NUR.211 - Pharm Questions

The nurse is counseling a woman who is beginning antitubercular therapy with rifampin. The patient also takes an oral contraceptive. Which statement by the nurse is most accurate regarding potential drug interactions? a. "You will need to switch to another form of birth control while you are taking the rifampin." b. "Your birth control pills will remain effective while you are taking the rifampin." c. "You will need to take a stronger dose of birth control pills while you are on the rifampin." d. "You will need to abstain from sexual intercourse while on the rifampin to avoid pregnancy."

a. "You will need to switch to another form of birth control while you are taking the rifampin."

A patient asks the nurse why a second drug is given with his drugs for Parkinson's disease. The nurse notes that this drug, an anticholinergic, is given to control or minimize which symptoms? (Select all that apply.) a. Drooling b. Constipation c. Muscle rigidity d. Bradykinesia e. Dry mouth

a. Drooling c. Muscle rigidity

Carbidopa-levodopa is prescribed for a patient with Parkinson's disease. The nurse will in form the patient of which possible adverse effects? (Select all that apply.) a. Palpitations b. Insomnia c. Hypotension d. Urinary frequency e. GI distress

a. Palpitations c. Hypotension e. GI distress

When planning care for a patient who is receiving interferon therapy, the nurse must keep in mind that the major dose-limiting factor is a. fatigue. b. bone marrow suppression. c. fever. d. nausea and vomiting.

a. fatigue.

During antitubercular therapy with isoniazid, a patient received another prescription for pyridoxine. Which statement by the nurse best explains the rationale for this second medication? a. "This vitamin will help to improve your energy levels." b. "This vitamin helps to prevent neurologic adverse effects." c. "This vitamin works to protect your heart from toxic effects." d. "This vitamin helps to reduce gastrointestinal adverse effects."

b. "This vitamin helps to prevent neurologic adverse effects."

The nurse is monitoring for liver toxicity in a patient who has been receiving long-term isoniazid therapy. Manifestations of liver toxicity include: (Select all that apply.) a. Orange discoloration of sweat and tears b. Darkened urine c. Dizziness d. Fatigue e. Visual disturbances f. Jaundice

b. Darkened urine d. Fatigue f. Jaundice

When monitoring for a therapeutic response to prednisone, the nurse will look for which potential outcome? a. Increased lymphocyte levels b. Decreased inflammation c. Increased growth characteristics d. Decrease in Cushing's syndrome characteristics

b. Decreased inflammation

While teaching a patient who is about to receive cyclophosphamide (Cytoxan) chemotherapy, the nurse will instruct the patient to watch for potential adverse effects, such as a. cholinergic diarrhea. b. hemorrhagic cystitis. c. peripheral neuropathy. d. ototoxicity.

b. hemorrhagic cystitis.

During a teaching session for a patient receiving an immunosuppressant drug, the nurse will include which statement? a. "It is better to use oral forms of these drugs to prevent the occurrence of thrush." b. "You will remain on antibiotics to prevent infections." c. "It is important to use some form of contraception during treatment and for up to 12 weeks after the end of therapy." d. "Be sure to take your medications with grapefruit juice to increase absorption."

c. "It is important to use some form of contraception during treatment and for up to 12 weeks after the end of therapy."

A patient who is newly diagnosed with Parkinson's disease and beginning medication therapy with en tacapone, a COMT inhibitor, asks the nurse, "How soon will improvement occur?" What is the nurse's best response? a. "That varies from patient to patient." b. "You should discuss that with your physician." c. "You should notice a difference in a few days." d. "It may take several weeks before you notice any degree of improvement."

c. "You should notice a difference in a few days."

. The nurse would correctly identify the method of action of isoniazid (INH) as which of the following? a. Inhibiting protein synthesis. b. Inhibiting mycobacterial ATP synthase c. Altering cell wall synthesis d. Its method of action is unknown.

c. Altering cell wall synthesis

The nurse is teaching a patient who is starting antitubercular therapy with rifampin. Which adverse effects would the nurse expect to see? a. Headache and neck pain b. Gynecomastia c. Reddish brown urine d. Numbness or tingling of extremities

c. Reddish brown urine

A client is receiving baclofen for muscle spasms because of a spinal cord injury. Which side/adverse effect related to this medication should the nurse monitor the client for? 1. Muscle pain 2. Hypertension 3. Slurred speech 4. Photosensitivity

3 Side/adverse effects of baclofen include drowsiness, dizziness, weakness, nausea. Others include headache, paresthesias of the hands and feet, constipation or diarrhea, anorexia, hypotension, confusion, and nasal congestion. Paradoxical central nervous system excitement and restlessness can occur, along with slurred speech, tremor, dry mouth, nocturia, and impotence.

