1063 Exam 1 (2040 Meds)

Which side effect is likely to be found in a patient who is receiving filgrastim for the treatment of chronic neutropenia? Select all that apply. One, some, or all responses may be correct. Pruritus Alopecia Anorexia Arthralgia Hypertension

Alopecia Anorexia Alopecia and anorexia are side effects found in patients receiving filgrastim for the treatment of severe neutropenia. Pruritus is a side effect of palifermin. Arthralgia and hypertension are side effects of erythropoietin.

Which outcome indicates a therapeutic response to antiretroviral therapy for human immunodeficiency virus (HIV) infections? 1 CD4 T-cell increase 2 Decreased T-cell reactivity 3 Elevation of HIV RNA levels 4 Increased immune system functioning

CD4 T-cell increase The expected outcome of highly active antiretroviral therapy (HAART) is a CD4 T-cell increase and suppression of HIV RNA levels in patients. Decreased T-cell reactivity, elevation of HIV RNA levels, and increased immune system functioning are not indicative of a therapeutic response to antiretroviral therapy.

Which teaching point about CD4+ T-cell count tests will a nurse provide a patient with human immunodeficiency virus (HIV)? Select all that apply. One, some, or all responses may be correct. 1 "Be sure to eat a full meal before the test." 2 "Get the test at the same time of day each time." 3 "Try to have the test done early in the morning each time." 4 "Use the same laboratory every time you have the test." 5 "Remind the lab to draw enough blood to conduct the test twice."

"Get the test at the same time of day each time." "Use the same laboratory every time you have the test." The CD4+ T-cell count can vary in the same patient based on the time of day the laboratory draws blood and can also vary between laboratories because of variation in lab value references. Therefore the nurse will advise the patient to get the test done at the same time of day each time and to use the same laboratory. Eating a meal does not affect the test results. Having the test in the morning is not important; however, it is important to have the test done at the same time each time. The laboratory will not need to conduct the test twice.

Which antiemetic drug effectively treats nausea and vertigo? Select all that apply. One, some, or all responses may be correct. 1 Dronabinol 2 Hydroxyzine 3 Meclizine HCl 4 Granisetron 5 Prochlorperazine maleate

2 Hydroxyzine 3 Meclizine HCl Hydroxyzine and meclizine are the antiemetic drugs that are used in the treatment of nausea and vertigo. Dronabinol, granisetron, and prochlorperazine maleate are antiemetic drugs for which dizziness (vertigo) is a side effect because they do not block the transmission of impulses to the vestibular pathway. Therefore these drugs are not effective for the treatment of vertigo.

Which medication acts as an antidote for pyridostigmine toxicity? 1 Neostigmine 2 Azathioprine 3 Edrophonium 4 Atropine sulfate

Atropine sulfate Overdose of pyridostigmine causes cholinergic crisis. Atropine sulfate acts as an antidote for pyridostigmine by decreasing acetylcholine. Neostigmine is administered to manage myasthenia gravis. Azathioprine is an immunosuppressant that is used to suppress immune reactions. Edrophonium is an acetylcholinesterase inhibitor that is used in the diagnosis of myasthenia gravis.

Which effect of interferon beta would the nurse anticipate when administering to a patient with multiple sclerosis (MS)? 1 Decrease in the progression of the disease 2 Neutralization of the virus that has caused the MS 3 Increased T-cell production and reduced risk for infection 4 Stimulation and synthesis of neutrophils resulting in bacterial destruction

Decrease in the progression of the disease The anticipated effect of the use of interferon beta in a patient with MS is a decrease in the progression of the disease. Interferon beta inhibits the proinflammatory cytokines responsible for triggering the autoimmune reaction that leads to MS. MS is an autoimmune disease. Interferon beta does not neutralize the virus. Interleukins treat different types of cancers by increasing the growth and activity of T cells and B cells, which affect the immune response system. Granulocyte colony-stimulating factor increases the production of neutrophils, which detect and destroy bacteria.

Which information describes filgrastim's modes of action? Select all that apply. One, some, or all responses may be correct. 1 Enhances neutrophil migration 2 Enhances granulocyte function 3 Enhances neutrophil cytotoxicity 4 Increases maturation of neutrophils 5 Stimulates proliferation of myeloid cells

Enhances neutrophil migration Enhances neutrophil cytotoxicity Increases maturation of neutrophils Enhancement of neutrophil migration, enhancement of neutrophil cytotoxicity, and maturation of neutrophils are filgrastim's modes of action. Sargramostim enhances the function of granulocytes and stimulates the proliferation of myeloid cells.

Which laboratory value is most significant for a patient with cancer being treated with epoetin alfa? 1 Hemoglobin (Hgb) 12 g/dL 2 Hematocrit (Hct) 35 g/dL 3 White blood cell (WBC) 6000 μL 4 Platelet count of 155,000 μL

Hemoglobin (Hgb) 12 g/dL The laboratory value that is most significant for the patient with cancer treated with epoetin alfa is Hgb 12 g/dL. Epoetin alfa is a biologic response modifier that increases the risk for death when given to target a hemoglobin greater than 11 g/dL in patients with cancer. The Hct, WBC, and platelet count values are insignificant.

A patient receiving treatment with erythropoietin is scheduled for a surgical procedure. Before sending the patient to the preoperative area, which action would be the nurse's priority? 1 Obtain a baseline physical assessment. 2 Hold the transfer and notify the health care provider. 3 Transfer the patient to the preoperative area. 4 Obtain a complete blood count, renal, and liver function labs.

Hold the transfer and notify the health care provider. Black Box Warning for surgery.

Which type of interferon is considered in the treatment of multiple sclerosis? 1 Interferon alfa-2b 2 Interferon beta-1b 3 Interferon alfa-2a 4 Interferon gamma-1b

Interferon beta-1b Interferon beta-1b is considered for the treatment of multiple sclerosis. Interferon alfa-2b and interferon alfa-2a are considered for the treatment of hairy-cell leukemia. Interferon gamma-1b is considered for the treatment of chronic granulomatous disease.

The nurse would question the prescription for epoetin in a patient with which condition? 1 Anemia 2 Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) 3 Chronic renal failure 4 Uncontrolled hypertension

Uncontrolled hypertension Hypertension is a side effect of epoetin; hence the drug should not be given to patients with uncontrolled hypertension. Zidovudine treatment is used for HIV/AIDS and may cause anemia and chronic renal failure, which may be helped by the therapeutic use of epoetin.

The nurse is teaching a student nurse about the importance of patients having adequate iron stores when being treated with epoetin (EPO). Which statement by the student indicates teaching was effective? 1 "Inadequate iron stores potentiate adverse effects of EPO." 2 "Inadequate iron stores interfere with EPO's therapeutic response." 3 "EPO use is contraindicated for a patient with inadequate iron stores." 4 "Inadequate iron stores interfere with white blood cell (WBC) production."

"Inadequate iron stores interfere with EPO's therapeutic response." A patient receiving treatment with EPO must have adequate iron stores because inadequate iron stores interfere with EPO's therapeutic response. Inadequate iron stores do not potentiate adverse effects of EPO. EPO is not contraindicated for a patient with inadequate iron stores. The patient's iron will be monitored, and supplemental iron will be administered as needed. EPO agents stimulate RBC production; they do not interfere with WBC production.

Which dose is the maintenance infusion dose of intravenous (IV) amiodarone in a patient with hemodynamically stable ventricular tachycardia? 1.5 mg/min 3 mg/min 1 mg/min 0.5 mg/min

0.5 mg/min A patient with hemodynamically stable ventricular tachycardia should be given IV amiodarone at a dose of 0.5 mg/min over 18 hours as a maintenance infusion to stabilize the heart rate. A dose of 1.5 mg/min IV or 3 mg/min IV may result in complications, such as bradycardia and hypotension in the patient. A dose of 1 mg/min IV is given as a continuous infusion to a patient in cardiac arrest.

Which condition other than nausea and vomiting may be treated with prochlorperazine maleate? Select all that apply. One, some, or all responses may be correct. 1 Anxiety 2 Tremors 3 Diarrhea 4 Schizophrenia 5 Urinary retention

Anxiety Schizophrenia Prochlorperazine maleate is a dopamine antagonist that is used primarily for the treatment of nausea and vomiting. It may also be used in the management of anxiety and schizophrenia. The prolonged use of prochlorperazine maleate causes imbalance in the neurotransmitters of the brain, resulting in extrapyramidal symptoms, such as tremors. Therefore prochlorperazine maleate does not reduce tremors. Prochlorperazine maleate does not act on the smooth muscles of the gastrointestinal tract. Therefore it does not reduce diarrhea. Prochlorperazine maleate does not block cholinergic receptor sites. Therefore it does not reduce anticholinergic symptoms, such as urinary retention.

The nurse is caring for a patient with bradycardia who weighs 60 kg. The health care provider prescribes 2.5 mg of atropine sulfate administered intravenously to the patient. Which condition does the nurse expect due to the administration of the medication? 1 Short period of asystole 2 Atrioventricular block 3 Paradoxical bradycardia 4 Blockage of vagus nerve

Blockage of vagus nerve The recommended dose of atropine sulfate for adults is 0.04 mg/kg. Administering a dose greater than 0.04 mg/kg can result in the inhibition of vagal activity. Here, the patient weighs 60 kg; the total dose that should be administered to the patient should not exceed 2.4 mg. However, the health care provider prescribed 2.5 mg; therefore complete blockage of vagal activity may occur in the patient. A short period of asystole may occur after the administration of adenosine, but not atropine sulfate. This drug is beneficial in the treatment of an atrioventricular block, but an overdose of atropine sulfate would not cause atrioventricular block in the patient. Paradoxical bradycardia occurs if the dose is less than 0.5 mg.

