Exam 2 Practice Questions- PHARM
The nurse is reviewing instructions for vaginal antifungal drugs with a patient. Which statement by the nurse is an appropriate instruction regarding these drugs? "The medication can be stopped when your symptoms are relieved." "Discontinue this medication if menstruation begins." "Daily douching is part of the treatment for vaginal fungal infections." "Abstain from sexual intercourse until the treatment has been completed and the infection has resolved."
"Abstain from sexual intercourse until the treatment has been completed and the infection has resolved."
A few months later, it is determined that Jane is not responding to treatment and is now prescribed isotretinoin. Which statement will the nurse include when teaching Jane about isotretinoin therapy? "Call your prescriber immediately if you experience any signs of depression." "If you become pregnant, the dose of isotretinoin will be cut in half." "Isotretinoin is administered by subcutaneous injection directly into the acne areas." "Isotretinoin should not be used with any form of birth control."
"Call your prescriber immediately if you experience any signs of depression." *oral product *must be used w/ 2 forms of BC
A young adult calls the clinic to ask for a prescription for "that new flu drug." He says he has had the flu for almost 4 days and just heard about a drug that can reduce the symptoms. What is the nurse's best response to his request? "Now that you've had the flu, you will need a booster vaccination, not the antiviral drug." "We will need to do a blood test to verify that you actually have the flu." "Drug therapy should be started within 2 days of symptom onset, not 4 days." "We'll get you a prescription. As long as you start treatment within the next 24 hours, the drug should be effective."
"Drug therapy should be started within 2 days of symptom onset, not 4 days."
A female patient has been taking isotretinoin (Amnesteem) for 3 months. During a follow-up appointment, which statement by the patient would be of highest concern to the nurse? "I am using two forms of contraception while on this drug." "I have been feeling rather down and lonely lately." "I wish I didn't have to be on this medication." "It's scary to know that this drug can cause birth defects."
"I have been feeling rather down and lonely lately."
Jane is a 17-year-old patient who is being seen in the dermatology clinic for treatment of acne vulgaris. The nurse practitioner prescribes benzoyl peroxide topically four times a day. Jane tells the nurse that she wants take the drug more frequently so the acne will go away quickly. What information will the nurse provide to Jane? "Improvement is usually seen in 1 week." "If you want faster results, a pill form of benzoyl peroxide will be used." "Overuse of this drug can result in painful, reddened skin." "Benzoyl peroxide causes the skin to blister or swell to clear the acne."
"Overuse of this drug can result in painful, reddened skin."
A teenage boy is taking tretinoin (Retin-A) for acne. Which statement will the nurse include in the teaching plan? "Avoid foods that are heavy in salt and oils." "This drug may cause increased redness of your skin." "Try using an abrasive cleanser to remove old skin layers." "Being out in the sunlight will help your skin heal."
"This drug may cause increased redness of your skin."
A female patient will be starting therapy with oral isotretinoin (Amnesteem) as part of treatment for severe acne, and the nurse is providing teaching. Which teaching point will the nurse include in her teaching plan about isotretinoin? "You will have to use two contraceptive methods while on this drug." "You must avoid sexual activity while on this drug." "You will have to avoid pregnancy for 2 weeks after taking this drug." "If you are taking an oral contraceptive, you may take this drug."
"You will have to use two contraceptive methods while on this drug."