A client with a severe allergic reaction is prescribed intravenous corticosteroids. The nurse should expect that which desired effect will be achieved? 1. Pain relief 2. Enhanced immunity 3. Increased serum glucose 4. Decreased inflammation

4 A corticosteroid acts as an antiinflammatory. Although reduction of inflammation may relieve pain, this is not the indication of the use of corticosteroids in the allergic response. Corticosteroids increase serum glucose, but this is not a therapeutic response. These medications decrease immunity.

A clinic nurse is assessing a client who has been on isoniazid for 6 months. Which client complaint should most concern the nurse? 1. Dry mouth 2. Cramping diarrhea 3. Frequent headaches 4. Difficulty tying shoes

4 The client complaint that should most concern the nurse is difficulty tying shoes because this may indicate neuropathy. Dose-related peripheral neuropathy is one of the more common adverse effects of isoniazid. Dry mouth, cramping diarrhea, and frequent headaches are not concerns with administration of this medication.

A patient is taking pregabalin but does not have a history of seizures. The nurse recognizes that this drug is also indicated for a. postherpetic neuralgia. b. viral infections. c. Parkinson's disease. d. depression.

a. postherpetic neuralgia.

A patient is starting therapy with adalimumab after a course of therapy with methotrexate failed to improve the patient's condition. The nurse recognizes that this patient is being treated for which condition? a. Advanced-stage cancer b. Multiple sclerosis c. Severe rheumatoid arthritis d. Systemic lupus erythematosus

c. Severe rheumatoid arthritis

. When caring for a patient with a diagnosis of myasthenia gravis, the nurse can expect to see which drug ordered for the symptomatic treatment of this disease? a. Bethanechol b. Tacrine c. Donepezil d. Pyridostigmine

d. Pyridostigmine

A nurse is caring for a client who has cancer and is taking a glucocorticoid as an adjuvant for pain control. The nurse should plan to perform which of the following interventions? (SATA) A. Monitor for urinary retention B. Monitor serum glucose C. Monitor serum potassium level D. Monitor for gastric bleeding E. Monitor for respiratory depression

B, C & D Monitoring serum glucose is important because glucococrticoids raises the glucose level, especially in clients whole have DM. Monitoring serum potassium level is important because glucocorticoids may cause hypokalemia. Monitoring for gastric bleeding is important because glucocorticoids irritate the gastric mucosa and put the client at risk for a peptic ulcer.

The nurse would correctly identify the method of action of ethambutol as which of the following? a. Inhibiting protein synthesis. b. inhibiting mycobacterial ATP synthase c. Altering cell wall synthesis d. Its method of action is unknown.

a. Inhibiting protein synthesis.

The nurse is providing teaching on COMT inhibitors to a patient with a new prescription. The nurse will be sure to educate the patient on the possibility of which adverse effect? a. Dizziness b. Urine discoloration c. Leg edema d. Visual changes

b. Urine discoloration

Baclofen is prescribed for the client with multiple sclerosis. The nurse determines that the medication is having the intended effect if which finding is noted in the client? 1. Increased muscle tone 2. Increased range of motion 3. Decreased muscle spasms 4. Decreased local pain and tenderness

3 Baclofen is a skeletal muscle relaxant and acts at the spinal cord level to decrease the frequency and degree of muscle spasms in clients with multiple sclerosis, spinal cord injury, or other diseases. The other options are incorrect.

A man has developed atrial fibrillation and has been placed on warfarin. The nurse is doing discharge dietary teaching with the client and determines that the client needs additional education if he states that he would choose which food while taking this medication? 1. Cherries 2. Potatoes 3. Broccoli 4. Spaghetti

3 Anticoagulant medications work by antagonizing the action of vitamin K, which is needed for clotting. When a client is taking an anticoagulant, foods high in vitamin K are often omitted from the diet. Vitamin K is found in large amounts in green leafy vegetables, such as broccoli, cabbage, turnip greens, and lettuce. The other options listed are foods that are lower in vitamin K.