Which baseline testing would the nurse anticipate for a patient who is prescribed a biologic response modifier (BRM)? Select all that apply. One, some, or all responses may be correct. 1 Chest radiograph 2 Electrocardiogram (ECG) 3 Pulmonary function test 4 Electroencephalogram (EEG) 5 Positron emission tomography (PET) scan

Chest radiograph Electrocardiogram (ECG) Pulmonary function test The baseline testing the nurse can anticipate for a patient prescribed a BRM includes a chest radiograph, ECG, and pulmonary function test. An EEG and PET scan are not included in the baseline testing for BRM therapy.

The health care provider has prescribed cyclobenzaprine to the patient with muscle spasms. Which condition, if found in the patient's medical history, prompts the nurse to contact the health care provider for an alternative prescription? Select all that apply. One, some, or all responses may be correct. 1 Asthma 2 Peptic ulcers 3 Hyperthyroidism 4 Hepatic impairment 5 Narrow-angle glaucoma

Hyperthyroidism Narrow-angle glaucoma The administration of cyclobenzaprine may cause hypertension and tachycardia in a patient who has hyperthyroidism. This medication may also cause an increase in intraocular pressure and is therefore contraindicated in patients who have narrow-angle glaucoma. Pyridostigmine may not be administered in patients who have conditions such as asthma, peptic ulcers, and hepatic impairment, because the medication may aggravate these conditions.

Baclofen is included in the treatment regimen of the patient with multiple sclerosis to treat which symptom? 1 Muscle aching 2 Muscle wasting 3 Muscle spasticity 4 Muscle deterioration

Muscle spasticity Baclofen is a muscle relaxant that is used to treat the spasticity of the muscles that occurs with multiple sclerosis. It does not specifically address muscle aching or wasting/deterioration of muscle tissue.

The patient reports to the clinic complaining of double vision. On further assessment, the nurse finds that the patient has dysphagia and dysarthria, as well. The nurse suspects which diagnosis will be made? 1 Multiple sclerosis 2 Cholinergic crisis 3 Myasthenic crisis 4 Myasthenia gravis

Myasthenia gravis Myasthenia gravis (MG) is characterized by muscle weakness and fatigue. Weakness of extraocular muscles may result in diplopia. A patient with MG has dysphagia due to weakness of the muscles associated with swallowing. Dysarthria in a patient with MG is due to weakness of the muscles involved in speech articulation. Multiple sclerosis is not associated with symptoms such as dysphagia and dysarthria. The manifestations of multiple sclerosis include diplopia, weakness in the extremities, and spasticity. Cholinergic crisis is another complication of MG, which may occur as a result of an overdose of acetylcholinesterase inhibitors, and would result in increased sweating, fatigue, muscle weakness, and salivation. Myasthenic crisis may occur because of an underdose of cholinesterase inhibitors that are used to treat MG; however, its manifestations do not include diplopia.

A patient who is receiving treatment for myocardial ischemia has developed severe hypotension. While communicating with the patient, the nurse finds that the patient uses sildenafil for erectile dysfunction. Which medication does the nurse check for in the patient's prescription? 1Aspirin 2 Adenosine 3 Nitroglycerin 4 Morphine sulfate

Nitroglycerin Nitroglycerin is used to treat chest pain associated with myocardial ischemia, but it is contraindicated in patients taking sildenafil. The interaction of sildenafil and nitroglycerin may cause fatal hypotension. Sildenafil does not interact with aspirin, adenosine, and morphine sulfate.

The nurse assesses the site of intravenous (IV) dopamine infusion to find an extravasation. The nurse requests a prescription for which medication to be infiltrated into the site? 1 Normal saline 2 Sodium bicarbonate 3 Phentolamine 4 Labetalol hydrochloride

Phentolamine Extravasation refers to the leakage of infused medications into the extravascular space or tissue around the infusion site. Dopamine HCl produces tissue necrosis. If the patient has extravasation at the injection site due to dopamine HCl, then phentolamine should be administered to the patient. Phentolamine reduces or prevents tissue damage. Infiltration of normal saline and sodium bicarbonate are not therapeutic for a dopamine extravasation. Labetalol hydrochloride is used to treat hypertension and hypertensive crises.

Which manifestation is an adverse reaction of erythropoietin? Select all that apply. One, some, or all responses may be correct. Rigors Seizures Neutropenia Hemorrhage Myocardial infarction

Seizures Myocardial infarction Seizures and myocardial infarction are the adverse reactions of erythropoietin. Rigors and hemorrhage are the adverse reactions of sargramostim. Neutropenia is an adverse reaction of filgrastim.

Which instruction will a nurse provide a patient who is prescribed scopolamine patches? Select all that apply. One, some, or all responses may be correct. 1 "After 3 days, switch patch to other ear." 2 "Do not take this drug if you have high blood pressure." 3 "Apply patch 4 hours before effect is desired." 4 "Do not use laxatives while on this drug." 5 "Do not use this drug for longer than a day." 6 "Drowsiness is a concern while on this drug."

"After 3 days, switch patch to other ear." "Apply patch 4 hours before effect is desired." "Drowsiness is a concern while on this drug." Scopolamine patches are used for motion sickness and nausea and vomiting. The patient can use it for longer than 3 days but must switch ears. It should be applied 4 hours before the effect is needed. Drowsiness is an anticipated side effect while using scopolamine. The drug may cause orthostatic hypotension. Thus hypertension is not a concern when using scopolamine. Laxatives have no bearing on the use of this drug, and it can be used for more than a day.

Which response by a nurse is best in regard to the administration of a scopolamine patch for motion sickness associated with travel? 1 "Apply the patch behind your ear 4 hours before traveling." 2 "Apply the patch behind your ear 24 hours before traveling." 3 "Apply the patch to your upper arm 4 hours before traveling." 4 "Apply the patch to your upper arm 24 hours before traveling."

"Apply the patch behind your ear 4 hours before traveling." Scopolamine is an anticholinergic drug that helps to reduce gastric acid secretions and alleviates nausea and vomiting. It effectively prevents nausea due to motion sickness. Because scopolamine is applied topically behind the ear, it is slowly absorbed into the blood and reaches its plasma concentration after 4 hours. Therefore applying the patch 24 hours before traveling may not be effective. Additionally, the upper arm is not an appropriate site of application for scopolamine patches.

Which instruction will a nurse provide a patient who has been recently prescribed metoclopramide? 1 "Avoid ingesting any alcohol." 2 "Increase sodium intake while taking this drug." 3 "Monitor your blood pressure carefully because this drug may increase blood pressure." 4 "Take the drug with grapefruit juice."

"Avoid ingesting any alcohol." Metoclopramide is an antiemetic drug used for the treatment of postoperative nausea and vomiting. The nurse instructs the patient to avoid alcohol because alcohol interacts with the drug and may cause central nervous system depression. Metoclopramide does not cause sodium wasting; therefore the nurse would not instruct the patient to increase sodium intake. Metoclopramide does not increase blood pressure; therefore careful monitoring of the blood pressure is not warranted while receiving therapy. The drug can but does not need to be taken with grapefruit juice.

A nurse is teaching a student nurse about CD4+ T-cell counts in patients with HIV infection. Which statement by the student indicates effective teaching? 1 "CD4 cell count is a measurement of the total viral load in the body." 2 "CD4 cell count indicates an overdose of antiretroviral therapy (ART)." 3 "CD4 cell count shows how well the body is adapting to the HIV virus." 4 "CD4 cell count is an indicator for immune function in those with HIV."

"CD4 cell count is an indicator for immune function in those with HIV." CD4+ T-cells are destroyed in HIV infection, which results in immune deficiency. Therefore the CD4+ cell count is an indicator for immune function in those with HIV. The count is not a measurement of the total viral load in the body, does not indicate an overdose of ART, and does not show how well the body is adapting to the HIV virus.

Which guidance will a nurse provide a patient about the administration of efavirenz? 1 "Do not drink alcohol while you are taking efavirenz." 2 "Be sure to eat a small meal with your dose of efavirenz." 3 "Take your dose of efavirenz at the same time every morning." 4 "If you have trouble swallowing the tablets, you can crush them."

"Do not drink alcohol while you are taking efavirenz." Patients taking efavirenz should avoid alcohol because of adverse effects on the liver and the central nervous system (CNS). Efavirenz should be taken on an empty stomach to reduce adverse reactions. The drug should be taken at night to minimize CNS adverse reactions. Patients should not crush efavirenz tablets; however, capsules may be opened and sprinkled into soft food.

Which response will a nurse share with a patient who has human immunodeficiency virus (HIV) who is receiving antiretroviral therapy (ART) and has expressed a desire to become pregnant? 1 "You should really think about whether the risk for infecting your child is worth it." 2 "It's good you told me, but it's rare for HIV to be transmitted from mother to child." 3 "I'm glad you told me. We will need to talk about risks and benefits of the ART options." 4 "If you keep your viral load down, you will be fine. Just keep us informed of your decision."

"I'm glad you told me. We will need to talk about risks and benefits of the ART options." Because of the risk for transmitting HIV to the fetus, the ART regimen may be different for pregnant patients. The nurse's response is supportive of the patient and lets the patient know that there will be decisions that will have to be made based on a risk assessment. The nurse would not tell the patient to think about if the risk for transmission is worth it because this is an insensitive and unproductive response. The nurse would not falsely reassure the patient that risk for transmission is rare. Telling the patient that she "will be fine" if she keeps her viral load down is inaccurate. The risk for transmission is lower when the viral load is lower, but the nurse cannot accurately offer this reassurance to the patient.

Which statement made by the nurse about opportunistic infections associated with human immunodeficiency virus (HIV) requires correction? 1 "Tuberculosis can affect organs such as the bowel and brain and the linings of the heart and the lungs." 2 "Toxoplasmosis can generally be avoided by cooking meat thoroughly and avoiding exposure to cat feces." 3 "Kaposi sarcoma, which often appears early in the course of HIV infection, is treated with antifungals if there is widespread disease." 4 "Cytomegalovirus most commonly causes blurred vision that can lead to blindness, but it can also affect other systems."