Fifteen minutes after an infusion of amphotericin B was started, the patient begins to complain of fever, chills, muscle pain, and nausea. His heart rate has increased slightly, but his blood pressure is down to 100/68 mm Hg. What is the nurse's PRIORITY? Notify the prescriber immediately. Recognize an impending anaphylactic reaction and stop the infusion. Assess for other symptoms of this expected infusion-related reaction. Slow the infusion to reduce these adverse effects
*Assess for other symptoms of this expected infusion-related reaction. D is partly right = 2-6 hours, infusion pump, must be diluted, no cloudy IV solution! Make sure you have premedication order!! (minimize infusion-related reactions)
The nurse is preparing to transfuse a patient with a unit of packed red blood cells (PRBCs). Which patient would be best treated with this transfusion? A patient with a coagulation disorder A patient with severe anemia A patient who has lost a massive amount of blood after an accident A patient who has a clotting-factor deficiency
A patient with severe anemia Coag disorders/ CF deficiencies = FFP Massive blood loss = whole blood
A patient who is diagnosed with genital herpes is taking topical acyclovir. The nurse will provide which teaching for this patient? (Select all that apply.) a. "Be sure to wash your hands thoroughly before and after applying this medicine." b. "Apply this ointment until the lesion stops hurting." c. "Use a clean glove when applying this ointment." d. "If your partner develops these lesions, then your partner can also use the medication." f. "You will need to avoid touching the area around your eyes." g. "You will have to practice abstinence when these lesions are active."
A, C, E, F
Which adverse effects will the nurse expect in a teenage patient who is using topical tretinoin (Retin-A)? (Select all that apply.) A. Crusted skin B. Itching C. Altered skin pigmentation D. Rosacea E. Red and edematous blisters
A. Crusted skin C. Altered skin pigmentation E. Red and edematous blisters
Intravenous (IV) therapy is ordered for a patient with a serum sodium of 150 mEq/L. Which of the following does the nurse anticipate administering? A.0.45% NS B.0.25% NS C.3% NS D.5% NS
A.0.45% NS- ISOTONIC solution Hypertonic saline injections (3% and 5%) are contraindicated in the presence of increased, normal, or only slightly decreased sodium concentrations. Conversely, infusing very low hypotonic saline (0.25% NaCl) is not recommended because it can cause hemolysis of the red blood cells.
A patient is taking linaclotide (Linzess) to treat irritable bowel syndrome (IBS). The nurse will monitor this patient for which adverse effect? Chest pain Chronic constipation Abdominal pain Elevated blood glucose levels
Abdominal pain Common adverse effects of linaclotide (Linzess) are diarrhea, abdominal pain, and flatulence.
During a regular follow-up visit, Jane points out a sore that she has developed on her mouth. She is diagnosed with herpes simplex. Which medication does the nurse anticipate Jane will receive? Miconazole (Monistat) Acyclovir (Zovirax) Clotrimazole (Lotrimin) Anthralin (Anthra-Derm)
Acyclovir (Zovirax)
A patient is taking nystatin (Mycostatin) in an oral troche form for oral candidiasis. Which instruction is correct? Allow the troche to dissolve slowly in the mouth. Swish the medication in the mouth and then swallow it. Chew the troche thoroughly to activate the medication. Swallow the troche whole without chewing.
Allow the troche to dissolve slowly in the mouth. (can take up to 15 minutes)! Do NOT chew!
A woman suffered a second-degree burn of the skin on her arm and hand while cooking breakfast. After examination in the urgent care center, silver sulfadiazine cream (Silvadene) is ordered for the burned area. The nurse will apply the medication using which procedure? Gently patting a moderate amount over the burned area Massaging the cream completely into the wound Applying a thick layer over the burned area, and then leaving the area open Applying a thin layer with a sterile, gloved hand to clean and débrided areas
Applying a thin layer with a sterile, gloved hand to clean and débrided areas
A patient with late-stage HIV infection also has Pneumocystis jirovecii pneumonia. The nurse anticipates treatment with which medication for this pneumonia? Ivermectin (Stromectol) Atovaquone (Mepron) Praziquantel (Biltricide) Metronidazole (Flagyl)
Atovaquone (Mepron)
The nurse is administering an amphotericin B infusion. Which actions by the nurse are appropriate? (Select all that apply.) a. Administering the medication by rapid IV infusion b. Discontinuing the drug immediately if the patient develops tingling and numbness in the extremities c. If adverse effects occur, reducing the IV rate gradually until they subside d. Using an infusion pump for IV therapy e. Monitoring the IV site for signs of phlebitis and infiltration f. Administering premedication for fever and nausea g. Knowing that the intravenous solution for amphotericin B will be cloudy h. Knowing that muscle twitching may indicate hypokalemia
B, D, E, F *muscle WEAKNESS, not twitching, indicates hypokalemia
Which solution should the nurse administer with packed red blood cells? A.Lactated Ringer's solution B.0.9% sodium chloride C.D5W D.0.45% sodium chloride
B.0.9% sodium chloride *ONLY solutions given w/ blood products! (everything else will lyse RBCs)
A patient is taken to the trauma unit after a motorcycle accident. It is estimated that he has lost 30% of his blood volume and he is in hypovolemic shock. The nurse anticipates a transfusion with which blood product? A.PRBCs B.Whole blood C.Cryoprecipitate D.FFP
B.Whole blood Whole blood is more beneficial in cases of extreme loss of blood volume (more than 25%).
