Evolve ?s Ch 27, 28, 31, 46, 47
Which statement indicates to the nurse that the patient understands the medication instructions regarding ketoconazole for treatment of candidiasis? "I can take this medication with antacids if it causes gastrointestinal discomfort. " "I need to take this drug with food to minimize gastrointestinal distress." "I can expect my skin to turn yellow from taking this drug." "I will take this medication with orange juice for better absorption."
"I need to take this drug with food to minimize gastrointestinal distress." Taking this medication with food will help minimize gastrointestinal upset. Ketoconazole should not be taken with coffee, tea, or acidic fruit juices. Additionally, it needs to be taken at least 2 hours before or after the ingestion of alkaline products or antacids.
A patient asks the nurse to explain the action of glucocorticoids. Which statement is the nurse's best response? "Glucocorticoids stimulate defense mechanisms to produce immunity." "Glucocorticoids influence carbohydrate, lipid, and protein metabolism." "Glucocorticoids decrease serum sodium and glucose levels." "Glucocorticoids are produced in decreased amounts during times of stress."
"Glucocorticoids influence carbohydrate, lipid, and protein metabolism." Glucocorticoids play a major role in carbohydrate, lipid, and protein metabolism within the body. They are produced in increasing amounts during stress. They increase sodium and glucose levels and suppress the immune system.
A patient with Mycobacterium tuberculosis is prescribed ethambutol for long-term use. Which statement by the patient indicates understanding of the instructions? "Constipation will be a problem, so I will increase the fiber and fluids in my diet." "This medication may cause my bodily secretions to turn red-orange." "Dizziness, drowsiness, and decreased urinary output are common with this drug, but they will subside over time." "I will need to have my eyes checked regularly while I am taking this drug."
"I will need to have my eyes checked regularly while I am taking this drug." Ethambutol can cause optic neuritis. Ophthalmologic examinations should be performed periodically to assess visual acuity.
The nurse prepares to administer IV amphotericin B. What action should the nurse implement before administering this medication to prevent adverse effects of therapy? Assess the patient's ability to swallow pills. Administer an antipyretic and antihistamine. Check the culture for growth of Sporothrix. Obtain a baseline serum hemoglobin level.
Administer an antipyretic and antihistamine. The nurse should premedicate the patient with acetaminophen and diphenhydramine because amphotericin B produces fever, chills, malaise, nausea, and headache. These reactions are caused by the release of proinflammatory cytokines, including tumor necrosis factor, interleukin-1, and interleukin-6, from monocytes and macrophages.
The health care provider has ordered ribavirin for the patient with respiratory syncytial virus (RSV). The nurse recognizes that which route is the most effective way to administer this medication to the patient? Intravenously over 1 hour Orally at regular intervals Aerosol inhalation By subcutaneous injection
Aerosol inhalation Ribavirin should be administered by aerosol inhalation.
A patient who is traveling to a malaria-prone country and weighs 180 pounds requires malaria prophylaxis. Which prescription can be administered starting 2 weeks before travel and then 4 weeks after travel? Quinine Hydroxychloroquine sulfate Artemether-lumefantrine Chloroquine
Chloroquine Chloroquine is administered beginning 2 weeks before travel into an endemic area and for 4 weeks after travel for malaria prophylaxis.
The patient has been diagnosed with tinea pedis. The nurse recognizes that the patient is most likely to be ordered which drug? Terconazole Griseofulvin Miconazole nitrate Butoconazole nitrate
Griseofulvin Of the drugs listed, the patient is most likely to be treated with griseofulvin. The other drugs treat candidiasis.
The health care provider has ordered amphotericin B for the patient. The nurse recognizes that which is the most effective way to administer this medication to the patient? Intravenously over 2 to 6 hours Orally at regular intervals Intravenously over 1 hour By subcutaneous injection
Intravenously over 2 to 6 hours Amphotericin B should be administered by slow intravenous infusion.
A baby is born on March 21. On what date should the parents bring the child to the health care provider for the second injection of inactivated poliovirus vaccine (IPV)? August 19 July 19 May 20 April 20
July 19 The second immunization against poliomyelitis for infants should take place at age 4 months, on July 19.
A patient enters the emergency department with suspected influenza. Prior to starting the patient on the prescribed oseltamivir phosphate, what priority information should the nurse determine? Length of time since onset of symptoms Immunization history Over-the-counter medications taken in the last 48 hours Allergies to antibiotics
Length of time since onset of symptoms Oseltamivir phosphate inhibits the replication and spread of influenza if given within 48 hours of symptoms. Even though determination of allergies is important, this medication is an antiviral and not an antibiotic. While it is important to know what OTC medications were taken recently as well as immunization history, these do not represent priority information.
Which thyroid drug a form thyroxine (T4) and is the drug of choice for hypothyroidism? Desiccated Thyroid Liothyronine Liotrix Levothyroxine
Levothyroxine The drug of choice for thyroid hormone replacement therapy is the purest form of thyroxine, levothyroxine.
A 60-year-old female patient who sunburns very easily and has a history of asthma requires prednisone for acute bronchitis. Which adverse effect of therapy is compounded by the patient's sex and age? Loss of muscle bulk Increasing weight Loss of bone density Mood changes
Loss of bone density Without taking a glucocorticosteroid, a female patient who is 60 years old, and postmenopausal is at high risk for osteoporosis; so because glucocorticoids are associated with bone demineralization, the patient has an even higher risk of osteoporosis on prednisone therapy.