A client has been administered cyclobenzaprine for the management of muscle spasms in the cervical spine. The client is experiencing drowsiness, dizziness, and dry mouth. How should the nurse interpret these findings? 1. Represent an allergic reaction to the medication 2. Are related to the problem with the cervical spine 3. Are the most common side effects of this medication 4. Are dose related, so the client should cut the medication dose in half

3 Drowsiness, dizziness, and dry mouth are the most common side effects of cyclobenzaprine, and these side effects usually diminish with continued therapy. This medication is a centrally acting skeletal muscle relaxant used in the management of muscle spasm that accompanies a variety of conditions. The remaining options are incorrect.

Zidovudine has been prescribed for a client, and the client asks the nurse about the side effects of the medication. The nurse responds that which is a common side effect of this medication? 1. Lethargy 2. Weakness 3. Headache 4. Constipation

3 Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Zidovudine is a nucleoside reverse transcriptase inhibitor that is used in combination with other antiretroviral agents to treat human immunodeficiency virus (HIV) infection. Common side effects include nausea and headache. Lethargy, weakness, and constipation are not side effects of this medication.

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

3 Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Zidovudine is a nucleoside reverse transcriptase inhibitor that is used in combination with other antiretroviral agents to treat human immunodeficiency virus (HIV) infections. Adverse effects include anemia, granulocytopenia, and neurotoxicity as evidenced by ataxia, fatigue, lethargy, and nystagmus. Seizures can also occur. Colitis, ototoxicity, and visual disturbances are not adverse effects of this medication.

The nurse is assisting in the care of a client with myasthenia gravis who is receiving pyridostigmine. Which medication should the nurse plan to have readily available should the client develop cholinergic crisis because of excessive medication dosage? 1. Vitamin K 2. Acetylcysteine 3. Atropine sulfate 4. Protamine sulfate

3 If the client is in cholinergic crisis, the antidote for the medication would be a medication that is an anticholinergic. Thus, the antidote for cholinergic crisis is atropine sulfate. Vitamin K is the antidote for warfarin. Protamine sulfate is the antidote for heparin, and acetylcysteine is the antidote for acetaminophen.

A client who has sustained an eye injury has been prescribed prednisolone. The nurse would most carefully monitor for side and adverse effects of this medication if the client has which health problem listed on the medical record? 1. Cirrhosis 2. Hypertension 3. Diabetes mellitus 4. Chronic constipation

3 The client with diabetes mellitus is especially at risk for side and adverse effects when taking this medication, which is a glucocorticoid. The client may experience elevations in the blood glucose level, which should be monitored frequently. Cirrhosis, hypertension, and chronic constipation are not a concern with the administration of this medication.

The nurse is caring for a client who is taking oral benztropine mesylate daily. What is the priority nursing assessment for the client? 1. Intake and output 2. The prothrombin time 3. The pupillary response 4. The partial thromboplastin time

1 Urinary retention is a side effect of benztropine mesylate. The nurse needs to observe for dysuria, distended abdomen, infrequent voiding of small amounts, and overflow incontinence. The remaining options are unrelated to the side effects of this medication.

The client with a head injury is experiencing signs of increased intracranial pressure (ICP), and mannitol is prescribed. The nurse administering this medication expects which as intended effects of this medication? Select all that apply. 1. Reduced ICP 2. Increased diuresis 3. Increased osmotic pressure of glomerular filtrate 4. Reduced tubular reabsorption of water and solutes 5. Reabsorption of sodium and water in the loop of Henle

1,2,3,4 Mannitol is an osmotic diuretic that induces diuresis by raising the osmotic pressure of glomerular filtrate, thereby inhibiting tubular reabsorption of water and solutes. It is used to reduce intracranial pressure in the client with head trauma. The incorrect option would cause fluid retention through reabsorption, thereby increasing ICP.

The client with breast cancer has been given a prescription for cyclophosphamide. The nurse determines that the client understands the proper use of the medication if the client states to take which measure? 1. Increase dietary intake of potassium. 2. Increase fluid intake to 2 to 3 L/day. 3. Take the medication with large meals. 4. Decrease dietary intake of magnesium.

2 An adverse effect of cyclophosphamide is hemorrhagic cystitis. The client should drink large amounts of fluid during the administration of this medication. Clients also should observe for hematuria. The medication should be taken on an empty stomach, unless gastrointestinal upset occurs. Hyperkalemia can result from the use of the medication; therefore, the client would not be encouraged to increase potassium intake. The client would not be instructed to alter magnesium intake.