The nurse is preparing an infusion of amphotericin B for a patient who has a severe fungal infection. Which intervention is appropriate regarding the potential adverse effects of amphotericin B? Discontinuing the infusion immediately if fever, chills, or nausea occur Gradually increasing the infusion rate until the expected adverse effects occur If fever, chills, or nausea occur during the infusion, administering medications to treat the symptoms Before beginning the infusion, administering an antipyretic and an antiemetic drug
Before beginning the infusion, administering an antipyretic and an antiemetic drug
A patient who is HIV-positive has been receiving medication therapy that includes zidovudine (Retrovir). However, the prescriber has decided to stop the zidovudine because of its dose-limiting adverse effect. Which of these conditions is the dose-limiting adverse effect of zidovudine therapy? Retinitis Renal toxicity Hepatotoxicity Bone marrow suppression
Bone marrow suppression
A patient with active HIV has been taking zidovudine (Retrovir). Which potential adverse effect may limit the length of time this medication can be taken? Lactic acidosis Bone marrow suppression Hepatomegaly Fatigue
Bone marrow suppression
A patient who is diagnosed with genital herpes is taking topical acyclovir, and the nurse is providing instructions about adverse effects. The nurse will discuss which adverse effects of topical acyclovir therapy? Insomnia and nervousness Temporary swelling and rash Burning when applied This medication has no adverse effects.
Burning when applied
Which of the following statements regarding colloid administration does the nurse identify as being true? A.Colloids enhance the oxygen-carrying capacity of the blood. B. Colloids increase the coagulation properties of blood. C. Dextran therapy can cause anaphylaxis or renal failure. D. Colloids are contraindicated in the treatment of hypovolemia.
C. Dextran therapy can cause anaphylaxis or renal failure. -Colloids do not have O2 or clotting factors (only blood products) -colloids contraindicated in hypervolemia
A patient is infected by invasive aspergillosis, and the medical history reveals that the patient has not been able to tolerate several antifungal drugs. The nurse anticipates an order for which medication to treat this infection? Fluconazole (Diflucan) Micafungin (Mycamine) Caspofungin (Cancidas) Nystatin (Mycostatin)
Caspofungin (Cancidas) Caspofungin is used for treating severe infection by Aspergillus species (invasive aspergillosis) in patients who are intolerant of or refractory to other drugs.