A patient who has tuberculosis and takes isoniazid experiences paresthesias of the hands and feet with clumsiness and unsteadiness. Which foods should the nurse provide in the patient's diet to help alleviate these clinical indicators? Meat, liver, cereal, bananas, nuts Soy milk, liver, whole grains, beans Milk, broccoli, whole grains, eggs Meat, yeast, milk, eggs
Meat, liver, cereal, bananas, nuts This patient most likely has dose-related isoniazid-induced peripheral neuropathy because isoniazid blocks pyridoxine (vitamin B6). The neuropathy can be improved with supplemental pyridoxine (vitamin B6). The nurse augments the patient's pyridoxine (vitamin B6) intake by including meat, liver, cereal grains, bananas, and nuts in the diet.
A patient receiving which drug is most likely to have exophthalmos? Levothyroxine Prednisone Methimazole Ergocalciferol
Methimazole Exophthalmos is a protrusion of the eye that develops in patients with Graves disease, a type of hyperthyroidism; it is caused by the infiltration of lymphocytes, macrophages, and other immune-mediated cells into the extraocular muscles and periorbital fat to make the eyes bulge from the orbit.
The patient has been diagnosed with candidiasis. The nurse recognizes that the patient is most likely to be ordered which drug? Sulconazole Tolnaftate Miconazole nitrate Haloprogin
Miconazole nitrate Miconazole nitrate can be ordered to treat candidiasis. The other drugs listed can be used to treat tinea pedis, corporis, and cruris.
Once a child has received a vaccination, what is the priority nursing action? Assess for muscle pain. Monitor for possible anaphylaxis. Assess for infection. Treat pain at the injection site.
Monitor for possible anaphylaxis. Anaphylaxis is a potentially life-threatening adverse reaction to vaccines. Muscle pain and pain at the injection site can occur, but assessment and treatment of these is not the primary action. Infection is not likely from this course.
The nurse is caring for a patient who is taking levothyroxine and warfarin. Which intervention is a priority for the nurse? Weigh patient daily for excessive weight loss. Assess peripheral pulses and Homans sign daily. Monitor the patient for cardiac dysrhythmias. Monitor the patient for increased risk of bleeding.
Monitor the patient for increased risk of bleeding. Levothyroxine can compete with protein-binding sites of warfarin (Coumadin), allowing more warfarin to be unbound or free, thus increasing the effects of warfarin and the risk of bleeding. This combination does not place the patient at an increased risk of dysrhythmias, weight loss, or deep vein thrombosis.
The nurse admitting a patient with acromegaly anticipates administering which medication? Somatropin Desmopressin Octreotide Corticotropin
Octreotide Octreotide suppresses growth hormone that causes acromegaly.
A patient is 1-week postoperative after a heart transplant. When administered concomitantly with dexamethasone, which drug requires the nurse to anticipate a higher dose of dexamethasone to prevent organ rejection? Triamterene Phenytoin Naproxen Warfarin
Phenytoin Maintaining a therapeutic blood level of dexamethasone is a vital aspect of immunosuppressive therapy following solid organ transplantation. If phenytoin must be administered along with dexamethasone, the nurse must verify a higher-than-normal dose of the glucocorticoid because phenytoin can increase the metabolism of a glucocorticoid, resulting in lower circulating levels of dexamethasone and diminishing the immunosuppressant effect.
What does the human papillomavirus (HPV) vaccine protect the patient from? All cervical cancers Several HPVs All genital wart viruses Invasive cervical cancers
Several HPVs The HPV vaccine provides protection against many HPVs; however, this protection covers many of the viruses that cause cervical cancers and genital warts.
Ch 28 online course ?s
below
Ch 28 resources ?s
below
Ch 31 online course ?s
below
Ch 31 resources ?s
below
Ch 46 resources ?s
below
The nurse is preparing to administer the hepatitis A vaccine to the patient. The nurse recognizes that the patient will be receiving recombinant viral antigen. inactivated bacteria. inactivated viral antigen. a toxoid.
inactivated viral antigen. The vaccine against hepatitis A is an inactivated viral antigen.
The patient is scheduled to receive a measles vaccine. The nurse recognizes that the patient will be receiving live attenuated virus. live virus. inactivated viral components. inactivated virus.
live virus. The measles vaccine is a live virus.
Which patient statement demonstrates understanding of the nurse's teaching for levothyroxine? "I can expect to see relief of my symptoms within 1 week." "It is best to take the medication with food to prevent gastrointestinal upset." "I will double my dose if I gain more than 1 pound/day." "I will take this medication first thing in the morning."
"I will take this medication first thing in the morning." Levothyroxine increases basal metabolism and thus wakefulness. It should be taken first thing in the morning. The patient should not increase the dose. The medication is absorbed best on an empty stomach. Depending on the symptoms, some symptoms may take weeks to improve.
A patient receiving propylthiouracil (PTU) asks the nurse how this medication will help relieve symptoms. Which statement is the nurse's best response? "PTU inactivates any circulating thyroid hormone, thus decreasing signs and symptoms of hyperthyroidism." "PTU helps the thyroid gland use iodine and synthesize hormones better." "This medication inhibits the formation of new thyroid hormone, thus gradually returning your metabolism to normal." "This medication stimulates the pituitary gland to secrete thyroid-stimulating hormone, which inhibits the production of hormones by the thyroid gland."
"This medication inhibits the formation of new thyroid hormone, thus gradually returning your metabolism to normal." Propylthiouracil (PTU) is an antithyroid medication used to treat hyperthyroidism. It works by inhibiting the synthesis of new thyroid hormone. It does not inactivate hormone already present.
The patient states that she has been prescribed prophylactic medication for tuberculosis for a period of 4 weeks. What is the nurse's best response? "Let me teach you about the medications." "We do not use medications prophylactically for tuberculosis." "You should be on the medications for only 2 weeks." "You should be on the drugs for a longer period of time."
"You should be on the drugs for a longer period of time." Between 6 months and 1 year is sufficient time for prevention of active tuberculosis. Because the tuberculosis mycobacterium is slow-growing, shorter lengths of time may not sufficiently eradicate the organism.