"Kaposi sarcoma, which often appears early in the course of HIV infection, is treated with antifungals if there is widespread disease." Kaposi sarcoma does often appear early in the course of HIV infection; however, chemotherapy is the preferred treatment when there is widespread disease. Antifungals are not used for treatment. The other statements are correct. Tuberculosis usually affects the lungs but can also affect organs such as the bowel and brain and the linings of the heart and the lungs. Toxoplasmosis is caused by a protozoan found in cat feces and uncooked meat. Cytomegalovirus infects the entire body but most commonly appears as retinitis, which causes blurred vision and can lead to blindness.

Which response will a nurse provide to a patient with human immunodeficiency virus (HIV) who is receiving antiretroviral therapy and forgets to take the therapy about once or twice a week due to impromptu overnight visits with a friend? 1 "You know it's very bad to miss doses. You need to try to remember to take them no matter what." 2 "Let's discuss strategies for adherence. For example, you might think about carrying a small drug organizer." 3 "You need to be more responsible about your health now that you are on ART. You need to get to 95% adherence." 4 "It's okay if you miss your doses once a week; however, if it is more than this, we will need to switch all of your drugs to injections."

"Let's discuss strategies for adherence. For example, you might think about carrying a small drug organizer." The goal for ART is 95% adherence to avoid HIV replication and drug resistance. In evaluating a patient's adherence to ART, a nurse will help the patient develop strategies. The nurse might suggest carrying a drug organizer or storing some doses at the friend's house. It is important to help the patient determine strategies that work for him or her as an individual. Telling the patient that it is bad to miss doses and that he or she needs to try to remember to take them does not support improved adherence because it does not invite solutions for the patient's problem. Telling the patient that he or she needs to be more responsible is disrespectful of the patient and does not help the patient address the reason for missed doses. It is not okay to miss doses once a week, and most of the antiretroviral therapies are oral formulations, not injectables.

Which instruction does the nurse give to the patient who is prescribed pyridostigmine? 1 "Seek medical help for nausea and vomiting." 2 "Ask for help to change positions or to stand." 3 "Take the medication 30 minutes after eating." 4 "Lower the dose if the usual dose results in drooping eyelids."

"Seek medical help for nausea and vomiting." Nausea and vomiting are the symptoms of a cholinergic crisis due to an overdose of anticholinesterase therapy. Hence, the nurse instructs the patient to report these symptoms immediately so that prompt action can be taken to reverse the adverse effects. The nurse instructs the patient to take the medication before eating to strengthen the muscles involved in chewing and swallowing and to help prevent aspiration or choking. The nurse instructs the patient to take the medication at the first sign of muscle weakness, and an early sign of impending muscle weakness in larger muscle groups is drooping eyelids.

Which explanation would the nurse give for how protease inhibitors (PIs) work to combat HIV infection? 1 "The medication prevents HIV entry into healthy cells." 2 "These drugs bind to certain enzymes and block DNA polymerization." 3 "PIs inhibit viral replication by interfering with HIV viral RNA-dependent DNA polymerase." 4 "These drugs result in the formation and release of immature, defective, and noninfectious virus particles."

"These drugs result in the formation and release of immature, defective, and noninfectious virus particles." PIs inhibit the activity of protease, which results in the formation and release of immature, defective, and noninfectious virus particles. Fusion (entry) inhibitors prevent HIV entry into healthy cells. Non-nucleoside reverse transcriptase inhibitors bind directly to the reverse transcriptase enzymes and block DNA polymerization. Nucleoside reverse transcriptase inhibitors interfere with HIV viral RNA-dependent DNA polymerase, which results in the inhibition of viral replication.

Which instruction would the nurse give a 30-year-old female patient who is prescribed efavirenz (EFV), a nonnucleoside reverse transcriptase inhibitor (NNRTI), to treat HIV infection? 1 "Take this medication with meals." 2 "A dry cough is a side effect of this drug." 3 "Use another method of contraceptive in addition to 'the pill.'" 4 "You will need to have your kidney function evaluated regularly."

"Use another method of contraceptive in addition to 'the pill.'" NNRTIs can decrease the efficacy of hormonal contraceptives, so individuals should use alternative means of contraception or an additional method of contraception. EFV enters cerebrospinal fluid, so side effects of the medication include neuropsychiatric symptoms, not a dry cough. EFV should be taken on an empty stomach. EFV is metabolized in the liver, so the patient is at risk for hepatotoxicity; the patient does not need kidney function evaluated on a regular basis.

The health care provider prescribes a translingual aerosol spray of nitroglycerin for a patient with chest pain. Which specific instruction does the nurse give the patient to ensure adequate absorption of the drug? 1 "Do not inhale the spray." 2 "Sit down while taking the medication." 3 "Spray the medication on your tongue." 4 "Wait for 10 seconds before swallowing."

"Wait for 10 seconds before swallowing." Waiting 10 seconds before swallowing a translingual aerosol preparation allows for proper absorption of the drug. The patient may want to inhale the spray; the nurse should instruct the patient not to inhale it. Instructing the patient to sit or lie down while getting the medication is helpful for correct administration of the dose, but it does not increase the absorption of the medication. Instructing the patient to spray the medication on his or her tongue ensures the administration of the drug through the proper route.

A patient with Kaposi sarcoma is to receive an initial subcutaneous dose of interferon alfa-2b and asks the nurse, "How long do I have to take this drug?" Which response would the nurse provide? 1" You will need to be treated indefinitely." 2 "You will receive treatment until you have an adverse reaction." 3 "You will receive treatment three times a week for a total duration of 48 weeks." 4 "You will receive treatment up to 16 weeks or until you have a severe intolerance."

"You will receive treatment up to 16 weeks or until you have a severe intolerance." The nurse would tell the patient, "You will receive treatment up to 16 weeks or until you have a severe intolerance." The patient will not be treated indefinitely. An adverse reaction is an injury caused by taking a medication and is not an intended part of any treatment. Interferon alfa-2b is an adjuvant treatment for malignant melanoma for which the patient will receive treatment three times a week for 48 weeks.

The nurse is caring for a child suffering from asystole. The health care provider prescribes epinephrine via the endotracheal tube. Which dose of the medication does the nurse administer? 0.1 mg/kg with 1:1000 preparation 0.01 mg/kg with 1:1000 preparation 0.1 mg/kg with 1:10,000 preparation 0.01 mg/kg with 1:10,000 preparation

0.1 mg/kg with 1:1000 preparation Epinephrine is available in two concentrations: 1:1000 and 1:10,000. While administering epinephrine through the endotracheal tube route, the concentration of the drug solution should be 1:1000. The ideal dose of epinephrine for a child with asystole would be 0.1 mg/kg with a 1:1000 preparation. Administering 0.01 mg/kg with a 1:1000 concentration would not be helpful in achieving the desired therapeutic effect in the patient. The dose of the drug administered through the endotracheal tube route should be more than when administered via the intravenous (IV) route because the plasma concentration of the drug obtained via the endotracheal tube route is lower than via the IV route. Therefore a concentration of 1:10,000 should be used for the IV route or the intraosseous route of administration.

The patient with atrioventricular block receives a dose of atropine and subsequently develops paradoxical bradycardia. Which dose of atropine caused the patient's symptoms? 0.4 mg 3.5 mg 2.5 mg 0.5 mg

0.4 mg Atropine sulfate is indicated for the treatment of bradycardia. The intravenous atropine dose for an adult should never be less than 0.5 mg. Any dose of atropine sulfate less than 0.5 mg may cause paradoxical bradycardia in the patient due to the disinhibition of vagal activity. A dose of 3.5 mg may block the vagal activity in the patient. Doses of 2.5 mg and 0.5 mg are normal doses administered to a patient with bradycardia.

The nurse is caring for a patient who is receiving procainamide for ventricular tachycardia. Which assessment finding does the nurse monitor to ensure safety in the patient? Select all that apply. One, some, or all responses may be correct. 1 Heart rate 2 Blood pressure 3 Width of QRS complex 4 Arterial blood gas results 5 Fluid and electrolyte balance

1 Heart rate 2 Blood pressure 3 Width of QRS complex The nurse should monitor the patient's heart rate because procainamide causes rhythm disturbances and heart block. Procainamide causes hypotension; therefore blood pressure should be monitored. A wide QRS complex in the electrocardiogram of the patient may indicate tachycardia; therefore monitoring the width of the QRS complex helps prevent complications in the patient. Arterial blood gas results should be monitored during the administration of sodium bicarbonate because it may cause metabolic alkalosis. Monitoring fluid and electrolyte balance is necessary after the administration of mannitol.

Which drug alleviates nausea caused by chemotherapy? Select all that apply. One, some, or all responses may be correct. 1 Granisetron 2 Aprepitant 3 Hydroxyzine 4 Cyclizine HCl 5 Dimenhydrinate

1,2

The nurse is teaching a nursing student about the use of colony-stimulating factors (CSFs) in the treatment of cancer. Which property of CSFs would the student infer to be the reason behind the use in cancer treatment? Select all that apply. One, some, or all responses may be correct. 1 "They increase the length of posttreatment neutropenia." 2 "They enhance the delivery of higher dosages of any kind of drug." 3 "They enhance macrophage or granulocyte tumor-destroying ability." 4 "They enhance thrombocytopenia after myelosuppressive chemotherapy." 5 "They reduce bone marrow recovery time after bone marrow transplantation."

2"They enhance the delivery of higher dosages of any kind of drug." 3"They enhance macrophage or granulocyte tumor-destroying ability." 5"They reduce bone marrow recovery time after bone marrow transplantation." The CSFs increase the delivery of higher doses of any kind of drug. They enhance macrophage or granulocyte tumor-, virus-, and fungus-destroying abilities. CSFs essentially reduce bone marrow recovery time after bone marrow transplantation. The hematopoietic CSFs decrease the length of posttreatment neutropenia. Neutropenia involves the length of time neutrophils are decreased as a secondary reaction to chemotherapy. CSFs prevent severe thrombocytopenia after myelosuppressive chemotherapy rather than enhancing it.