The client with human immunodeficiency virus (HIV) infection has been started on therapy with zidovudine. The nurse reviews the laboratory results and determines that the client is experiencing an adverse effect of the medication if which is noted? 1. Phosphorus 4.5 mg/dL (1.45 mmol/L) 2. Hemoglobin of 10 g/dL (100 mmol/L) 3. Blood glucose level 70 mg/dL (4 mmol/L) 4. Blood urea nitrogen (BUN) 10 mg/dL (3.6 mmol/L)

2 An adverse effect of this medication therapy is agranulocytopenia and anemia. The nurse carefully monitors the CBC count for these changes. With early HIV infection or in the client who is asymptomatic, CBC counts are monitored monthly for 3 months and then every 3 months thereafter. In clients with advanced disease, these counts are monitored every 2 weeks for the first 2 months and then once a month if the medication is tolerated well. The normal hemoglobin level is 14 to18 g/dL (140 to180 mmol/L); thus this client is experiencing anemia. The remaining options identify normal values. The normal phosphorus 3.0 to4.5 mg/dL (0.97 to 1.45 mmol/L). The normal blood glucose level is 70 to110 mg/dL (4 to 6 mmol/L). The normal BUN is 10 to 20 mg/dL (3.6 to 7.1 mmol/L).

A client with multiple sclerosis is receiving baclofen. The nurse assessing the client monitors for which finding as an indication of a primary therapeutic response to the medication? 1. Decreased nausea 2. Decreased muscle spasms 3. Increased muscle tone and strength 4. Increased range of motion of all extremities

2 Baclofen is a skeletal muscle relaxant and acts at the spinal cord level to decrease the frequency and amplitude of muscle spasms in clients with spinal cord injuries or diseases or with multiple sclerosis. Increased muscle tone and strength and increased range of motion of all extremities are not directly related to the effects of this medication. Decreased nausea is an incorrect option.

A client with lung cancer is receiving a high dose of methotrexate. A health care provider also prescribes leucovorin to the client. The nurse should explain to the client that leucovorin is prescribed for which reason? 1. "It promotes DNA synthesis." 2. "It helps to preserve normal cells." 3. "It promotes excretion of the medication." 4. "It facilitates the synthesis of nucleic acids."

2 High concentrations of methotrexate harm and damage normal cells. To save normal cells, leucovorin is given; this is known as leucovorin rescue. Leucovorin bypasses the metabolic block caused by methotrexate, thereby permitting normal cells to synthesize. Note that leucovorin rescue is potentially hazardous. Failure to administer leucovorin in the right dose at the right time can be fatal.

A client has been taking isoniazid for 2 months. The client complains to the nurse about numbness, paresthesias, and tingling in the extremities. The nurse interprets that the client is experiencing which problem? 1. Hypercalcemia 2. Peripheral neuritis 3. Small blood vessel spasm 4. Impaired peripheral circulation

2 Isoniazid is an antitubercular medication. A common side effect of isoniazid is peripheral neuritis, manifested by numbness, tingling, and paresthesias in the extremities. This can be minimized with pyridoxine (vitamin B6) intake. Options 1, 3, and 4 are not associated with the information in the question.

The nurse teaches the client being discharged to home with a prescription for a daily dose of prednisone to take the medication at which best time? 1. Any time of the day 2. In the early morning 3. In the middle of the day 4. An hour before bedtime

2 The client should be instructed to take glucocorticoids (corticosteroids) before 9 a.m. This helps minimize adrenal insufficiency and also mimics the burst of glucocorticoids released naturally by the adrenal glands each morning. Therefore, in the middle of the day, an hour before bedtime, and any time of the day are incorrect.

A pregnant client who has human immunodeficiency virus (HIV) infection is being seen in the antenatal clinic. The nurse expects the health care provider (HCP) to initiate zidovudine at how many weeks of gestation? 1. 4 2. 14 3. 24 4. 34

2 The pregnant woman with HIV infection will be prescribed oral zidovudine in the 14th week of gestation. Before this time, the fetus is at risk because of the teratogenic effects of the medication. In addition, a bolus of zidovudine is given intravenously during labor, and the neonate is treated for 6 weeks after birth.

A client has been prescribed cyclobenzaprine for the treatment of painful muscle spasms accompanying a herniated intervertebral disk. The nurse should withhold the medication and question the prescription if the client has a concurrent prescription for which medication? 1. Ibuprofen 2. Furosemide 3. Valproic acid 4. Tranylcypromine

4 The client should not receive cyclobenzaprine if the client has taken monoamine oxidase inhibitors such as tranylcypromine or phenelzine within the last 14 days. Otherwise, the client could experience hyperpyretic crisis, seizures, and possibly death. The medications in the remaining options are not contraindicated.