Which patient should the nurse expect to be most likely to be treated with somatropin? An 8-year-old with Prader-Willi syndrome A 17-year-old who is 5 feet tall A 10-year-old of short stature who has severe asthma A 7-year-old diagnosed with growth hormone deficiency
A 7-year-old diagnosed with growth hormone deficiency For this medication to be used, the patient has to be diagnosed with a growth hormone deficiency, and the epiphyses must not be fused, so the child needs to be young. Severe respiratory conditions, Prader-Willi syndrome, and age of 17 years are contraindications to this medication.
Which patient is the worst candidate for corticosteroid therapy? A patient who has type 1 diabetes A patient who has truncal obesity A patient who has chronic asthma A patient who has just had surgery
A patient who has type 1 diabetes The patient who has diabetes mellitus should be monitored closely when taking corticosteroids because these drugs impair the immune system, delay wound healing, increase blood glucose, and increase the risk of infection for a patient who lives with these risks as a result of the diabetes.
Which patient assessment is the nurse's priority before initiating antitubercular therapy that includes ethambutol and isoniazid to decrease the risk of ineffective therapy? Number of people living in patient's home Ability to self-administer drugs accurately Discriminating for high-pitched sounds Presence of unusual peripheral sensations
Ability to self-administer drugs accurately If the patient cannot follow directions, the potential effectiveness of the therapeutic regimen is at risk from food and drug interactions, so the nurse assesses the patient's ability to follow directions and self-administer antitubercular medication. This is because, for antitubercular medications to work properly, the patient must avoid taking antacids with the medication, take the medication on an empty stomach, and take the medication as directed, even when the patient feels well.
Which agent is prescribed for infections caused by herpes simplex viruses and varicella-zoster virus but not influenza virus? Ganciclovir Amantadine Acyclovir Zanamivir
Acyclovir Acyclovir is prescribed for infections caused by herpes simplex viruses and varicella-zoster viruses and is used to suppress replication of the herpes virus. However, it is not used to treat the influenza virus.
The nurse is caring for a patient who has been diagnosed with genital herpes. Which medication is the drug of choice for this patient? Acyclovir Ribavirin Zidovudine Amantadine
Acyclovir Acyclovir is the drug of choice to treat herpes simplex infections. Ribavirin is effective against respiratory syncytial virus (RSV); zidovudine is effective against HIV; amantadine is effective against H. influenzae type A.
Antimalarial medications are contraindicated in patients with which conditions? Select all that apply. Alcohol abuse for 20 years or more Chronic kidney disease Hypoalbuminemia Bitemporal hemianopia Hypercholesterolemia Dumping syndrome
Alcohol abuse for 20 years or more Chronic kidney disease Hypoalbuminemia Bitemporal hemianopia Contraindications to the use of antimalarial agents include severe cardiovascular, renal, liver, kidney, or hematologic disease and visual field defects because antimalarial therapy can aggravate these serious conditions or the related organ system. A patient with hypoalbuminemia should not receive antimalarial medications because they are protein-bound moderately; this means a patient with hypoalbuminemia has a higher risk of toxicity because fewer protein molecules are available for binding. Bitemporal hemianopia is a visual field defect wherein the patient loses the lateral half of both visual fields. Polycystic kidney disease is a hereditary disorder wherein renal cysts form in the kidneys, ultimately leading to renal failure, and a patient who abused alcohol is likely to have impaired liver function; antimalarial drugs are contraindicated for these patients because these drugs concentrate in the liver, transform into metabolites, and leave the body through the kidneys.
The nurse is preparing to administer vaccines to a young child. What will the nurse do first? Explain active and passive immunity to the child and caregivers. Tell the child to lie on the stomach to receive the vaccines. Rub the site of the vaccination with alcohol. Ask the caregivers about food allergies and over-the-counter medications.
Ask the caregivers about food allergies and over-the-counter medications. Before immunizations are administered, children and their caregivers should be questioned regarding their use of prescription and over-the-counter medications, including herbal preparations and any food or drug allergies. Depending on the patient's allergies, the other interventions may not occur if it is determined that it is too dangerous for the patient to receive the vaccine.
The patient is being treated with intravenous amphotericin B. What is the nurse's primary intervention? Encourage the patient to drink at least a liter of fluid per shift. Assess blood urea nitrogen and creatinine. Administer with dextrose. Assess the IV site for infiltration.
Assess blood urea nitrogen and creatinine. Amphotericin B is considered highly toxic and can cause nephrotoxicity and electrolyte imbalance, especially hypokalemia and hypomagnesemia (low serum potassium and magnesium levels). Urinary output, blood urea nitrogen, and serum creatinine levels need to be closely monitored.
When should an infant born on March 21 receive recombinant hepatitis B virus vaccine (HepB)? April 4 At Birth May 10 July 19
At Birth Infants should receive monovalent hepatitis B vaccine as a one-time injection.
The nurse is working with a patient who will be traveling to a country where the incidence of malaria is high. The nurse anticipates that the health care provider is most likely to place the patient on which medication? Amantadine HCl Praziquantel Artemether/lumefantrine Atovaquone/proguanil
Atovaquone/proguanil Of the drugs listed, atovaquone/proguanil is the drug of choice for prevention of malaria.
Which instruction should the nurse include in the education of a patient beginning therapy with metronidazole for diarrhea due to a clostridium infection? Take with food. Use sunscreen or wear long sleeves Monitor pulse daily. Avoid alcohol and products containing alcohol.
Avoid alcohol and products containing alcohol. Patients taking metronidazole should avoid alcohol and products containing alcohol.
