatitis. A serum amylase level that is increased to 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 reviewing the results of serum laboratory studies drawn on a client with acquired immunodeficiency syndrome who is receiving didanosine. The nurse interprets that the client may have the medication discontinued by the primary health care provider if which elevated result is noted? 1.Serum protein level 2.Blood glucose level 3.Serum amylase level 4.Serum creatinine level

4.Allow permethrin to remain on the hair for 10 minutes and then rinse with water. Rationale:Permethrin is a medication that may be prescribed to treat scabies. The instructions for the use of permethrin include wash, rinse, and towel-dry the hair; apply sufficient volume to saturate the hair and scalp; allow the medication to remain on the hair for 10 minutes; and then rinse with water. The remaining options are incorrect instructions.

The school nurse is providing instructions to the parents of the children attending the school regarding the application of permethrin. Which action should the nurse tell the parents to take? 1.Apply permethrin before washing the hair. 2.Apply permethrin at bedtime and rinse it off in the morning. 3.Avoid saturating the hair and scalp when applying permethrin. 4.Allow permethrin to remain on the hair for 10 minutes and then rinse with water.