NCLEX Pharm: Infectious disease and Respiratory

What is the minimum amount of time vanco can be infused over?

the minimum time vanco can be infused over is 60 minutes

A community health nurse is preparing to administer influenza vaccines. Which clients can safely receive the live-attenuated, intranasal influenza vaccine?

1) A 3 year old who is afraid of needles 2) 24 year old patient who is 6 weeks PP

Which medication prescriptions should the nurse question?

1) Cephalexin for the patient with severe allergy to penicillin 2) Ibuprofen for a patient with asthma 3) Propanolol for a patient with asthma - Those with an allergy to penicillin can have a cross-sensitivity to cephalosporins. - Nonselective beta blockers are contraindicated in clients with asthma. - ACE inhibitors are protective for diabetic nephropathy.

What is the therapeutic range of theophylline?

10-20

When are peak drug levels taken with theophylline?

30 mins after adminsitration

What are the major adverse effects of theophylline?

Seizures and life threatening arrhythmias

A community health nurse evaluates several clients' vaccination status. Which clients would the nurse recommend receive the influenza vaccine injection?

A patient with newly diagnosed HIV A 9 month old child with no problems 75 year old is ESRD 45 year old caretaker of elderly person 5 year old with congenital heart defect *all patients greater than 6 months in age should get the vaccine

A client with asthma was recently prescribed fluticasone/salmeterol. After the client has received instructions about this medication, which statement would require further teaching by the nurse?

At the first sign of an asthma attack, I will take with medication - It is used for long-term control of asthma but not for acute attacks.

The nurse is preparing to administer the fourth dose of vancomycin IVPB to a client with infective endocarditis. Which intervention does the nurse anticipate?

Drawing a trough level just before administration of the next dose

What can ethambutol cause?

Ethambutol causes ocular toxicity, and clients will need frequent eye examinations.

The nurse is assessing a client diagnosed with tuberculosis who started taking rifapentine a week ago. Which statement by the client warrants further assessment and intervention by the nurse?

I do not want to get pregnant, so I restarted my birth control last month - Clients taking rifampin or rifapentine (Priftin) as part of antitubercular combination therapy should be taught to prevent pregnancy with non-hormonal contraceptives -notify the health care provider of any signs or symptoms of hepatotoxicity (eg, jaundice, fatigue, weakness, nausea, anorexia) - expect red-orange-colored body secretions.

What type of medication should be given to patients with COPD?

In general, sedatives (eg, narcotics, benzodiazepines) can also depress the respiratory center and effort; therefore, they should not be given to clients with respiratory diseases (eg, asthma, COPD).

What are other side effects of isoniazid?

Isoniazid causes hepatotoxicity and peripheral neuropathy

What is acetylcysteine?

Mucolytic - Used in nebulizer - Must be given with a broncholilator to prevent suffocation - inhaled to help loosen thick respiratory secretions. ***Used in cyctic fibrosis***

What is the normal vanco trough level?

The normal therapeutic level of vancomycin is 10-20 mg/L (6.9-13.8 µmol/L)

Who should not be given the intranasal influenza vaccine?

should not be given to clients who are immunocompromised, pregnant, or age <2 years.

The home health nurse reviews the laboratory results for 4 clients. Which laboratory value is most important for the nurse to report to the health care provider?

A patient with RA taking adalimumab has a WBC count of 14,000 - Adalimumab (Humira), etanercept (Enbrel), and infliximab (Remicade) are common tumor necrosis factor inhibitor, biologic disease-modifying antirheumatic drugs. Major adverse effects include immunosuppression and infection.

The nurse is preparing medication for 4 clients on a respiratory medical-surgical unit. Which situation would prompt the nurse to clarify the prescribed treatment with the health care provider?

A patient with bronchospasm who is due to receive nebulized acetylcysteine - Bronchospasm is a side effect of this drug

What category is the drug tiotropium (Spiriva) in?

Anticholinergic - can't see, can't pee, can't spit, can't shit

The hospice nurse is caring for an actively dying client who is unresponsive and has developed a loud rattling sound with breathing ("death rattle") that distresses family members. Which prescription would be most appropriate to treat this symptom?

Atropine SL drops - Anticholinergic medications such as transdermal scopolamine or atropine sublingual drops effectively treat this symptom by drying up the excess secretions.

A nurse has received new medication prescriptions for a client admitted with hypertension and an exacerbation of chronic obstructive pulmonary disease. Which prescription should the nurse question?

Codeine - Codeine is a narcotic analgesic used for acute pain or as a cough suppressant. Depressing the cough reflex can cause an accumulation of secretions in the presence of chronic obstructive pulmonary disease (COPD), leading to respiratory difficulty.

A client with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia has been receiving IV vancomycin for the last 3 days. Which blood test trend is most important for the nurse to review when preparing to administer this medication?

Creatinine levels - Creatinine levels should be closely monitored for signs of nephrotoxicity in the client receiving IV vancomycin.