The nurse instructs a patient with herpes simplex virus-1 (HSV-1) infection to apply acyclovir to oral lesions. Which instruction should the nurse provide in patient teaching to help prevent the transmission of HSV-1? Select all that apply. Wash the applicator in hot soap and water. Avoid applying the ointment to multiple lesions. Touch the ointment with a clean, gloved hand. Apply the ointment with a clean, gloved hand. Keep the ointment handy for touch-ups. Massage the ointment until it disappears.
Avoid applying the ointment to multiple lesions. Touch the ointment with a clean, gloved hand. Apply the ointment with a clean, gloved hand. To help prevent transmission of the virus, the nurse instructs the patient to wear fresh gloves to apply the medication and to touch the container of ointment with a different, clean gloved finger each time ointment is needed. This means that the patient should not touch the lesion and then touch the container because this will contaminate the container with HSV-1. The nurse also instructs the patient to apply ointment to each lesion individually, meaning that the patient should use a fresh surface to move the ointment from the container to the lesion for each lesion. The nurse instructs the patient to consider the gloved finger surface contaminated after touching a lesion. CORRECT
A patient takes isoniazid, rifampin, and ethambutol. Which instruction should the nurse include in patient teaching to prevent the most likely adverse effects of this therapy? (Select all that apply.) Avoid drinking alcoholic beverages. Drink 2 to 3 L of fluid every day. Take these medications with food. Avoid any over-the-counter drugs. Report nausea, vomiting, or itching. Report vision changes or eye pain.
Avoid drinking alcoholic beverages. Avoid any over-the-counter drugs. Report nausea, vomiting, or itching. Report vision changes or eye pain. The most likely adverse effects of this therapy are liver dysfunction and optic neuritis, so the nurse instructs the patient to report nausea, vomiting, and itching and about the importance of avoiding alcohol and other medications that affect the liver adversely. To help prevent irreversible eye damage, the nurse instructs the patient to report visual changes or eye pain to help in the early detection of ophthalmic problems.
A patient who takes isoniazid, rifampin, and streptomycin sulfate complains about nausea, anorexia, and itching. Which serum study is the nurse's priority to help prevent serious organ damage? Bilirubin Glucose Creatinine Uric acid
Bilirubin Taken as monotherapy or in combination, isoniazid, rifampin, and streptomycin sulfate can cause hepatoxicity. Thus, because the patient presents with clinical indicators of liver dysfunction, the nurse should check liver function tests (which include bilirubin) to determine the most likely cause of the patient's complaint. This is the nurse's priority in preventing hepatic dysfunction because early detection of hyperbilirubinemia from liver dysfunction can prevent liver damage with suitable treatment.
The nurse is caring for a patient taking a polymyxin. What should the nurse monitor to identify potential side effects of this medication? Blood urea nitrogen and creatinine Stool guaiac Platelets Hemoglobin and hematocrit
Blood urea nitrogen and creatinine Polymyxins can cause kidney damage. Blood urea nitrogen and creatinine should be closely monitored.
A patient who has hepatic cytomegalovirus infection and renal insufficiency needs antiviral therapy. Which diagnostic test result should the nurse monitor to prevent complications of the antiviral therapy indicated for this patient? Viral load CD4 count CBC with differential Culture
CBC with differential The antiviral therapy indicated for this patient is ganciclovir or valganciclovir. Thus to reduce the risk of neutropenia, thrombocytopenia, and aplastic anemia from therapy, the nurse must evaluate the patient's bone marrow function by monitoring the neutrophil count because one diagnostic test for bone marrow function is the differential count. Because the patient has renal dysfunction, ganciclovir is safer than foscarnet or cidofovir, which can cause renal toxicity.
Which action is the nurse's priority assessment before administering voriconazole? Determine suitability of patient's venous access. Ensure that the patient is 1 hour postprandial. Check the culture for a susceptible fungal species. Gather baseline data on renal and liver function.
Check the culture for a susceptible fungal species. The nurse's priority is to check the culture before administering voriconazole to ensure that the medication is indicated because if a susceptible species of fungus does not grow on the culture, the medication is not indicated, and additional nursing care related to voriconazole is not needed.
What is the primary assessment the nurse should make for a patient who is taking ganciclovir sodium? Complete blood count Bowel elimination Blood urea nitrogen Input and output
Complete blood count Bone marrow suppression is a dose-limiting toxicity of ganciclovir, and a complete blood count should be monitored.
Hypervolemia is most likely to occur after the administration of which drug? Ketoconazole Cosyntropin Methimazole Octreotide
Cosyntropin Cosyntropin, synthetic adrenocorticotropic hormone, stimulates the adrenal cortex to release cortisol. Cortisol is a glucocorticoid that promotes renal reabsorption of sodium, leading to the passive movement of water with sodium.
The patient has been administered a toxoid. The patient is most likely being vaccinated against which disease? Human papillomavirus Diphtheria Hepatitis B Mumps
Diphtheria Vaccination against diphtheria is performed with administration of a toxoid. Human papillomavirus and hepatitis B both require a recombinant viral antigen vaccine; mumps requires a live attenuated virus.
The nurse is caring for a patient who is taking rifampin. The patient has a heart rate of 90 beats/min, blood pressure of 100/89 mm Hg, and red-orange urine. What is the nurse's best action? Collect a urine culture. Document the findings and teach the patient. Discard the first void and start a 24-hour urine collection. Call the health care provider.
Document the findings and teach the patient. Red-orange discoloration of body fluids is a common side effect of rifampin, but it is not harmful and does not indicate infection. There is no need to call the health care provider, collect a urine culture, or start 24-hour urine collection.