The nurse notes that the white blood cell (WBC) count of a patient being treated with myelosuppressive antineoplastic drugs during bone marrow transplantation has dropped to a critical level. Which medication would the nurse suspect as the cause? 1 Oprelvekin administered immediately after chemotherapy 2 Sargramostim administered after 24 hours of chemotherapy 3 Filgrastim administered less than 24 hours before chemotherapy 4 Filgrastim administered more than 24 hours before chemotherapy

3 Filgrastim administered less than 24 hours before chemotherapy Myelosuppressive antineoplastic drugs are given to a patient during bone marrow transplantation. Filgrastim is indicated in the treatment of chemotherapy-induced leukopenia. Filgrastim is given before chemotherapy administration to stimulate WBC so it does not drop to dangerously low levels and does not expose the patient to a potential infection. It needs to be given at least 24 hours before chemotherapy is initiated.

Which intervention does the nurse include in the plan of care for the patient receiving oral neostigmine? 1 Monitor for onset of action in 4 hours. 2 Administer neostigmine every 8 hours. 3 Monitor the patient for respiratory depression. 4 Make sure that naloxone hydrochloride is readily available.

3 Monitor the patient for respiratory depression. Neostigmine is a fast-acting acetylcholinesterase inhibitor that, when administered orally, has an onset of action of 0.5 to 1 hour; it is given every 2 to 4 hours. The nurse should monitor the patient for respiratory depression, which is a life-threatening adverse effect. Atropine, rather than naloxone hydrochloride, is the antidote for a cholinergic crisis.

The nurse is preparing to teach a patient about the administration of epoetin alfa. Which adverse effect would the nurse include in the teaching? Select all that apply. One, some, or all responses may be correct. 1 Seizures 2 Thrombocytopenia 3 Myocardial infarction 4 Thromboembolic disease 5 Gastrointestinal (GI) hemorrhage

3 Myocardial infarction 4 Thromboembolic disease The most life-threatening adverse reactions for a patient who has been prescribed epoetin alfa are myocardial infarction and thromboembolic disease in extreme cases for a patient with hypertension. Seizures are a common adverse reaction during the administration of epoetin alfa, but these seizures are not fatal. Thrombocytopenia is a life-threatening reaction of filgrastim and pegfilgrastim. A common adverse reaction of the prototype drug sargramostim is GI hemorrhage.

Which symptom is suspected in the patient after an acetylcholinesterase inhibitor overdose? 1 Mydriasis 2 Tachycardia 3 Constipation 4 Fasciculation

Fasciculation Cholinergic crisis is an overstimulation at a neuromuscular junction due to an excess of acetylcholine, which occurs due to an overdose of acetylcholinesterase inhibitors. Acetylcholine is a neurotransmitter involved in the motor system, and an overdose causes fasciculation, or involuntary muscle twitching. Cholinergic crisis causes abnormal pupil constriction, or miosis, not mydriasis. Cholinergic crisis results in bradycardia, or decreased heart rate, not tachycardia. Cholinergic crisis is associated with increased gastrointestinal motility and results in diarrhea, not constipation.

A pregnant patient with HIV has a viral load of 450 copies/mL and is receiving antiretroviral therapy (ART). Which action would the nurse anticipate the health care provider (HCP) will take? 1 No change because all is going well 2 Increased dosages for all ARTs 3 Discontinuance all ART medications except efavirenz 4 Addition of intravenous (IV) zidovudine to the patient's treatment regimen

Addition of intravenous (IV) zidovudine to the patient's treatment regimen Regardless of the type of ART a pregnant patient is prescribed, IV zidovudine is recommended when the patient's viral load is 400 copies/mL or greater. Treatment recommendations do not include increasing the dosages of all ART medications. Combination drug therapy (not one drug only) is considered to be the standard of care for treatment of maternal HIV infection and prophylaxis to reduce the risk for perinatal HIV transmission.

The patient taking pyridostigmine develops symptoms of a cholinergic crisis. Which order does the nurse anticipate? 1 Administer atropine. 2 Administer epinephrine. 3 Increase the dose of pyridostigmine. 4 Monitor the patient's blood pressure.

Administer atropine. Atropine is the antidote for treating a cholinergic crisis. Administering epinephrine will not be effective nor will increasing the dosage of the pyridostigmine. Monitoring the patient's blood pressure will not alleviate the cholinergic crisis.

The patient undergoing tracheostomy is administered a nondepolarizing muscle relaxant before the surgery. Which instruction does the nurse anticipate to receive from the health care provider immediately after the surgery? 1 Administer atracurium. 2 Administer pyridostigmine. 3 Avoid suctioning to the patient. 4 Administer an intravenous bolus of normal saline.

Administer pyridostigmine. Nondepolarizing muscle relaxants are administered during surgery to induce muscle relaxation. Prolonged relaxation of the muscles may cause respiratory depression in the patient. Therefore to prevent these effects, indirect-acting cholinergic drugs such as pyridostigmine should be administered to the patient to reverse the effects of the nondepolarizing muscle relaxant. Airway suctioning should be performed to remove chest secretions and prevent respiratory complications associated with the surgery. Patients who undergo tracheostomy may not necessarily lose fluids. Therefore it is not mandatory to administer saline to the patient. Atracurium is a nondepolarizing muscle relaxant and may cause respiratory depression in the patient. Hence, it should not be administered after the surgery.

Which action would the nurse take upon receiving an prescription for lorazepam and a glucocorticoid to be given to a patient with chemotherapy-induced nausea and vomiting? 1 Call the health care provider and question the prescription. 2 Only administer the lorazepam if the patient seems anxious. 3 Administer the two drugs at least 12 hours apart. 4 Administer the drugs and assess the patient for relief.

Administer the drugs and assess the patient for relief. Drug combination therapy is commonly used to manage chemotherapy-induced nausea and vomiting. Both lorazepam and the glucocorticoids have been found to be effective drugs to assist in preventing and managing chemotherapy-induced nausea and vomiting. The nurse would not question the prescription. The lorazepam provides emesis control, sedation, anxiety reduction, and amnesia and would be given as part of the antiemetic regimen regardless of anxiety. The two drugs do not have to be given 12 hours apart.

Which intervention does the nurse include in the plan of care for the patient with myasthenia gravis who has been prescribed a cholinergic medication? 1 Discourage the patient from drinking fruit juice. 2 Administer the medication 30 minutes before meals. 3 Remind the patient to avoid beets and other high-fiber foods. 4 Provide the patient with sources of dark, leafy greens throughout the day.

Administer the medication 30 minutes before meals. Patients with myasthenia gravis have difficulty swallowing food. To decrease dysphagia, the nurse should administer the medication 30 minutes before meals so that the drug exerts its effects. It is not necessary to discourage the patient from drinking juice. The patient should be reminded to eat (not avoid) beets and other high-fiber foods. Although providing the patient with sources of dark, leafy greens throughout the day is helpful to the patient, it is not required for cholinergic medication administration.

The health care provider prescribes aspirin to a patient with chest pain. The nurse finds that the patient has nausea. Which treatment strategy is beneficial to the patient? 1 Administering a chewable aspirin tablet 2 Administering an aspirin tablet before meals 3 Administering an antiemetic along with aspirin 4 Administering the rectal suppository form of aspirin

Administering the rectal suppository form of aspirin Aspirin aggravates nausea and vomiting. Oral intake of this drug would precipitate vomiting in the patient; a rectal suppository form of aspirin is preferred for a patient who has nausea and vomiting. The administration of a chewable tablet may also cause nausea and vomiting. Aspirin should be taken with meals, or immediately after, to avoid nausea. The administration of aspirin before meals increases stomach irritation. Administering an anti-emetic along with aspirin may also be beneficial for the patient; however, administering a drug through an alternative route is preferable to administering two drugs at a time.

The nurse notices that a patient has taken an excessive dose of baclofen. Which action does the nurse implement immediately? 1 Comfort measures 2 Seizure precautions 3 Antidote preparation 4 Airway maintenance

Airway maintenance An overdose of baclofen can cause respiratory depression as a result of excessive central nervous system depression, so the nurse has to maintain an open airway with the use of oxygen and a bag for ventilation. General supportive therapy and seizure therapy, including cardiac monitoring, gastric lavage, and fluid therapy, are instituted to maintain vital functions until the depressant effects of baclofen wear off. An antidote to baclofen does not exist. Although comfort measures are usually appropriate, the nurse's priority is the maintenance of vital functions.

The nurse advises the patient prescribed cyclobenzaprine to avoid which substance? Select all that apply. One, some, or all responses may be correct. 1 Alcohol 2 Anesthetics 3 Barbiturates 4 Aminoglycosides 5 Tricyclic antidepressants

Alcohol Barbiturates Tricyclic antidepressants Cyclobenzaprine is a medication that acts as a central nervous system (CNS) depressant. The consumption of alcohol during the course of cyclobenzaprine therapy may result in severe CNS depression; therefore the nurse should advise the patient who is prescribed cyclobenzaprine to avoid alcohol consumption. Concomitant administration of barbiturates and cyclobenzaprine may result in coma. The administration of tricyclic antidepressants along with cyclobenzaprine may also cause severe CNS depression; therefore these medications should not be prescribed concurrently. Anesthetics and aminoglycosides do not interact with cyclobenzaprine and can be safely prescribed together.

The nurse is caring for a patient with paroxysmal supraventricular tachycardia (PSVT). The nurse finds that the patient has sick sinus syndrome. Which medication can be safely administered to the patient? 1 Diltiazem 2 Adenosine 3 Amiodarone 4 Atropine sulfate

Amiodarone Amiodarone is used for the treatment for PSVT. Amiodarone does not aggravate sick sinus syndrome, and it can be safely prescribed to a patient with that condition. Diltiazem and adenosine are helpful in the treatment of PSVT, but they are contraindicated in patients with sick sinus syndrome. Atropine sulfate is used to treat bradycardia, not PSVT.