A client is prescribed long-term use of oral prednisone for treatment of chronic asthma. The nurse should instruct the client to watch for which of the following? A. Weight gain and fluid retention B. Nervousness and insomnia C. Chest pain and tachycardia D. Dry mouth and constipation

A. Weight gain and fluid retention weigh gain and fluid retention are adverse effects of oral prednisone due to the effect of sodium and water retention.

A nurse is evaluating teaching for a client who has RA and is beginning a prescription for methotrexate. which of the following statements by the client indicates understanding of the teaching? A. "I will be sure to return to the clinic at least once a year to have my blood drawn while I'm taking methotrexate." B. "I will take this medication on an empty stomach." C. "I'll let the Dr. know if I develop sores in my mouth while taking this medication." D. I should stop taking oral contraceptives while I'm taking methotrexate."

C. "I'll let the Dr. know if I develop sores in my mouth while taking this medication."

A nurse is caring for a client who takes several antiretroviral medications, including the NRTI zidovudine, the treat HIV. For which of the following adverse effects of zidovudine should the nurse monitor? (SATA) A. Fatigue B. Visual disturbances C. Ataxia D. Hyperventilation E. Vomiting

D & E Hyperventilation is a finding that may occur if the client develops lactic acidosis, a serious advers effect of zidovudine Vomiting and other GI effects may occur in the client who takes zidovudine

A nurse is preparing to administer filgrastim for the first time to a client who has just undergone a bone marrow transplant. Which of the following interventions is appropriate? A. administer IM in a large muscle mass to prevent injury. B. Insure that the medication is refrigerated just prior to administration. C. Shake the vial gently to mix well before drawing dose. D. Discard vial after removing one dose from the vial.

D. Discard Vial after removing one dose from the vial.

A nurse is reviewing food interactions with a client who is taking Levodopa/carbidopa for Parkinson's disease. Which of the following instructions should the nurse include? A. Eat large amounts of protein rich foods with the medication. B. May take the medication with whole grain cereal. C. Consider eating a banana with the medication. D. May take the medication crushed in grapefruit juice.

D. May take medication Crushed in grapefruit juice

The nurse is reviewing the medication list of a patient who has been newly diagnosed with tuberculosis and will be taking rifampin (Rifadin). Which class of drugs, if taken with rifampin, may cause increased metabolism? (Select all that apply.) a. Beta blockers b. Proton pump inhibitors c. Selective serotonin reuptake inhibitors d. Oral anticoagulants e. Oral antidiabetic drugs

a. Beta blockers d. Oral anticoagulants e. Oral antidiabetic drugs

When chemotherapy with alkylating drugs is planned, the nurse expects to implement which intervention to prevent nephrotoxicity? a. Hydrating the patient with intravenous fluids before chemotherapy b. Limiting fluids before chemotherapy c. Monitoring drug levels during chemotherapy d. Assessing creatinine clearance during chemotherapy

a. Hydrating the patient with intravenous fluids before chemotherapy

When teaching a patient who has been prescribed a daily dose of prednisone, the nurse knows that the patient will be told to take the medication at which time of day to help reduce adrenal suppression? a. In the morning b. At lunchtime c. At dinnertime d. At bedtime

a. In the morning

A patient is taking entacapone as part of the therapy for Parkinson's disease. Which intervention by the nurse is appropriate at this time? a. Notify the patient that this drug causes discoloration of the urine. b. Limit the patient's intake of tyramine-containing foods. c. Monitor the results of renal studies because this drug can seriously affect renal function. d. Force fluids to prevent dehydration.

a. Notify the patient that this drug causes discoloration of the urine.

The nurse is reviewing the use of the COX-2 inhibitor celecoxib. Which conditions are indications for celecoxib? (Select all that apply.) a. Osteoarthritis b. Prevention of thrombotic events c. Rheumatoid arthritis d. Primary dysmenorrhea e. Fever reduction

a. Osteoarthritis c. Rheumatoid arthritis d. Primary dysmenorrhea

When assessing a patient who is to begin therapy with an immunosuppressant drug, the nurse recognizes that such drugs should be used cautiously in patients with which condition(s)? (Select all that apply.) a. Pregnancy b. Glaucoma c. Anemia d. Myalgia e. Renal dysfunction f. Hepatic dysfunction

a. Pregnancy e. Renal dysfunction f. Hepatic dysfunction

While caring for a newly admitted patient who has a long history of alcoholism, the nurse anticipates that part of the patient's medication regimen will include which vitamin? a. Vitamin B1 (thiamine) b. Vitamin B6 (pyridoxine) c. Vitamin C (ascorbic acid) d. Vitamin A (retinol)

a. Vitamin B1 (thiamine)

The expected side effects of the anticholinergic drugs used to treat Parkinson's disease include (Select all that apply.) a. dry mouth and decreased salivation. b. urinary retention. c. decreased GI motility and constipation. d. pupillary constriction. e. smooth muscle relaxation.

a. dry mouth and decreased salivation. b. urinary retention. c. decreased GI motility and constipation. e. smooth muscle relaxation.