The nurse administers fludrocortisone to a patient with acute primary adrenocortical insufficiency. Prevention of which adverse effect of therapy is the nurse's priority? High blood pressure Edema in the lungs Edema of cerebrum Erosion of GI tract
Edema in the lungs Fludrocortisone, a synthetic mineralocorticoid, is indicated in the treatment of primary adrenocortical insufficiency because cortical production of aldosterone, the endogenous mineralocorticoid, is inadequate. Just like aldosterone, fludrocortisone causes sodium and water retention, so the nurse's priority is to prevent pulmonary edema, which is associated with hypervolemia and is likely to impair oxygenation and ventilation.
The nurse assesses a patient with a closed head injury that resulted in trauma to the hypothalamus. Which patient assessment finding is a clinical indicator of hypothalamic dysfunction? Excessive amount of dilute urine Not responding to commands High cerebral perfusion pressure Altered quality of respirations
Excessive amount of dilute urine Hypothalamic dysfunction from trauma can promote antidiuretic hormone (ADH) release from the posterior pituitary gland, resulting in excessive urine output as the kidneys become unable to conserve water.
What nursing diagnosis is a priority for a patient receiving desmopressin (DDAVP)? Risk for injury Fluid volume excess Knowledge deficit Alteration in comfort
Fluid volume excess Desmopressin (DDAVP) is a form of antidiuretic hormone, which increases sodium and water retention, leading to an alteration in fluid volume. Although the other nursing diagnoses may be appropriate, they are not a priority using Maslow hierarchy of needs.
A patient who has primary hypothyroidism receives levothyroxine and regular insulin. For which patient assessment should the nurse monitor to help prevent complications of the pharmacotherapy? Anxiety and warmth Frequent urination Fatigue and edema Intolerance to heat
Frequent urination Levothyroxine can decrease the effectiveness of insulin, so the nurse should assess a patient who receives levothyroxine and insulin for clinical indicators of hyperglycemia, including polyuria. This is because the patient's blood glucose level is likely to increase with the combination therapy, and more insulin will be required to maintain a steady serum glucose level.
The nurse administers a bet- blocker to a patient who has thyroid nodules. Which parameter should the nurse assess to evaluate the therapeutic effect of the pharmacotherapy? Urine output Heart rate Serum glucose level T3 and T4 levels
Heart rate Nodular goiter of the thyroid gland is a form of hyperthyroidism, so a beta-adrenergic blocker such as propranolol is administered to blunt the hypermetabolic state caused by an excessive serum level of thyroid hormone. One of the effects of hyperthyroidism is tachycardia, so the nurse monitors the patient's heart rate to evaluate the therapeutic effect of atenolol, which is given to decrease the heart rate by blocking sympathetic stimulation.
A patient who has herpes genitalis receives a prescription for famciclovir. Which criterion should the nurse use to determine whether the antiviral therapy is effective? The serum is negative for HSV-2. Duration of latency is shortened. Secondary infections are scarce. Herpetic lesions occur less often.
Herpetic lesions occur less often. The nurse instructs the patient who has a herpes simplex-2 (HSV-2) infection that although famciclovir can diminish the physical manifestations of HSV-2 infections, the goal of therapy is to reduce the frequency with which lesions appear.
Which drug should the nurse administer to a patient with adrenal insufficiency to provide what the patient is unable to produce endogenously? Epinephrine Spironolactone Regular insulin Hydrocortisone
Hydrocortisone A patient with adrenal insufficiency lacks an endogenous source of cortisol, so treatment consists of synthetic cortisol in the form of hydrocortisone.
A patient with type 2 diabetes mellitus taking a antidiabetic drug is prescribed somatropin. Which assessment finding should be the nurse's priority? Hypothyroidism Hypercalciuria Hypertension Hypoglycemia
Hypoglycemia Exogenous growth hormone antagonizes insulin secretion to increase the blood glucose, which is a troublesome adverse effect of therapy for a patient with diabetes mellitus because it increases the risk of target organ damage and complicates therapy. In a nondiabetic patient, this increased blood glucose stimulates release of insulin to maintain the blood glucose level within the normal range. In type 2 diabetes mellitus, somatropin can enhance the effects of antidiabetics and can cause hypoglycemia.
Aldosterone is released from the adrenal cortex in response to what? Hypernatremia Hypovolemia Polyuria Bradycardia
Hypovolemia Aldosterone is released by inappropriate sympathetic stimulation in the stress response and in response to hypovolemia, low blood volume, or hypotension to conserve sodium. This results in sodium and water retention, increased blood volume, and increased blood pressure.
The nurse would identify which of the following as examples of passive immunity? Select all that apply. Immune-globulin to provide antibodies against a specific disease Immunizations Antibodies from an outside source, such as the mother's placenta and breast milk Antigen response to a pathogen Exposure to a disease
Immune-globulin to provide antibodies against a specific disease Immune-globulin to provide antibodies against a specific disease One example of natural immunity passively acquired is in infants, who are unable to protect against disease because of immature immune systems but instead require antibodies from an outside source, such as the mother's placenta and breast milk. Another example is receiving an immune-globulin to provide antibodies against a specific disease. Passive acquired immunity is essential when (1) time does not permit active vaccination alone, (2) the exposed individual is at high risk for complications of the disease, or (3) the individual suffers from an immune system deficiency that renders that person unable to produce an effective immune response.
What assessment finding indicates to the nurse that vasopressin has been effective? Increased urine specific gravity Increased serum albumin levels Relief of pain Decreased adrenocorticotropic hormone levels
Increased urine specific gravity Vasopressin causes decreased water excretion in the renal tubule, thus increasing urine specific gravity. It is used to treat diabetes insipidus, which presents with a low urine specific gravity. This medication does not affect serum albumin, decrease adrenocorticotropic hormone levels, or decrease pain.