A patient is receiving an infusion of fresh frozen plasma. Based on this order, the nurse interprets that this patient has which condition? Hypovolemic shock Anemia Coagulation disorder Previous transfusion reaction
Coagulation disorder
A patient is admitted to the hospital for possible septicemia. He has a large pressure ulcer on his heel that is open and includes necrotic tissue. However, his prothrombin time/international normalized ratio (PT/INR) values are too high to permit surgical débridement at this time. The nurse expects that which wound-care product will be used to treat the wound? Cadexomer iodine (Iodosorb) Biafine topical emulsion Povidone-iodine (Betadine) Collagenase (Santyl)
Collagenase (Santyl)
A patient has an infected stage II pressure ulcer that contains some necrotic tissue and some normal, healing granulation tissue. The patient is taking warfarin (Coumadin). Which product would be most appropriate for wound care? Sodium hypochlorite (Dakin's solution) Hydrogen peroxide Collagenase (Santyl) Sterile water
Collagenase (Santyl)- good for patients taking anticoagulants
During an intravenous (IV) infusion of amphotericin B, a patient develops tingling and numbness in his toes and fingers. What will the nurse do first? Discontinue the infusion immediately. Reduce the infusion rate gradually until the adverse effects subside. Administer the medication by rapid IV infusion to reduce these effects. Nothing; these are expected side effects of this medication.
Discontinue the infusion immediately. *vital signs must be monitored frequently to assess for adverse reactions such as cardiac dysrhythmias, visual disturbances, paresthesias (numbness or tingling of the hands or feet), respiratory difficulty, pain, fever, chills, and nausea. STOP infusion if any of these present!
During an infusion of albumin, the nurse monitors the patient closely for the development of which adverse effect? Hypernatremia Dehydration Fluid volume overload Transfusion reaction
Fluid volume overload *esp in those at risk for HF
A 55-year-old obese patient was diagnosed with candidiasis in the skin folds under her breasts. When the nurse sees her at a follow-up visit 2 months later, she complains that it has returned. She said she applied the medicine for 1 week and stopped because the itching stopped and the cream was messy. Which statement is true regarding fungal infections of the skin? Fungal infections often require prolonged therapy. The patient has a new infection now. The patient needs to apply a dressing if the cream is too messy. This infection will probably never be cured.
Fungal infections often require prolonged therapy.
A patient who has undergone a lung transplant has contracted cytomegalovirus (CMV) retinitis. The nurse expects which drug to be ordered for this patient? Acyclovir (Zovirax) Ganciclovir (Cytovene) Ribavirin (Virazole) Amantadine (Symmetrel)
Ganciclovir (Cytovene)
If a patient is taking fluconazole (Diflucan) with an oral anticoagulant, the nurse will monitor for which possible interaction? Reduced action of oral anticoagulants Increased effects of oral anticoagulants Hypokalemia Decreased effectiveness of the antifungal drug
Increased effects of oral anticoagulants "azole" antifungal drugs increase effects of anticoagulants
The nurse is administering intravenous acyclovir (Zovirax) to a patient with a viral infection. Which administration technique is correct? Infuse intravenous acyclovir slowly, over at least 1 hour. Infuse intravenous acyclovir by rapid bolus. Refrigerate intravenous acyclovir. Restrict oral fluids during intravenous acyclovir therapy.
Infuse intravenous acyclovir slowly, over at least 1 hour.
A patient has been treated with alosetron (Lotronex) for severe irritable bowel syndrome (IBS) for 2 weeks. She calls the clinic and tells the nurse that she has been experiencing constipation for 3 days. The nurse will take which action? Advise the patient to increase intake of fluids and fiber. Advise the patient to hold the drug for 2 days. Instruct the patient to stop taking the drug and to come to the clinic right away to be evaluated. Instruct the patient to continue the alosetron and to take milk of magnesia for the constipation.
Instruct the patient to stop taking the drug and to come to the clinic right away to be evaluated. *Alosetron must be discontinued immediately if constipation or signs of ischemic colitis occur.
The nurse administers maraviroc (Selzentry) to a patient with HIV infection. It is most important for the nurse to monitor which of the following? CD4 count Bone marrow suppression Urinary output Liver function tests
Liver function tests
Before starting treatment with antiprotozoal therapy, it is most important for the nurse to assess the patient's baseline? Blood sugar Blood pressure QT interval Liver function
Liver function- renal and liver function most important for antiprotozoals
A patient has developed an aspergillosis infection. Which tissue does the aspergillosis affect? Skin Nails Blood Lungs
Lungs- disease caused by fungus/ mold called aspergillus - immunocompromised patients at risk!