Hypotension is an adverse effect of which medication? Select all that apply. One, some, or all responses may be correct. 1 Dopamine 2 Amiodarone 3 Epinephrine 4 Nitroglycerin 5 Morphine sulfate

Amiodarone Nitroglycerin Morphine sulfate Amiodarone is effective in the treatment of ventricular dysrhythmias. It causes vasodilation and has a negative inotropic action, causing hypotension. Nitroglycerin is effective in treating angina pectoris. It causes vasodilation, resulting in hypotension. Morphine sulfate is an opioid medication, which acts as a systemic analgesic. It also causes hypotension due to vasodilation. Dopamine and epinephrine are beneficial in alleviating hypotension during shock. They cause vasoconstriction, which results in hypertension.

Which laboratory finding in a patient receiving long-term treatment with atazanavir will a nurse anticipate observing? Select all that apply. One, some, or all responses may be correct. 1 A decrease in neutrophil count 2 An increase in cholesterol levels 3 An increase in triglyceride levels 4 A decrease in creatinine clearance 5 An increase in blood glucose levels 6 An increase in liver function tests

An increase in cholesterol levels An increase in triglyceride levels An increase in blood glucose levels An increase in liver function tests Atazanavir can increase cholesterol levels, triglycerides, blood glucose levels, and liver function tests. The drug does not alter bone marrow function or impact kidney functioning; therefore blood cell counts (neutrophils) and creatinine clearance would not be affected.

The health care provider has prescribed diltiazem to a patient who has a heart rate of 160 beats per minute. Which specific nursing intervention prevents myocardial depression? 1 Avoiding concomitant administration of digoxin 2 Avoiding concomitant administration of labetalol 3 Monitoring the serum digoxin levels after administering digoxin 4 Providing a continuous infusion of diltiazem

Avoiding concomitant administration of labetalol A sudden, uncontrolled rapid rhythm greater than 150 beats per minute is known as paroxysmal supraventricular tachycardia (PSVT). An intravenous bolus of diltiazem is used to treat PSVT. It has a strong negative chronotropic action. The simultaneous use of diltiazem and beta blockers, such as labetalol, is contraindicated because their negative chronotropic actions are synergistic and may cause myocardial depression. The simultaneous use of diltiazem and digoxin causes digitalis toxicity. Monitoring serum digoxin levels helps prevent digitalis toxicity but not myocardial depression. A continuous infusion of diltiazem is given to a patient with atrial fibrillation.

Which medication is used to treat spasticity? 1 Baclofen 2 Diazepam 3 Mupirocin 4 Beclomethasone

Baclofen Baclofen is a skeletal-muscle relaxant that is used to treat spasticity in a patient who has suffered a stroke or other neurologic disorders that produce spasticity, such as cerebral palsy. Spasticity is caused when the upper motor neurons fail to exert an inhibitory effect on the lower motor neurons. Baclofen inhibits lower motor neuron activity and decreases spasticity in a patient. Diazepam is used to relieve muscle spasms in a patient. Mupirocin is a topical antibiotic medication. This antibiotic and other forms of antibiotics are not used to treat spasticity. Beclomethasone is a corticosteroid inhalant and would not be an effective treatment for spasticity.

The patient who is undergoing treatment for myasthenia gravis (MG) reports severe muscle weakness, drooling, diarrhea, nausea, and vomiting. On assessment, the nurse finds the patient has miosis, pallor, and sweating. The nurse anticipates which diagnosis will be made? 1 Leukopenia 2 Hypokalemia 3 Cholinergic crisis 4 Myasthenic crisis

Cholinergic crisis Cholinergic crisis may occur in a patient who has myasthenia gravis and who is being treated with acetylcholinesterase inhibitors. In cholinergic crisis, the muscle receptors stop responding to the acetylcholinesterase enzyme, which results in severe muscle weakness and drooling. The inhibition of acetylcholinesterase also results in miosis, pallor, and sweating. The smooth muscles of the intestine also become affected, which may result in diarrhea. Inhibition of acetylcholinesterase leads to increased levels of acetylcholine which may cause stimulation of the vestibular apparatus and result in nausea and vomiting. Leukopenia, a condition in which the number of leukocytes, or white blood cells, is decreased in the blood, may occur in a patient who has been administered azathioprine, an immunosuppressant; however, leukopenia should not cause severe muscle weakness. Hypokalemia, a condition in which potassium levels are low in the blood, may trigger a myasthenic crisis in a patient who is administered acetylcholinesterase inhibitors. Although hypokalemia may result in muscle weakness, it does not cause diarrhea and vomiting. Myasthenic crisis may lead to muscular weakness, which may also include weakness of the respiratory muscles.

The patient prescribed an acetylcholinesterase (AChE) inhibitor to help control myasthenia gravis is admitted to the emergency department exhibiting severe muscle weakness and is prescribed neostigmine. After the nurse administers the neostigmine, the patient's muscle weakness becomes progressively worse. The nurse reports the change in patient status to the health care provider and anticipates which diagnosis to be made? 1 Myasthenic crisis 2 Cholinergic crisis 3 Progressive relapsing crisis 4 Secondary progressive crisis

Cholinergic crisis Neostigmine is a short-acting AChE inhibitor that may be used to distinguish between a myasthenic crisis and a cholinergic crisis. If the muscle weakness gets progressively worse after the administration of the neostigmine, the cause of the muscle weakness is due to a cholinergic crisis related to an AChE inhibitor drug overdose. If the administration of neostigmine resolves the muscle weakness, the patient is experiencing a myasthenic crisis. Secondary progressive crisis and progressive relapsing crisis are not technical terms. Secondary progressive and progressive relapsing are classifications of multiple sclerosis.

Which pathophysiologic change occurs due to the neuromuscular autoimmune disorder multiple sclerosis (MS)? 1 Thymic hyperplasia 2 Destruction of the acetylcholine receptor sites 3 Destruction of the myelin sheath of nerve fibers 4 Impaired transmission of messages at the neuromuscular junction

Destruction of the myelin sheath of nerve fibers MS is a neuromuscular autoimmune disorder that attacks and destroys the myelin sheath of nerve fibers. Thymic hyperplasia occurs in over half of patients with myasthenia gravis (MG). MG is an acquired autoimmune disease in which the acetylcholine receptor sites are destroyed resulting in an impaired transmission of messages at the neuromuscular junction.

Which condition does glucagon treat? Select all that apply. One, some, or all responses may be correct. Diabetic shock Beta blocker overdose Benzodiazepine overdose Tricyclic antidepressant overdose Calcium channel blocker overdose

Diabetic shock Beta blocker overdose Calcium channel blocker overdose Diabetic shock is a condition in which the presence of excess insulin in the blood leads to severe hypoglycemia. Glucagon increases the production of glucose in the liver and increases blood sugar levels during diabetic shock. Glucagon reverses the actions of beta blockers and calcium channel blockers; therefore glucagon is used in the treatment of beta blocker overdoses and calcium channel blocker overdoses. Glucagon is not effective in treating overdoses of benzodiazepine and tricyclic antidepressants. Flumazenil is used to treat benzodiazepine overdoses. Sodium bicarbonate is used in the treatment of tricyclic antidepressant overdoses.

Before administering the first dose of pyridostigmine to the patient with myasthenia gravis, the nurse reviews the patient's medical history and notes the patient has asthma. The nurse reports this finding to the health care provider and anticipates which instruction? 1 Elevate the patient's bed while sleeping. 2 Discontinue administering pyridostigmine. 3 Administer pyridostigmine intramuscularly. 4 Teach deep breathing exercises to the patient.

Discontinue administering pyridostigmine. Cholinergic drugs such as pyridostigmine should not be administered to the patient with asthma because it will worsen asthma symptoms. Pyridostigmine may cause muscle cramps and difficulty in breathing. Therefore it should be discontinued in asthma patients. Deep breathing exercises and elevating the patient's bed may not help to prevent the adverse effects caused by pyridostigmine. Administering pyridostigmine worsens the symptoms of asthma, and the patient will face breathing difficulty. Therefore the nurse should avoid administering pyridostigmine intramuscularly.

The nurse has initiated an intravenous (IV) administration of nitroglycerin to a patient. The nurse later discovers that the patient's systolic blood pressure is 65 mm Hg. Which action does the nurse take first? 1 Position the patient in a supine position. 2 Discontinue the nitroglycerin infusion. 3 Administer intravenous fluids. 4 Contact the health care provider.

Discontinue the nitroglycerin infusion. The patient has a systolic blood pressure of 65 mm Hg, indicating that the patient has hypotension due to IV nitroglycerin administration. In this situation, the nurse should immediately discontinue the nitroglycerin infusion and then place the patient in a supine position with legs elevated to maintain blood pressure. Intravenous fluids should be administered as well to bolster blood pressure. The health care provider can be contacted once the patient is safe.

The nurse has administered atropine sulfate to a patient experiencing bradycardic rhythms. The nurse notices that the patient's heart rate is 42 beats per minute after administering the drug. Which medicine does the nurse expect the health care provider to prescribe to improve the patient's condition? 1 Labetalol hydrochloride 2 Dopamine 3 Epinephrine 4 Diphenhydramine hydrochloride

Dopamine The patient has persistent bradycardia, despite administration of atropine sulfate. Dopamine produces a beta1 effect—it increases the heart rate. Consequently, it is used to treat bradycardic rhythms. If atropine sulfate is ineffective in the patient, dopamine should be administered. Labetalol hydrochloride is an alpha- and beta-adrenergic blocker, and thus it lowers the heart rate. Administration of this drug would worsen bradycardia. Epinephrine and diphenhydramine hydrochloride are used for the treatment of anaphylactic shock. These medicines do not increase the heart rate, and they are not useful in treating bradycardia.

Which antiviral drug does a nurse suspect is causing a patient to feel dizzy and to experience strange dreams? 1 Efavirenz 2 Etravirine 3 Nevirapine 4 Darunavir

Efavirenz Efavirenz is associated with adverse central nervous system effects. These effects may include lack of concentration, abnormal dreams, and dizziness; therefore a nurse may expect efavirenz to be the cause of the patient's symptoms. The administration of etravirine may cause hypersensitivity reactions such as rash or Stevens-Johnson syndrome. The administration of nevirapine causes adverse effects that include severe rashes and hepatotoxicity. The possible adverse effects of darunavir include hepatotoxicity and pancreatitis.