A patient requires vasopressin after a hypophysectomy. Which patient assessment is used to evaluate the therapeutic effect? Increasing specific gravity Low serum sodium level Low serum potassium Increased serum glucose
Increasing specific gravity After hypophysectomy, the patient lacks the tissue that releases antidiuretic hormone, so to survive, the patient requires vasopressin therapy to conserve water. As the water is conserved, the urine should become increasingly concentrated as less water is excreted in the urine. This continues until a balance is achieved between urine osmolarity and the vasopressin dosage.
The nurse is caring for a patient who has just started taking levothyroxine. What assessment finding is a priority for the nurse to address? Heart rate 55 beats/min Weight gain of 3 pounds in the last week Irritability Intolerance to cold
Irritability Irritability is a symptom of hyperthyroidism. This could be a sign that the medication dose is too high. A lowered heart rate, weight gain, and intolerance to cold could be symptoms of hypothyroidism and are expected in this patient, who just began medication therapy.
A patient must start antitubercular therapy after a sputum culture reveals Mycobacterium tuberculosis, but the sensitivity results from the culture are not available. Which antitubercular agents are classified in the group of drugs used to treat patients at this stage of therapy? Select all that apply. Isoniazid Levofloxacin Rifampin Pyrazinamide Ethambutol Rifabutin
Isoniazid Rifampin Pyrazinamide Ethambutol Rifabutin Isoniazid, rifampin, rifabutin, pyrazinamide, and ethambutol are first-line medications used to treat patients in whom tuberculosis has been diagnosed before the sensitivity results are known; these and other drugs are used in combination to treat M. tuberculosis
Why is desmopressin indicated for a patient who has von Willebrand disease? It lowers plasminogen activator. It inhibits factor X selectively. It increases clotting factor VIII. It prevents platelet aggregation.
It increases clotting factor VIII. Desmopressin is an antifibrinolytic agent that increases clotting factor VIII (von Willebrand factor) and increases plasma concentration of tissue plasminogen activator to promote clot formation.
What makes desmopressin acetate a good choice for the treatment of diabetes insipidus? It has few adverse effects. It is short acting. It is administered topically. It lasts from 5 to 21 hours.
It lasts from 5 to 21 hours. Desmopressin acetate is a good choice for the treatment of diabetes insipidus because it has a long duration of action and is administered intranasally. The smallest effective dosage should be used to prevent water intoxication.
The nurse should teach a patient taking isoniazid to report which clinical indicators of liver toxicity? Increased thirst Itching, nausea Ophthalmic pain Fever, numbness
Itching, nausea Because hepatotoxicity is a serious complication of isoniazid therapy, the nurse instructs the patient to report clinical indicators of liver dysfunction, including nausea, vomiting, itching, and dark urine.
The nurse prepares to administer the initial dose of propylthiouracil to a patient with toxic nodular disease of the thyroid gland. What baseline patient assessment is a priority for the nurse before the start of therapy? Thyroid size Leukocyte count Skin condition Color of urine
Leukocyte count The nurse obtains a white blood cell count to establish baseline data for future comparison because propylthiouracil can cause bone marrow suppression leading to agranulocytosis. This is the nurse's priority baseline patient assessment because agranulocytosis impairs the patient's immune system significantly and increases the risk of severe bacterial and fungal infections.
Which baseline data should the nurse record before administering mebendazole to a patient with a helminth infestation? Select all that apply. Pain level Appetite Balance Bowel sounds Visual acuity Blood disorders
Pain level Appetite Balance Bowel sounds Visual acuity The nurse collects baseline data about the patient's balance, appetite, pain level, and bowel sounds for future comparison when initiating mebendazole therapy because mebendazole can cause dizziness, anorexia, headaches, and diarrhea.
Which individuals should receive tuberculin skin testing? (Select all that apply.) Patients in a residential facility Attendant at an amusement park Individuals in homeless shelters Community home health nurses Students in off-campus housing Inmates of correctional centers
Patients in a residential facility Individuals in homeless shelters Community home health nurses Inmates of correctional centers Individuals who are at high risk for tuberculosis infection include residents and staff of high-risk congregate settings; this includes prisons and jails, nursing homes, hospitals, and other facilities such as homeless shelters and residential facilities for patients with AIDS. Although home health care nurses are not associated with hospitals, as health care workers they are bound to help prevent the transmission of potential pathogens and therefore undergo regular screening for TB.
Which medication is indicated in the treatment of flat, nonsegmented helminths? Pyrantel pamoate Praziquantel Mebendazole Metronidazole
Praziquantel A trematode, or fluke, is a flat, nonsegmented helminth. It can be treated with praziquantel, which acts by increasing the permeability of the fluke's cell membrane to calcium.
The nurse is working with a patient who has been diagnosed with tapeworms. The nurse anticipates that the health care provider is most likely to place the patient on which medication? Amantadine HCl Artemether/lumefantrine Praziquantel Atovaquone/proguanil
Praziquantel Praziquantel is the drug of choice for the treatment of tapeworms.
Prior to the administration of intravenous amphotericin B, what action should the nurse take? Premedicate the patient with an antipyretic, antihistamine, and antiemetic as prescribed. Set up an IV solution with potassium. Administer insulin as prescribed to prevent severe hyperglycemia. Administer intravenous dextrose as prescribed to prevent severe hypoglycemia.
Premedicate the patient with an antipyretic, antihistamine, and antiemetic as prescribed. Almost all patients given intravenous amphotericin B develop fever, chills, nausea and vomiting, and hypotension. Pretreatment with an antipyretic, antihistamine, and antiemetic can minimize or prevent these adverse reactions. There is no need to treat with IV potassium or administer insulin or IV dextrose.