A patient with Parkinson's disease will start taking entacapone along with the carbidopa-levodopa he has been taking for a few years. The nurse recognizes that the advantage of taking entacapone is that a. the entacapone can reduce on-off effects. b. the levodopa may be stopped in a few days. c. there is less GI upset with entacapone. d. it does not cause the cheese effect.

a. the entacapone can reduce on-off effects.

During teaching of a patient who will be taking warfarin sodium at home, which statement by the nurse is correct regarding over-the- counter drug use? a. "Choose nonsteroidal antiinflammatory drugs as needed for pain relief." b. "Aspirin products may result in increased bleeding." c. "Vitamin E therapy is recommended to improve the effect of warfarin." d. "Mineral oil is the laxative of choice while taking anticoagulants."

b. "Aspirin products may result in increased bleeding."

A patient is starting warfarin therapy as part of treatment for atrial fibrillation. The nurse will follow which principles of warfarin therapy? (Select all that apply.) a. Teach proper subcutaneous administration. b. Administer the oral dose at the same time every day. c. Assess carefully for excessive bruising or unusual bleeding. d. Monitor laboratory results for a target INR of 2 to 3. e. Monitor laboratory results for a therapeutic aPTT value of 1.5 to 2.5 times the control value.

b. Administer the oral dose at the same time every day. c. Assess carefully for excessive bruising or unusual bleeding. d. Monitor laboratory results for a target INR of 2 to 3.

A patient who has been taking carbidopa-levodopa for Parkinson's disease for over 1 year wants to start a low-carbohydrate/high-protein weight-loss diet. The nurse tells the patient that this type of diet may have what effect on his drug therapy? a. There will be no problems with this diet while on this medication. b. The high-protein diet can slow or prevent absorption of this medication. c. The high-protein diet may cause increased blood levels of this medication. d. The high-protein diet will cause no problems as long as the patient also takes pyridoxine (vitamin B6).

b. The high-protein diet can slow or prevent absorption of this medication.

The nurse is administering methotrexate as part of treatment for a patient with rheumatoid arthritis and will monitor for which sign of bone marrow suppression? a. Edema b. Tinnitus c. Increased bleeding tendencies d. Tingling in the extremities

c. Increased bleeding tendencies

In caring for a patient receiving therapy with a myelosuppressive antineoplastic drug, the nurse notes an order to begin filgrastim after the chemotherapy is completed. Which statement correctly describes when the nurse will begin the filgrastim therapy? a. It can be started during the chemotherapy. b. It will begin immediately after the chemotherapy is completed. c. It will be initiated 24 hours after the chemotherapy is completed. d. It will not be started until at least 72 hours after the chemotherapy is completed.

c. It will be initiated 24 hours after the chemotherapy is completed.

A patient is receiving instructions regarding warfarin therapy and asks the nurse about what medications she can take for headaches. The nurse will tell her to avoid which type of medication? a. Opioids b. acetaminophen (Tylenol) c. NSAIDs d. There are no restrictions while taking warfarin.

c. NSAIDs

During treatment with zidovudine, the nurse needs to monitor for which potential adverse effect? a. Retinitis b. Deep vein thromboses c. Kaposi's sarcoma d. Bone marrow suppression

d. Bone marrow suppression

The patient visits the warfarin clinic for follow up and to get the results of the latest PT-INR. The nurse notes the INR levels indicate significant risk for hemorrhage caused by prolonged clotting times. In conversation with the patient, the nurse obtains a list of all current medications. Which medication would the nurse suspect is contributing to the prolonged times? a. Saw palmetto b. St. John's wort c. Echinacea d. Garlic

d. Garlic

A patient has a new order for glatiramer acetate. The patient has not had an organ transplant. The nurse knows that the patient is receiving this drug for which condition? a. Psoriasis b. Rheumatoid arthritis c. Irritable bowel syndrome d. Relapse-remitting multiple sclerosis

d. Relapse-remitting multiple sclerosis

Which statement describes the rationale for combining carbidopa with levodopa in the treatment of Parkinson's disease? a. The combination eliminates the side effects of both medications b. The combination decrease the liver's first pass effect on dopamine c. The combination decreases the level of acetylcholine at the synapses. d. The combination allows lower levels of dopamine to be used with the same effect on alleviation of symptoms.

d. The combination allows lower levels of dopamine to be used with the same effect on alleviation of symptoms.