Which nonnucleoside reverse transcriptase inhibitor (NNRTI) should be taken on an empty stomach? 1 Efavirenz 2 Etravirine 3 Rilpivirine 4 Delavirdine

Efavirenz Efavirenz should be taken on an empty stomach. Etravirine and rilpivirine should be taken with food to enhance absorption. Delavirdine can be taken without regard to food.

The nurse is administering a prescribed dose of an acetylcholinesterase (AChE) inhibitor to the patient diagnosed with myasthenia gravis (MG). Which symptom does the nurse monitor the patient for after administering the drug? 1 Tachycardia 2 Constipation 3 Dilated pupils 4 Fasciculations

Fasciculations The nurse will monitor the patient for fasciculations, or involuntary muscle movements that may indicate a cholinergic crisis that can occur within 30 to 60 minutes after taking anticholinergic drugs. Diarrhea, bradycardia, and miosis, not constipation, tachycardia, and dilated pupils, are accompanying symptoms of a patient in a cholinergic crisis, but fasciculations are the best indicator.

Which drug may cause adult respiratory distress syndrome in neutropenic patients? 1 Filgrastim 2 Aldesleukin 3 Erythropoietin 4 Sargramostim

Filgrastim Filgrastim may cause adult respiratory distress syndrome in neutropenic patients. Capillary leak syndrome is a side effect of aldesleukin. Hypertension is a side effect of erythropoietin. Peripheral edema is a side effect of sargramostim.

Which antiemetic is contraindicated for a patient with glaucoma? Select all that apply. One, some, or all responses may be correct. 1 Droperidol 2 Lorazepam 3 Dolasetron 4 Hydroxyzine 5 Scopolamine

Hydroxyzine Scopolamine A side effect and adverse reaction to antihistamines and anticholinergics is blurred vision caused by pupillary dilation; therefore both are contraindicated for patients with glaucoma. Hydroxyzine is a prescription antihistamine, and scopolamine is an anticholinergic. Droperidol, a butyrophenone; lorazepam, a benzodiazepine; and dolasetron, a serotonin-receptor antagonist, are not contraindicated for patients with glaucoma.

Which potential complication might result if a nurse continues weekly epoetin alfa drug administration for a patient undergoing chemotherapy whose hemoglobin levels have increased to 11.7 g/dL? 1 Constipation 2 Hematemesis 3 Hyperglycemia 4 Hypertension

Hypertension Overdose of epoetin alfa when undergoing chemotherapy causes hypertension, vomiting, and nausea. Administration of epoetin alfa in a patient who has a hemoglobin level of 12 g/dL or more can lead to serious adverse effects such as stroke and myocardial infarction due to high blood pressure. Excess iron supplementation can cause constipation. This difficulty in defecation can be minimized by increasing fluid and fiber intake in the diet. Hematemesis (vomiting blood) is a sign of toxicity caused by iron supplements. Hyperglycemia is an immediate effect of injecting iron preparations such as iron sucrose and iron dextran.

The health care provider has prescribed norepinephrine for a patient. The nurse takes care to avoid sudden discontinuation of norepinephrine to prevent which complication? 1 Tinnitus 2 Hypotension 3 Blurred vision 4 Hyponatremia

Hypotension Norepinephrine is a catecholamine and a potent vasoconstrictor. Abrupt cessation of this drug would activate the parasympathetic nervous system, which may result in severe hypotension. Norepinephrine does not affect hearing and thus does not cause tinnitus. Norepinephrine does not interfere with visual acuity; therefore it does not cause blurred vision. Norepinephrine does not affect sodium levels and thus does not cause hyponatremia. Tinnitus and blurred vision are the adverse effects of nitroprusside sodium. Hyponatremia is an adverse effect of furosemide.

Which information would the nurse include when teaching a patient about the administration of antiretroviral therapy (ART) for treatment of HIV infection? 1 Smoking cessation methods 2 Methods to avoid side effects 3 Importance of medication adherence 4 Necessity of only taking one medication to decrease interactions

Importance of medication adherence For patients taking medications for ART, medication adherence of at least 95% is necessary to decrease the development of medication resistance. Smoking cessation would always be taught as a general health principle, but smoking is not specifically contraindicated with ART. Side effects of the medications cannot be avoided, but they may be managed. ART usually consists of several medications.

Which assessment finding indicates filgrastim therapy has been effective? 1 Increase in red blood cells 2 Decrease in red blood cells 3 Increase in white blood cells 4 Decrease in white blood cells

Increase in white blood cells Filgrastim increases the production of white blood cells in the bone marrow. The desired patient outcome is that the patient will not contract an infection. An increase in red blood cells, decrease in red blood cells, and decrease in white blood cells are not therapeutic effects of filgrastim therapy.

The nurse is administering nitroglycerin at 10 mcg/min. The patient continues to complain of chest pain. Which action by the nurse is appropriate? 1 Perform an electrocardiogram (ECG). 2 Stop the infusion. 3 Increase the infusion by 5 mcg/min. 4 Call the health care provider.

Increase the infusion by 5 mcg/min. A continuous infusion is started for the patient with chest pain at a rate of 10 to 20 mcg/min, and it is increased by 5 mcg/min to 10 mcg/min based on the patient's symptoms. The patient would have had an ECG at the beginning of the episode. Another ECG is not needed. The infusion should not be stopped. The health care provider does not need to be called because there are interventions that the nurse can do.

Which assessment is used to determine the effectiveness of pyridostigmine bromide? 1 Clear vision 2 Ability to walk 3 Decrease in pain 4 Increased muscle strength

Increased muscle strength Pyridostigmine is given to increase muscle strength. It will not actually provide the ability to walk and will not decrease pain or provide clear vision.

The patient with multiple sclerosis is ordered to receive intramuscular administration of 30 mcg of an interferon once per week. Which interferon does the nurse administer to the patient? 1 Interferon alfa-n3 2 Interferon beta-1a 3 Interferon alfacon-1 4 Interferon gamma-1b

Interferon beta-1a Interferon beta-1a is the interferon most likely prescribed in the treatment of multiple sclerosis. It is administered intramuscularly at a dose of 30 mcg once per week. Interferon alfa-n3 is an interferon used in the treatment of condylomata acuminata. It is given intralesionally 250,000 units (0.05 mL) into the base of each wart twice per week. Interferon alfacon-1 is an interferon used in the treatment of chronic hepatitis C. It is given at 9 mcg three times per week subcutaneously. Interferon gamma-1b is an interferon used in the treatment of chronic granulomatous disease and osteopetrosis. It is given subcutaneously (50 mcg/m2) three times per week for body surface area more than 0.5 m2.

The presence of which manifestation alerts the nurse to a patient's poor response to erythropoietin therapy? 1 Edema 2 Hyperkalemia 3 Iron deficiency 4 Shortness of breath

Iron deficiency Erythropoietin is used in the treatment of anemia secondary to cancer therapy. Iron deficiency should be evaluated if a patient does not respond or maintain response to erythropoietin. Edema, hyperkalemia, and shortness of breath are the adverse reactions of erythropoietin. These situations are not related to improper response to erythropoietin.

Which information would the nurse keep in mind when preparing to incorporate filgrastim therapy into a patient's plan of care? 1 It can be started during chemotherapy. 2 It can be initiated 24 hours before chemotherapy. 3 It is used in the treatment of chemotherapy-induced thrombocytopenia. 4 It is discontinued when a patient's absolute neutrophil count (ANC) is below 1000 cells/mm3.

It can be initiated 24 hours before chemotherapy. Filgrastim is a hematopoietic drug given 24 hours before the administration of myelosuppressive antineoplastics to prevent white blood cell (WBC) levels from dropping to dangerous levels. It also promotes WBC production. It should not be started during chemotherapy. It is used in the treatment of chemotherapy-induced leukopenia. It is discontinued when a patient's ANC rises above 10,000 cells/mm3.

Which action does indirect biologic response modifier (BRM) therapy have on cancer? 1 It targets cancer cells. 2 It genetically produces antibodies. 3 It stimulates the body's immune system. 4 It alters cancer cells to make them behave like healthy cells.

It stimulates the body's immune system. BRMs are a class of pharmacologic drugs used to enhance, direct, or restore the body's immune system. Indirect therapies with BRMs stimulate the body's immune system. Targeted therapy with BRMs directly target the cancer cells. Genetically produced antibodies are created through recombinant DNA, a genetic engineering process. Direct BRM therapy alters cancer cells to make them behave like healthy cells.

Which statement is true regarding pyridostigmine? 1 It has a long half-life. 2 It requires once-a-day dosing. 3 Its overdose causes cholinergic crisis. 4 It is absorbed more through the gastrointestinal tract.

Its overdose causes cholinergic crisis. Pyridostigmine is an acetylcholinesterase inhibitor that is used to treat myasthenia gravis. Overdose of this drug increases acetylcholine in the neuromuscular junction and causes cholinergic crises. Pyridostigmine has a short half-life and is therefore administered several times in a day. It is poorly absorbed from the gastrointestinal tract.

Which action is the result of adding a pharmacokinetic (PK) booster to the drug regimen of a patient receiving protease inhibitor (PI) therapy for HIV infection? 1 Less drug exposure 2 Increased drug metabolism 3 Less complex drug regimens 4 Increased dietary restrictions

Less complex drug regimens PI drug regimens "boosted" by the addition of a PK booster result in less complex drug regimens (reduced dose frequency and pill burden) that make them easier for patients to follow. They also result in increased drug exposure, decreased drug metabolism, and decreased dietary restrictions.