A patient who receives chemotherapy for colon cancer develops malaria. Which antimalarial treatment used to destroy Plasmodium vivax and Plasmodium ovale should be used with great caution for this patient? Primaquine phosphate Quinine SO4 Pyrimethamine Chloroquine HCl
Primaquine phosphate Primaquine phosphate should be used with caution in an immunocompromised patient. Primaquine phosphate can suppress the bone marrow, leading to granulocytopenia, and deficient granulocytes greatly increase the patient's risk for infection. The remaining drugs are not associated with causing bone marrow suppression.
What will the nurse teach a patient who is taking isoniazid (INH)? You will need to take vitamin C to potentiate the action of INH. Multidrug therapy is necessary to prevent the occurrence of resistant bacteria. You should not be on that drug. I will check with the health care provider. Pyridoxine (vitamin B6) will prevent numbness and tingling that can occur when taking isoniazid.
Pyridoxine (vitamin B6) will prevent numbness and tingling that can occur when taking isoniazid. Isoniazid can cause neurotoxicity. Pyridoxine (vitamin B6) is the drug of choice to prevent this adverse reaction. It is not an anti-infective agent and thus will work to destroy the mycobacterium or prevent drug resistance. Vitamin C is not taken with this drug; the drug is appropriate for most patients, and INH with pyridoxine is not multidrug therapy. If the nurse has any concerns about the medication, this should be discussed directly with the health care provider and not with the patient.
A patient is being treated for Enterobius vermicularis infestation with mebendazole. Which parameter should the nurse use to evaluate the therapeutic effectiveness of pharmacotherapy? Normal level of leukocytes Alertness in the daytime Relief from perianal pruritus Fewer diarrhea episodes
Relief from perianal pruritus Pinworm is the common name for the helminth E. vermicularis. Infestation carries very few clinical indicators, although some patients experience perianal itching and excoriation as a result of scratching. As the infestation abates, meaning mebendazole is effective, the itching should improve.
The community health nurse is assessing a child who has a rash. The child is found to have measles. What is the nurse's best action? Take no action; let the disease process run its course. Report the measles to public health officials. Tell the parent to stay away from the child to avoid infection. Take the child to the nearest emergency department for treatment.
Report the measles to public health officials. Health care providers are responsible for reporting cases of vaccine-preventable diseases to public health officials, who then make weekly reports to the Centers for Disease Control and Prevention. These data identify whether an outbreak is occurring and the impact of immunization policies and procedures.
A patient who was born on December 2, 1999, receives the first varicella virus vaccine on May 1, 2010. Which should the nurse provide in patient teaching to protect the patient against the varicella virus? Return for the second injection between May 30 and June 29. Avoid crowds and sick people until the second dose. Take aspirin for injection site pain. Try a cold compress at the injection site for pain.
Return for the second injection between May 30 and June 29. The nurse instructs the patient and family to return for the next injection of the vaccine between 1 and 2 months from the date of the first injection because the second injection is needed to achieve adequate immunity against varicella. After administration of the varicella vaccine, the patient's immune system starts synthesizing antibodies against the varicella virus; the first injection initiates the synthesis of the antibodies, and the second injection augments the host's antibody level to produce adequate immunity.
Which confers active immunity through the administration of a living microorganism? (Select all that apply.) Rubella Herpes zoster Measles disease Hepatitis A
Rubella Herpes zoster Active immunity can be innate or develop from an immune response to the antigen. By administering the herpes zoster and rubella live vaccines, the nurse administers a live, attenuated virus to stimulate the host's production of antibodies; thus, the immune system confers resistance to herpes zoster and rubella after an immunization because the immune system remembers herpes zoster and rubella as antigens, formulates antiherpes zoster and rubella antibodies, and releases these antibodies upon subsequent exposure.
The nurse should monitor a patient taking vasopressin for which clinical indication of water intoxication? Seizures Polyuria Hypotension Polydypsia
Seizures Vasopressin can cause excessive water retention progressing to water intoxication because it has a longer duration of action than vasopressin. Clinical indicators of water intoxication include drowsiness, headache, listlessness, seizures, and coma.
A patient with hyperaldosteronism feels lightheaded with increasing frequency. Which patient assessment finding is the nurse's priority in planning care? Serum sodium 147 mEq/L Moderate peripheral edema Serum potassium 3.0 mEq/L Blood pressure 156/98 mm Hg
Serum potassium 3.0 mEq/L The edema and excess sodium can resolve with the use of spironolactone, a potassium-sparing diuretic. The hypertension can require antihypertensive therapy or can resolve after diuresis if it is due to hypervolemia.
Which of these routes is a mode of transmission for malaria? Select all that apply. Sexual contact Mosquito bite Blood products Droplet spread Airborne Fecal-oral
Sexual contact Mosquito bite Blood products In addition to being spread by infected needles and childbirth, malaria can be spread through sexual contact, blood products, or a bite from an Anopheles mosquito.
The patient is taking an antithyroid medication. Which foods should the nurse teach the patient to avoid eating? Ham and cheese omelet, rye toast with butter, orange juice Chicken salad sandwich with mayonnaise, vegetable soup, milk Hamburger on sesame roll, salad with French dressing, milk Shrimp cocktail, boiled lobster, spinach salad without dressing, water
Shrimp cocktail, boiled lobster, spinach salad without dressing, water Seafood contains high amounts of iodine. The other choices do not. The nurse instructs a patient taking an antithyroid medication to avoid foods high in iodine.
The patient has been administered a live virus as a vaccine. The patient is most likely being vaccinated against which disease? Smallpox Anthrax Diphtheria Tetanus
Smallpox A live virus is included in the smallpox vaccine. Toxoids are used to immunize against both tetanus and diphtheria. Anthrax requires a vaccine of inactivated bacteria.
Which information should the nurse provide to a patient receiving tetanus toxoid? Soreness at the injection site is a common reaction. Lifetime immunity is achieved from this injection. Tetanus toxoid must be repeated weekly for 4 weeks. Increase the fluid and fiber in your diet to prevent constipation.