The nurse is reviewing discharge instructions with a client going home on linezolid therapy for a vancomycin-resistant enterococcus infection. Which client statement requires further teaching?

I can restart paroxetine once I get home - Linezolid has monoamine oxidase inhibitor (MAOI)-type properties; concurrent use with selective serotonin reuptake inhibitors (SSRIs) (eg, paroxetine, fluoxetine, sertraline) increases the risk of serotonin syndrome,

The nurse reinforces medication teaching to a client prescribed metronidazole. Which client statement indicates a need for further education?

I need to decrease the amount of alcohol I drink while taking this medication - Clients prescribed metronidazole are instructed to abstain from using alcohol during, and for 3 days after, therapy, as it may cause flushing, headaches, nausea, vomiting, and abdominal cramping. - This drug may cause a harmless metallic taste

The nurse is teaching a client with advanced chronic obstructive pulmonary disease who was prescribed oral theophylline. Which client statement indicates that additional teaching is required?

I take cimetidine instead of omeprazole for heartburn - medications that increase serum theophylline levels (eg, cimetidine, ciprofloxacin) and can cause toxicity of the drug

A client with bronchial asthma and sinusitis has increased wheezing and decreased peak flow readings. During the admission interview, the nurse reconciles the medications and notes that which of the following over-the-counter medications taken by the client could be contributing to increased asthma symptoms?

Ibuprofen 400 mg PO orally every 6 hours for pain as needed - Ibuprofen, aspirin, and beta blockers are common over-the-counter anti-inflammatory drugs that can cause bronchospasm in some clients with asthma.

A client is having a severe asthma attack lasting over 4 hours after exposure to animal dander. On arrival, the pulse is 128/min, respirations are 36/min, pulse oximetry is 86% on room air, and the client is using accessory muscles to breathe. Lung sounds are diminished and high-pitched wheezes are present on expiration. Based on this assessment, the nurse anticipates the administration of which of the following medications?

Inhaled albuterol neb Q 20 mins Inhaled ipratropium neb Q20 mins IV methlyprednisolone

The nurse is preparing to administer IV cefazolin to a client with cellulitis. The client's allergies are listed as amoxicillin, ciprofloxacin, and sulfa drugs. What should the nurse do first?

Inquire about type of allergic reaction - A client with a penicillin allergy may experience a cross-sensitivity reaction to cephalosporin antibiotics (eg, cefazolin, cephalexin, ceftriaxone). - Cephalosporins can typically be administered safely to clients with a history of mild allergic reaction (eg, rash), but are contraindicated in clients with a history of penicillin anaphylaxis.

What is linezolid used for?

MRSA and VRE (resistant infections) - has MAOI like qualities

The nurse is caring for a client receiving IVPB azithromycin. Which client data obtained by the nurse should be reported to the health care provider (HCP) prior to administering any additional doses?

Prolonged QT interval - Macrolide antibiotics (eg, erythromycin, azithromycin, clarithromycin) can cause QT prolongation, which can lead to life-threatening arrhythmias (eg, torsades de pointes).

What can drugs ending in mycin lead to?

Prolonged QT interval which can lead to torsades de pointes

An 80-year-old client is receiving amikacin, an aminoglycoside antibiotic, IVPB every 12 hours. Which data obtained by the nurse is most important to report to the health care provider before hanging the next dose?

Report of tinnitus - Serious adverse reactions to aminoglycosides (eg, gentamicin, tobramycin, amikacin) include ototoxicity and nephrotoxicity.

A client with latent tuberculosis has been taking oral isoniazid (INH) 300 mg daily for 2 months. The client tells the nurse that for the past week she has had numbness, a burning sensation, and tingling in her hands and feet. Additional intake of which of the following would most likely have prevented this?

Vitamin B6 - High-risk clients on isoniazid therapy for treatment of tuberculosis may experience neurological side effects due to a decrease in the body's ability to utilize vitamin B6 (pyridoxine).

The nurse develops a teaching plan for a client prescribed isoniazid, rifampin, ethambutol, and pyrazinamide to treat active tuberculosis (TB). Which of the following instructions associated with the adverse effects of rifampin is most important for the nurse to include?

Wear eyeglasses instead of soft contacts lenses while taking this medication - Rifampin changes the color of body fluids (eg, urine, sweat) due to its body-wide distribution. Tears can turn red, making contact lenses appear discolored - Rifampin (Rifadin) also causes hepatotoxicity. Therefore, baseline liver function tests should be obtained. Clients should be advised to watch for signs and symptoms of hepatotoxicity (eg, jaundice, anorexia).

What are the common side effects of codeine?

include constipation, nausea, vomiting, orthostatic hypotension, and dizziness. - helps to take it with food

A client has nausea, abdominal cramping, and persistent mucus-like, watery diarrhea that is positive for Clostridium difficile. The nurse anticipates the client will be prescribed which medication to treat this condition?

metronidazole - Metronidazole (Flagyl) is an anti-infective drug commonly used to treat C difficile. - For severe C difficile infection, oral vancomycin may be used; intravenous vancomycin is ineffective.