The nurse is assessing a patient who has been diagnosed with MRSA on the right arm. The nurse anticipates use of which medication to treat the MRSA? Bacitracin Neomycin Polymyxin B Mupirocin (Bactroban)
Mupirocin (Bactroban)
A child has been diagnosed with impetigo, a skin infection. The nurse anticipates that which drug will be used to treat this condition? Spinosad (Natroba) Nystatin (Mycostatin) Acyclovir (Zovirax) Mupirocin (Bactroban)
Mupirocin (Bactroban) Mupirocin (Bactroban) is used on the skin for treatment of staphylococcal and streptococcal impetigo.
When monitoring a patient for signs of hypokalemia, the nurse looks for what early sign? Seizures Cardiac dysrhythmias Diarrhea Muscle weakness
Muscle weakness Also early signs- hypotension, lethargy, mental confusion, nausea (cardiac dysrhythmias are a late sign)
A patient with a severe fungal infection has orders for voriconazole (Vfend). The nurse is reviewing the patient's medical record and would be concerned if which assessment finding is noted? Decreased breath sounds in the lower lobes Patient is also taking quinidine History of type 2 diabetes Potassium level of 4.0 mEq/L
Patient is also taking quinidine Voriconazole is contraindicated when co-administered with certain other drugs metabolized by the cytochrome P-450 enzyme 3A4 (e.g., quinidine) because of the risk for inducing serious cardiac dysrhythmias.
Which statement should the nurse include when teaching the patient about indinavir (Crixivan) therapy? The drug must be taken with food. Patients taking the drug should be encouraged to drink at least 48 ounces of liquid daily. This drug is best absorbed in an alkaline environment. Indinavir decreases CD4 cell counts.
Patients taking the drug should be encouraged to drink at least 48 ounces of liquid daily.
A patient with HIV infection is seen in the clinic. The nurse notes the patient is experiencing weight loss, chronic diarrhea, fever, and dropping CD4 counts. The nurse anticipates the patient is in which stage of HIV infection? Stage 1 Stage 2 Stage 3 Stage 4
Stage 3 S/S of moderate symptoms of disease
Which of the following drugs does the nurse include when teaching caregivers about treatment of neonates with RSV? Telbivudine (Tyzeka) Sofosbuvir (Solvaldi) Ganciclovir (Cytovene) Ribavirin (Virazole)
Ribavirin (Virazole)
During therapy with amphotericin B, the nurse will monitor the patient for known adverse effects that would be reflected by which laboratory result? Serum potassium level of 2.7 mEq/L Serum potassium level of 5.8 mEq/L White blood cell count of 7000 cells/mm3 Platelet count of 300,000/microliter
Serum potassium level of 2.7 mEq/L The nurse needs to monitor for hypokalemia, a possible adverse effect of amphotericin B. The other options are incorrect.
An 82-year-old woman is unable to take the influenza vaccine because of allergies, but she has been exposed to the virus through a family reunion. She does not yet have symptoms of the flu. Which option would be best for her? She should receive the flu vaccine as soon as possible. She should receive zanamivir (Relenza) in the inhalation form. She should begin oral oseltamivir (Tamiflu) therapy when symptoms begin. She should begin oral oseltamivir (Tamiflu) therapy as soon as possible.
She should begin oral oseltamivir (Tamiflu) therapy as soon as possible. *can be used prophylaxis
A patient is receiving a ribavirin (Virazole) aerosol treatment. Which precaution is important for the pregnant health care provider? No special precautions are needed. Wearing a mask while in the room during the treatment. Staying out of the room during the aerosol treatment. Limiting exposure to the aerosol treatment to a maximum of 15 minutes per shift.
Staying out of the room during the aerosol treatment.