The nurse is caring for a patient with ventricular tachycardia. The nurse finds a prolonged QT interval in the patient's electrocardiogram (ECG). Which medication does the nurse expect the health care provider to prescribe? 1 Diltiazem 2 Procainamide HCL 3 Morphine sulfate 4 Magnesium sulfate

Magnesium sulfate An unusual ventricular tachycardia with a prolonged QT interval indicates torsades de pointes. Magnesium sulfate blocks the sodium and calcium channels, and it is the drug of choice for torsades de pointes. Diltiazem treats atrial fibrillation and supraventricular tachycardia. Procainamide HCL is contraindicated in patients with torsades de pointes. Morphine sulfate is a narcotic analgesic that is helpful in treating chest pain and unstable angina.

Which phrase describes the major advantage of administering colony-stimulating factors (CSFs) to a patient who requires higher doses of chemotherapy? 1 Prevention of thrombocytopenia 2 Minimized myelosuppressive toxicity 3 Enhanced macrophage-destroying abilities 4 Decreased length of posttreatment neutropenia

Minimized myelosuppressive toxicity The major advantage of administering CSFs to a patient who requires higher doses of chemotherapy is that it minimizes myelosuppressive toxicity, thus allowing the delivery of higher doses of chemotherapy. CSFs are administered to prevent thrombocytopenia, enhance macrophage-destroying abilities, and decrease the length of posttreatment neutropenia, but these benefits are not as relevant to the chemotherapy dosage.

The health care provider instructs the nurse to administer dopamine to a patient. Which safety measure should the nurse take while administering the drug to the patient? 1 Mixing 50 mg of dopamine into 250 mL of D5W solution 2 Mixing 1000 mg dopamine into 250 mL of D5W or normal saline solution 3 Mixing 8 mg of dopamine into 250 mL D5W or normal saline solution 4 Mixing 400 mg of dopamine into 250 mL D5W or normal saline solution

Mixing 400 mg of dopamine into 250 mL D5W or normal saline solution Dopamine is used to treat bradycardic rhythms. The standard dose of dopamine is 400 to 800 mg. Therefore administer 400 mg of dopamine mixed with 250 mL D5W or normal saline solution. It is administered in a central vein by an electronic infusion pump for precision. Nitroprusside sodium is administered by mixing a 50 mg dose with 250 mL D5W solution. Dobutamine is administered by mixing 1000 mg with 250 mL of D5W or normal saline. Norepinephrine is administered by mixing 8 mg into 250 mL D5W or normal saline solution.

The patient with a history of stroke has been prescribed dantrolene. The nurse includes which intervention in the plan of care? Select all that apply. One, some, or all responses may be correct. 1 Monitoring liver enzyme levels in the patient 2 Instructing the patient to stop the medication after a week 3 Observing the patient for side effects related to the central nervous system (CNS) 4 Keeping atropine sulfate readily available for the patient 5 Administering the medication in intravenous (IV) undiluted form at a rate of 0.5 mg/min

Monitoring liver enzyme levels in the patient Observing the patient for side effects related to the central nervous system (CNS) Dantrolene is used to treat muscle spasticity in patients who have had a stroke. Because dantrolene may cause an increase in liver enzyme levels, the nurse should continuously monitor these levels in a patient. Dantrolene causes CNS depression, so the nurse should observe the patient for signs of CNS depression. This medication is usually not used for more than 3 weeks, rather than 1 week, because it may cause hepatotoxicity. Atropine sulfate is an antidote for pyridostigmine, and it is not an antidote for dantrolene. It is not necessary to keep the atropine sulfate readily available. Dantrolene is administered orally at a dose of 25 mg/day and the dosage would gradually be increased.

Which medication is used to differentiate muscle weakness associated with myasthenic crisis and cholinergic crisis in the patient who is undergoing treatment for myasthenia gravis? 1 Phenytoin 2 Neostigmine 3 Azathioprine 4 Pyridostigmine

Neostigmine Myasthenia gravis is treated by anticholinesterase inhibitors. An overdose of anticholinesterase inhibitors may result in cholinergic crisis, whereas an underdose of these medications may result in myasthenic crisis. Neostigmine is a medication that is administered to differentiate the muscle weakness associated with myasthenic crisis from a cholinergic crisis in a patient. If muscle weakness persists after the administration of this medication, a patient would be assessed as having cholinergic crisis. If skeletal muscle weakness improves with the administration of neostigmine, a patient would be assessed as having myasthenic crisis. Phenytoin is associated with the development of myasthenic crisis in a patient. Azathioprine is an immunosuppressive agent. Pyridostigmine is an acetylcholinesterase inhibitor used to treat myasthenia gravis and would not be used to differentiate between myasthenic and cholinergic crises.

The patient receiving dopamine HCl and dobutamine infusions is persistently hypotensive. The nurse anticipates administering which additional medication? 1 Naloxone 2 Procainamide 3 Atropine sulfate 4 Norepinephrine

Norepinephrine Norepinephrine is a catecholamine drug with an extremely potent vasoconstrictor action. It can be administered to the patient if dopamine HCl and dobutamine are ineffective. Naloxone is an opioid antagonist, and it is used in the treatment of opiate overdoses. Procainamide reduces blood pressure; it would worsen the patient's condition if administered. Atropine sulfate will not be effective for this patient because dopamine HCl was ineffective in this patient. Dopamine HCl is administered to the patient when atropine sulfate is ineffective.

Which drug would be most beneficial to treat nausea and vomiting caused by chemotherapy? 1 Bisacodyl 2 Ondansetron HCl 3 Promethazine 4 Scopolamine

Ondansetron HCl Anticancer drugs stimulate the chemoreceptor trigger zone and induce nausea and vomiting in chemotherapy patients. Ondansetron HCl is a serotonin 5-HT3 receptor antagonist that antagonizes the emetic action of the anticancer medication, which prevents nausea and vomiting. Bisacodyl is a stimulant laxative that alleviates constipation. Scopolamine is an anticholinergic drug that decreases gastric acid secretion and alleviates nausea caused by motion sickness. Promethazine is a phenothiazine that alleviates postoperative nausea and vomiting.

Which is a common method of human immunodeficiency virus (HIV) transmission in the United States? Select all that apply. One, some, or all responses may be correct. 1 Oral sex 2 Mosquito bites 3 Blood transfusions 4 Vaginal intercourse 5 Drug use with shared needles 6 Sharing contaminated dining utensils

Oral sex Vaginal intercourse Drug use with shared needles Oral sex, vaginal intercourse, and drug use with shared needles are among the primary methods of HIV transmission. Mosquitoes do not transmit HIV. Transmission via blood transfusions is extremely rare in the United States. Sharing contaminated dining utensils does not transmit HIV.

The nurse administers which medication into subcutaneous tissue where dopamine has extravasated? 1 Phentolamine 2 Atropine 3 Flumazenil 4 Naloxone

Phentolamine The antidote for dopamine infiltration is phentolamine (5 to 10 mg diluted in 10 to 15 mL of normal saline) injected in multiple areas of the infiltration. Atropine treats bradycardia. Flumazenil treats benzodiazepines overdoses. Naloxone treats opioid overdoses.

Which condition does a nurse suspect in a patient who underwent a blood transfusion 12 weeks ago who reports lymphadenopathy, night sweats, muscle aches, fever, and pharyngitis? 1 Cytomegalovirus infection 2 Systemic fungal infection 3 Primary human immunodeficiency virus (HIV) infection 4 Stevens-Johnson syndrome

Primary human immunodeficiency virus (HIV) infection A patient who has recently been infected with HIV would have symptoms such as fever, fatigue, myalgias, night sweats, headache, lymphadenopathy, and pharyngitis. The patient experiences these symptoms 2 to 12 weeks after exposure to HIV. Because of the patient's history of a blood transfusion 12 weeks before coupled with the patient's current symptoms of fever, lymphadenopathy, night sweats, myalgias, and pharyngitis, the nurse might suspect the patient has a primary HIV infection.

The health care provider prescribes amiodarone to a patient. The nurse checks all of the patient's current medications. The nurse would alert the health care provider about which drug? 1 Amoxicillin 2 Ibuprofen 3 Procainamide 4 Acetaminophen

Procainamide Amiodarone is effective with patients who have life-threatening ventricular dysrhythmias and cardiac arrest. It should not be used with agents, such as procainamide, that prolong the QT interval on an electrocardiogram (ECG). There are no known interactions between amiodarone and amoxicillin, ibuprofen, and acetaminophen.

The patient with multiple sclerosis participates in a rehabilitation program and also takes baclofen to help manage muscle spasticity. The nurse anticipates the baclofen interferes with the patient's rehabilitation activities in which manner? 1 Causing gastrointestinal distress 2 Impairing coordinated movements 3 Increasing pain associated with activities 4 Producing drowsiness, lethargy, and blurred vision

Producing drowsiness, lethargy, and blurred vision Baclofen falls under the barbiturates category, and drowsiness, lethargy, and blurred vision are adverse effects of baclofen, which will make it difficult for this patient to participate actively in rehabilitation activities. Gastrointestinal distress is one of the adverse effects of niacin, which is an antilipemic drug. Another adverse effect of antilipemic drugs is increased muscle pain associated with activity. Impaired physical mobility is an adverse effect related to antiemetic and antinausea drugs.

Which antiemetic may cause a false pregnancy test? 1 Droperidol 2 Promethazine 3 Metoclopramide HCl 4 Granisetron

Promethazine Promethazine is used for the treatment of motion sickness and to alleviate the symptoms of nausea and vomiting. Promethazine increases the elimination of human chorionic gonadotropin (hCG) hormone in the urine, which causes a false-positive pregnancy result. Droperidol, metoclopramide HCl, and granisetron do not increase hCG levels in the urine. Therefore these drugs would not lead to a false-positive pregnancy test.

The patient who has been administered a neuromuscular drug has severe muscle paralysis. Which medication does the nurse expect the health care provider to prescribe for this condition? 1 Isoflurane 2 Dantrolene 3 Sevoflurane 4 Pyridostigmine

Pyridostigmine Pyridostigmine is an anticholinesterase drug. It blocks the action of neuromuscular blocking drugs and reverses muscle paralysis. Therefore pyridostigmine is administered to the patient for the management of muscle paralysis. Isoflurane, sevoflurane, and dantrolene do not reverse the action of neuromuscular blocking drugs. Isoflurane and sevoflurane are anesthetic agents. Dantrolene is a muscle relaxant. Therefore these drugs are not useful for the management of muscle paralysis in the patient.