While monitoring a patient, the nurse knows that a therapeutic response to antitubercular drugs would be: a. The patient states that he or she is feeling much better. b. The patient's laboratory test results show a lower white blood cell count. c. The patient reports a decrease in cough and night sweats. d. There is a decrease in symptoms, along with improved chest x-ray and sputum culture results.

d. There is a decrease in symptoms, along with improved chest x-ray and sputum culture results.

The nurse is reviewing the medication history of a patient who is taking hydroxychloroquine. However, the patient's chart does not reveal a history of malaria or travel out of the country. The patient is most likely taking this medication for a. Plasmodium. b. thyroid disorders. c. roundworms. d. rheumatoid arthritis

d. rheumatoid arthritis

The nurse is teaching the client about his prescribed prednisone. Which statement, if made by the client, indicates that further teaching is necessary? 1. "I can take aspirin or my antihistamine if I need it." 2. "I need to take the medication every day at the same time." 3. "I need to avoid coffee, tea, cola, and chocolate in my diet." 4. "If I gain more than 5 pounds (2.25 kg) a week, I will call my health care provider (HCP)."

1 Aspirin and other over-the-counter medications should not be taken unless the client consults with the HCP. The client needs to take the medication at the same time every day and should be instructed not to stop the medication. A slight weight gain as a result of an improved appetite is expected; however, after the dosage is stabilized, a weight gain of 5 pounds (2.25 kg) or more weekly should be reported to the HCP. Caffeine-containing foods and fluids need to be avoided because they may contribute to steroid-ulcer development.

A client with a history of spinal cord injury is beginning medication therapy with baclofen. The nurse determines that the client understands the side/adverse effects of the medication if the client makes which statement? 1. "The medication may make me drowsy." 2. "The medication can cause high blood pressure." 3. "The medication may cause me to have some muscle pain." 4. "The medication may increase my sensitivity to bright light."

1 Baclofen is a central-acting skeletal muscle relaxant useful in treating muscle spasticity, usually in upper motor neuron injury. Side/adverse effects include drowsiness, dizziness, weakness, and nausea. Occasional side effects include headache, paresthesias of the hands and feet, constipation or diarrhea, anorexia, hypotension, confusion, and nasal congestion. The other options are incorrect.

The nurse is giving medication instructions to a client who is receiving baclofen as maintenance therapy. Which client statement about the maintenance dose of baclofen indicates that education was effective? 1. "I will take 15 mg four times daily." 2. "I will take 30 mg four times daily." 3. "I will take 25 mg of this medication four times daily." 4. "I will take 40 mg of this medication four times daily."

1 Baclofen is dispensed in tablets of 10 and 20 mg for oral use. Dosages are low initially and then are increased gradually. Maintenance doses range from 15 to 20 mg administered three to four times a day.

The health care provider is planning to administer a skeletal muscle relaxant to a client with a spinal cord injury. The medication will be administered intrathecally. Which medication should the nurse expect to be prescribed and administered by this route? 1. Baclofen 2. Chlorzoxazone 3. Dantrolene sodium 4. Cyclobenzaprine hydrochloride

1 Baclofen is the skeletal muscle relaxant that can be administered intrathecally, which means within the spinal column. Therefore, the remaining options are incorrect.

The nurse is providing medication instructions to a client with multiple sclerosis receiving baclofen. Which information should the nurse include in the instructions? 1. Watch for urinary retention as a side effect. 2. Stop taking the medication if diarrhea occurs. 3. Restrict fluid intake while taking this medication. 4. Notify the health care provider if fatigue occurs.

1 Baclofen, a skeletal muscle relaxant, also is a central nervous system (CNS) depressant, which can cause urinary retention. The client should not restrict fluid intake. Constipation, rather than diarrhea, is an adverse effect of baclofen. Fatigue is a CNS effect that is most intense during the early phase of therapy and diminishes with continued medication use. It is not necessary to notify the health care provider if fatigue occurs.