A woman who is taking isotretinoin calls the office to say that she thinks she may be pregnant. What will the nurse instruct the patient to do first? Stop the isotretinoin immediately. Reduce the dosage of the isotretinoin to every other day. Switch to tretinoin (retinoic acid). Consult an obstetrician.
Stop the isotretinoin immediately.
A patient asks about using minoxidil (Rogaine) for hair thinning. Which statement about minoxidil is accurate? The product is applied once daily in the morning. Systemic absorption of topically applied minoxidil is rare. Results may be seen as soon as 2 weeks after beginning therapy. Systemic absorption may cause tachycardia, fluid retention, and weight gain.
Systemic absorption may cause tachycardia, fluid retention, and weight gain. -applied 2x daily -results may not be seen for 4 months -systemic effects may result bc of absorption
A patient with an intestinal infection that is positive for the Giardia lamblia organism will be taking an antiprotozoal drug. The nurse will include which information in the teaching plan for this patient? The urine may become dilute and pale during therapy. Taking the medications with food reduces gastrointestinal upset. The medications should be taken on an empty stomach. The drugs may be discontinued once the diarrhea subsides.
Taking the medications with food reduces gastrointestinal upset.
A patient is diagnosed with onychomycosis. The nurse anticipates use of which medication for the treatment of this condition? Terbinafine (Lamisil) Voriconazole (Vfend) Fluconazole (Diflucan) Amphotericin B (Amphocin, Fungizone)
Terbinafine (Lamisil) - tablet form used primarily to treat onychomycoses of fingernails or toes *fungal nail infection *can be cleared more quickly than with a topical form
When teaching patients about treatment of viral infection with acyclovir (Zovirax), which of the following statements will the nurse include? The drug is used mainly to suppress the replication of HSV-1, HSV-2, and VZV. Acyclovir (Zovirax) is only effective for initial viral infections Acyclovir (Zovirax) is available in topical form only Acyclovir (Zovirax) is taken once daily
The drug is used mainly to suppress the replication of HSV-1, HSV-2, and VZV. *both initial and recurrent *oral, topical, and injectable form
A patient is receiving amphotericin B lipid complex. The nurse knows which as an advantage of the lipid formulations of this drug? They have a lower cost. They can be administered quickly. They take longer to be absorbed. They cause fewer adverse effects.
They cause fewer adverse effects.
After a severe auto accident, a patient has been taken to the trauma unit and has an estimated blood loss of more than 30% of his blood volume. The nurse prepares to administer which product? Albumin Whole blood Packed red blood cells Fresh frozen plasma
Whole blood
When reviewing the antiviral medications oseltamivir (Tamiflu) and zanamivir (Relenza) used for treatment of the flu, which of the following statements should the nurse include? These drugs are effective only for influenza A These drugs decrease the effects of the flu by 12 hours Zanamivir is currently indicated only for treatment of active influenza The most commonly reported adverse events with oseltamivir are diarrhea, nausea, and sinusitis
Zanamivir is currently indicated only for treatment of active influenza *effective for A + B, decrease effects by several days
The nurse is providing counseling to a woman who is HIV positive and has just discovered that she is pregnant. Which anti-HIV drug is given to HIV-infected pregnant women to prevent transmission of the virus to the infant? Acyclovir (Zovirax) Zidovudine (Retrovir) Ribavirin (Virazole) Foscarnet (Foscavir)
Zidovudine (Retrovir)
Admin 300 mL platelets over which of the following infusion times: a. within 30 min/unit b. within 60 min/unit c. within 2 hr/unit d. within 4 hr/unit
a. within 30 min/unit *platelets fragile, prevent clumping
What values to monitor on Amphotericin B? SATA: a. albumin b. amylase c. potassium d. hematocrit e. creatinine
c. potassium d. hematocrit e. creatinine *causes hypokalemia, bone marrow suppression, nephrotoxicity