Which medication is used as an antidote for the nerve gas soman? 1 Diazepam 2 Carisoprodol 3 Neostigmine 4 Pyridostigmine bromide

Pyridostigmine bromide Soman is a nerve gas that is used by United States military personnel and acts by blocking acetylcholine receptors. Pyridostigmine bromide is used as an antidote for soman. None of the other medications are used as anti-nerve gas agents. Diazepam is used to relieve muscle spasms associated with paraplegia and cerebral palsy. Carisoprodol is used for relaxation of the skeletal muscles. Neostigmine is used to treat myasthenia gravis.

Which is an adverse effect of cyclobenzaprine? Select all that apply. One, some, or all responses may be correct. 1 Seizures 2 Dyspnea 3 Angioedema 4 Bronchospasm 5 Myocardial infarction

Seizures Angioedema Myocardial infarction Cyclobenzaprine is a muscle relaxant that acts on the central nervous system (CNS). Because this medication affects the CNS, its overdose may cause seizures. Angioedema may occur as a result of the release of bradykinins upon the administration of cyclobenzaprine. Long-term administration of this medication may cause myocardial infarction because it facilitates the development of plaques in the coronary arteries. *Dyspnea and bronchospasm are the adverse effects of pyridostigmine, not cyclobenzaprine.

The nurse has initiated a continuous intravenous (IV) infusion of dopamine to a patient in shock. The registered nurse instructs the student nurse to administer sodium bicarbonate to the patient via a different IV line. Which statement describes the rationale behind the instruction? 1 Sodium bicarbonate inactivates the action of dopamine. 2 Sodium bicarbonate increases the absorption of dopamine. 3 Dopamine and sodium bicarbonate combined can cause hypoglycemia. 4 Dopamine and sodium bicarbonate combined can cause renal failure.

Sodium bicarbonate inactivates the action of dopamine. Dopamine is helpful in the treatment of hypotension in shock states. The nurse should avoid infusing sodium bicarbonate in the dopamine IV line, because sodium bicarbonate inactivates dopamine action and the desired effect will not be achieved. Sodium bicarbonate does not increase the serum concentration of dopamine. This does not produce toxicity. A dopamine and sodium bicarbonate interaction does not affect glucose metabolism, and it will not produce hypoglycemia. A dopamine and sodium bicarbonate interaction does not interfere with renal function, and it will not cause renal failure.

Which drug is preferred for anesthesia before emergency intubation? 1 Propofol 2 Midazolam 3 Succinylcholine 4 Dexmedetomidine

Succinylcholine Succinylcholine is a neuromuscular blocking agent. Succinylcholine is preferred for emergency intubation due to its rapid onset of action, which is less than a minute. It achieves peak plasma concentration within 60 seconds. Its duration of action is 4 to 6 minutes. Therefore it is used for rapid-sequence induction of anesthesia. Propofol, midazolam, and dexmedetomidine do not have these characteristics. Therefore these drugs are not preferred for emergency intubation. Propofol is a general anesthetic. Midazolam is an adjunct drug usually administered along with general anesthetics as it causes preoperative amnesia and lessens anxiety. Dexmedetomidine is also an adjunct drug administered with general anesthetics as it causes sedation.

For which condition can cannabinoids be prescribed as a treatment option? Select all that apply. One, some, or all responses may be correct. 1 Anxiety due to paranoia 2 Suppressed appetite due to AIDS 3 Hypotension as a result of anorexia 4 Depressive episode of bipolar disorder 5 Nausea and vomiting as a result of cancer therapy

Suppressed appetite due to AIDS Nausea and vomiting as a result of cancer therapy Cannabinoids are indicated to alleviate nausea and vomiting as a result of cancer therapy and an appetite stimulant for patients with AIDS. Cannabinoids are contraindicated for patients with psychiatric disorders such as anorexia, anxiety, or bipolar disorder. Side effects of cannabinoids include hypotension and paranoia; therefore a patient presenting with either should not take cannabinoids.

Which drug would a nurse expect to be the most beneficial for a patient with human immunodeficiency virus (HIV) who is coinfected with chronic hepatitis B? 1 Tenofovir 2 Rifampin 3 Phenytoin 4 Carbamazepine

Tenofovir Tenofovir is a nucleotide reverse transcriptase inhibitor (NRTI), which hinders the synthesis of reverse transcriptase enzyme and destroys the virus that causes chronic hepatitis B and HIV infection. A nurse would expect that tenofovir would be the most beneficial drug for the patient because it alleviates the symptoms of chronic hepatitis B and HIV infection. Additionally, the patient is at risk for severe acute exacerbation of chronic hepatitis B upon discontinuation of tenofovir. Rifampin, phenytoin, and carbamazepine do not have any antiviral properties and therefore are not beneficial drugs for the patient. Rifampin is an antitubercular drug prescribed for tuberculosis. Phenytoin and carbamazepine are anticonvulsant drugs commonly prescribed for seizures.

The health care provider instructs the nurse to administer dopamine HCl to a patient. The nurse finds that the patient has developed a dysrhythmia, tissue sloughing, and symptoms of gangrene after administration of the drug. Which information does the nurse understand from these findings? 1 The patient has a sulfonamide allergy. 2 The medication has extravasated from the vein. 3 Dopamine HCl is ineffective for the patient. 4 Prednisone should be administered to the patient.

The medication has extravasated from the vein. Dopamine HCl is a sympathomimetic agent, and it is used to increase heart rate in patients with atropine-refractory bradycardia. Tissue sloughing and symptoms of gangrene indicate that the medication has extravasated from the vein into the surrounding tissue and caused damage. The patient's symptoms do not indicate a sulfonamide allergy. Moreover, dopamine HCl is not a sulfonamide derivative, and it thus can be administered safely to a patient with a sulfonamide allergy. The patient would have bradycardia if dopamine HCl is ineffective. Prednisone is administered for anaphylactic shock treatment. The patient does not exhibit signs of anaphylactic shock, such as bronchoconstriction and hypotension.

Which action by a nurse is most appropriate in response to a patient's excitement of learning that the human immunodeficiency virus (HIV) "is gone and I no longer need to take my therapy"? 1 The nurse will congratulate the patient on achieving a cure and remind the patient to follow up for annual physical examinations with his or her health care provider. 2 The nurse will give the patient information on diet and nutritional supplements that will support a healthy immune system. 3 The nurse will offer the patient resources on how to decrease changes of reinfection with HIV by avoiding high-risk behaviors. 4 The nurse will educate the patient on the importance of continuing therapy to maintain the undetectable viral load.

The nurse will educate the patient on the importance of continuing therapy to maintain the undetectable viral load. The most appropriate action the nurse can take is to educate the patient on the importance of continuing the antiretroviral therapy to maintain the undetectable viral load. Failure to adhere to antiretroviral therapy can lead to drug resistance and viral replication. The patient is not cured of the disease when experiencing an undetectable viral load but will need to follow up as requested by the health care provider to ensure the viral load remains undetectable. Offering information on diet and nutritional supplements does not address the serious problem of the patient discontinuing the therapy. Offering resources on how to avoid reinfection is incorrect because the patient has not been cured.

Which laboratory test would be evaluated in a patient who is newly diagnosed with human immunodeficiency virus (HIV) infection to determine when to monitor efficacy of antiretroviral therapy? Select all that apply. One, some, or all responses may be correct. 1 Viral load 2 CD4+ count 3 Thyroid function 4 Creatinine kinase 5 HIV resistance testing

Viral load CD4+ count HIV resistance testing The laboratory tests used to determine when to initiate medication therapy and to monitor efficacy of therapy and indications for changing therapy are viral load (or plasma HIV RNA quantitative assay), CD4+ count, and HIV resistance testing. The HIV viral load is indicative of the level of the virus circulating in the blood and is the best determinant of treatment efficacy. The CD4+ count reflects the number of CD4+ cells, which play a role in the immune system, circulating in the blood. Determination of the presence of a drug-resistant strain of HIV is important to prevent ineffective treatment. Thyroid function and creatinine kinase levels do not monitor the efficacy of antiretroviral therapy. Alterations in these levels might indicate a complication of therapy.

Within which time frame should postexposure prophylaxis (PEP) be initiated after potential human immunodeficiency virus (HIV) exposure? 1 Within 24 hours 2 Within 36 hours 3 Within 48 hours 4 Within 72 hours

Within 72 hours PEP should be initiated within 72 hours of potential HIV exposure and should be continued for 4 weeks. The periods of 24, 36, and 48 hours are within the 72-hour time frame.

Which antiretroviral drug does a nurse suspect a patient with human immunodeficiency virus (HIV) is taking if the patient's neutrophil count has decreased from 600 cells/mm3 to 500 cells/mm3 while on therapy? 1 Efavirenz 2 Zidovudine 3 Etravirine 4 Delavirdine

Zidovudine A sudden decrease of neutrophil count in a patient with HIV may occur if the patient is receiving zidovudine. Efavirenz, etravirine, and delavirdine are not expected to cause neutropenia.

Which intravenous antiretroviral drug would likely be prescribed to a patient with human immunodeficiency virus (HIV) who is in the first trimester of pregnancy and has a viral load of 550 copies/mL? 1 Efavirenz 2 Didanosine 3 Ritonavir 4 Zidovudine

Zidovudine To prevent mother-to-child transmission of HIV, antiretroviral therapy (ART) is recommended for all pregnant patients who test positive for HIV infection, regardless of virologic, immunologic, or clinical parameters. As this patient has a viral load over 400 copies/mL, intravenous zidovudine would be prescribed, regardless of the patient's current antiretroviral therapy. Efavirenz has been associated with a risk for neural tube defects when given during pregnancy. Efavirenz, didanosine, and ritonavir would not be given intravenously to a pregnant patient.