Soreness at the injection site is a common reaction. Myalgia at the injection site is a common side effect of tetanus toxoid. There is no need to repeat the toxoid weekly for 4 weeks, and the vaccine should not produce constipation. The toxoid usually is given approximately every 10 years.
A patient who will be traveling to a malaria-infested country is receiving instructions on the prophylactic use of chloroquine. What priority instruction will the nurse give the patient? Take the medication for 4 weeks. Start the medication 2 weeks before the trip. After leaving the affected area, take the medication for a year. Do not take the medication until you are certain you do not have the disease.
Start the medication 2 weeks before the trip. Treatment for malaria prophylaxis is usually started 2 weeks before travel and continued for 8 weeks after travel is completed.
The nurse administers a nystatin to a patient who has AIDS-associated candidiasis of the mouth. Which instruction should the nurse include in patient teaching? Insert the medication into the vagina. Chew the tablet, sip water, and swish. Swish and swallow the medication. Allow the discoid to dissolve slowly.
Swish and swallow the medication. To administer nystatin the nurse instructions the patient to siwsh the medication around the mouth and then swallow it.
Which instruction should the nurse include in the education of a patient beginning therapy with ivermectin for a helminth infection? Use sunscreen or wear long sleeves. Take on an empty stomach. Monitor pulse daily. Take with food.
Take on an empty stomach. Ivermectin should be taken on an empty stomach with water. The pulse does not need to be monitored, and the drug does not produce photosensitivity.
What should the nurse include in the plan of care for the patient beginning prednisone therapy? Administer the medication early evening to coincide with the natural secretion pattern of the adrenal cortex. Take the medication only every other day to decrease the risk of adrenal hyperplasia. Plan to keep a strict, unchanging schedule to prevent adverse reactions. Take the medication with food to diminish the risk of gastric irritation.
Take the medication with food to diminish the risk of gastric irritation. Glucocorticoids can cause gastric distress and should be administered with food. The normal circadian secretion of the adrenal cortex is early morning to wake the person up, not early evening. These medications should be tapered off slowly to prevent adrenal crisis. The patient takes the medication daily.
A patient taking amantadine complains of depression and dizziness. What intervention will the nurse perform first? Take the patient's blood pressure sitting and standing. Call the health care provider. Evaluate the patient for other central nervous system effects from the medication. Order a consult for counseling.
Take the patient's blood pressure sitting and standing. The side effects and adverse reactions to amantadine include central nervous system effects, such as insomnia, depression, anxiety, confusion, and ataxia; orthostatic hypotension; neurologic problems, such as weakness, dizziness, and slurred speech; and gastrointestinal disturbances, such as anorexia, nausea, vomiting, and diarrhea. The nurse should evaluate the patient for orthostatic hypotension first to address safety issues.
A patient is taking rifabutin with other antitubercular agents after standard first-line therapy fails. The patient's family of six people live with the brother's family in a small house. What is the most important patient teaching for the nurse to provide? Teach the household about infection control. Tell the patient to report signs of liver dysfunction. Stress the need to eat a well-balanced diet. Emphasize the need for adhering to therapy.
Teach the household about infection control. Neutropenia is a life-threatening adverse effect of rifabutin therapy, meaning that the patient is at high risk for infection; the nurse's priority patient teaching is about infection control because neutropenia is more likely to result in severe adverse effects or patient death more quickly than nonadherence to therapy. Unless the entire household participates in and adheres to infection-control measures to prevent the transmission of pathogens, the patient is likely to contract other infections in a small house due to crowded conditions.
A patient is diagnosed with an oral candidal infection. Which is the best intervention for the nurse to perform? Teach the patient how to take nystatin. Administer valacyclovir hydrochloride and monitor lips and gums. Instruct the patient to brush her teeth and gargle hourly. Start an IV so the patient does not have to eat by mouth.
Teach the patient how to take nystatin. Nystatin is an antifungal ointment that is used for a variety of candidal infections. The patient needs to be taught how to "swish and swallow" to treat this infection. There is no need to brush the teeth hourly or administer Valtrex, and starting an IV is an extreme measure.
The nurse is caring for several patients who will be receiving glucocorticoid therapy. Which patient should be assessed first based on clinical diagnosis? Recovering from septic shock Uncontrolled diabetes mellitus Chronic rheumatoid arthritis Exacerbation of asthma controlled using oxygen therapy.
Uncontrolled diabetes mellitus A common side effect of steroid therapy is hyperglycemia. The patient with uncontrolled diabetes mellitus could suffer a severe hyperglycemic episode. The other clinical diagnoses presented do not required immediate action.
What will the nurse monitor to evaluate the effectiveness of antiviral agents administered to treat human immunodeficiency virus infection? Viral load Megakaryocyte counts Lymphocyte counts Red blood cell counts
Viral load All antiretroviral agents work to reduce the viral load, which is the number of viral RNA copies per milliliter of blood.
An adult patient says, my children are being vaccinated. Are there any that I should have? What is the nurse's best reply? No, there are no vaccines that an adult needs. Yes, you will need the same ones your children need. No, you have probably had all of the childhood diseases by now. Yes, you need to remain current on several vaccines; check with your provider.
Yes, you need to remain current on several vaccines; check with your provider. While much emphasis is placed on regularly immunizing infants and children, adult immunizations are frequently overlooked. However, they are equally important to the health and well-being of this population.
The nurse is preparing to administer the tetanus vaccine to the patient. The nurse recognizes that the patient will be receiving recombinant viral antigen. a toxoid. inactivated viral antigen. inactivated bacteria.
a toxoid. The vaccine against tetanus is a toxoid.
CH 46 online course ?s
below
Ch 27 online course ?s
below
Ch 27 resources ?s
below