Cyclobenzaprine is prescribed for a client for muscle spasms and the nurse is reviewing the client's record. Which disorder, if noted in the record, would indicate a need to contact the health care provider about the administration of this medication? 1. Glaucoma 2. Emphysema 3. Hypothyroidism 4. Diabetes mellitus

1 Because cyclobenzaprine has anticholinergic effects, it should be used with caution in clients with a history of urinary retention, glaucoma, and increased intraocular pressure. Cyclobenzaprine should be used only for a short time (2 to 3 weeks). The conditions in options 2, 3, and 4 are not a concern with this medication.

A client with previously well-controlled diabetes mellitus has had fasting blood glucose levels ranging from 180 to 200 mg/dL. The client takes glyburide 5 mg orally daily. In reviewing the client's medication list, the home health care nurse suspects that which newly added medications could be contributing to the elevated blood glucose levels? 1. Prednisone 2. Ranitidine 3. Cimetidine 4. Ciprofloxacin

1 Corticosteroids, thiazide diuretics, and lithium may decrease the effect of glyburide, thus causing hyperglycemia. The medications listed in the incorrect options increase the effect of glyburide, leading to hypoglycemia.

The nurse teaches a client about the effects of diphenhydramine, which has been prescribed as a cough suppressant. The nurse determines that the client needs further instruction if the client makes which statement? 1. "I will take the medication on an empty stomach." 2. "I won't drink alcohol while taking this medication." 3. "I won't do activities that require mental alertness while taking this medication." 4. "I will use sugarless gum, candy, or oral rinses to decrease dryness in my mouth."

1 Diphenhydramine has several uses, including as an antihistamine, antitussive, antidyskinetic, and sedative-hypnotic. Instructions for use include taking with food or milk to decrease gastrointestinal upset and using oral rinses, sugarless gum, or hard candy to minimize dry mouth. Because the medication causes drowsiness, the client should avoid use of alcohol or central nervous system depressants, operating a car, or engaging in other activities requiring mental awareness during use.

A client has been taking glucocorticoids to control rheumatoid arthritis. Which laboratory abnormality is the client at risk for as a result of taking this medication? 1. Increased serum glucose 2. Decreased serum sodium 3. Elevated serum potassium 4. Increased white blood cells

1 Glucocorticoids have 3 primary uses: replacement therapy for adrenal insufficiency, immunosuppressive therapy, and antiinflammatory therapy. Exogenous glucocorticoids cause the same effects on cellular activity as those of the naturally produced glucocorticoids; however, exogenous glucocorticoids also may have undesired effects. The glucocorticoids stimulate appetite and increase caloric intake. They also increase the availability of glucose for energy. These combined effects cause the blood glucose levels to rise, making the client prone to hyperglycemia. Glucocorticoids can also lead to hypokalemia. The remaining options are not expected effects of the use of glucocorticoids.

A female client with a diagnosis of breast cancer is taking cyclophosphamide. The client calls the health care clinic and tells the nurse that the medication is upsetting her stomach. Which instruction should the nurse provide to the client? 1. Take the medication with food. 2. Avoid drinking fluids while taking the medication. 3. Try to take the medication with a small amount of orange juice. 4. Continue to take the medication on an empty stomach, and lie down after taking the medication.

1 Hemorrhagic cystitis is a toxic effect that can occur with the use of this medication. The medication should be taken on an empty stomach, but if the client complains of gastrointestinal (GI) upset, it can be taken with food. The client who is taking cyclophosphamide needs to be instructed to drink copious amounts of fluids during the administration of this medication. Orange juice probably would cause and increase the GI upset. Option 4 will not assist in relieving the discomfort experienced by the client.

A client has begun a course of therapy with rifampin. The home care nurse instructs the client on which measure due to an anticipated side effect? 1. Wear dark clothing to avoid staining. 2. Always take the medication with food or antacids. 3. Double the next medication dose if one is forgotten. 4. Stop the medication if symptoms disappear in 2 months.

1 Rifampin causes orange-red discoloration of body secretions and will permanently stain light clothing as well as soft contact lenses. The medication should be taken on an empty stomach unless it causes gastrointestinal upset, and then it may be taken with food. Antacids, if prescribed, should be taken at least 1 hour before the medication. Rifampin should be taken exactly as directed, and doses should not be doubled or skipped. The client should not stop therapy until directed to do so by a health care provider.

A health care provider (HCP) prescribes warfarin sodium for a client. The home care nurse visits the client at home and teaches the client about the medication and its administration. Which statement by the client indicates a need for further teaching? 1. "The urine normally changes to orange." 2. "This medicine will still be working 4 to 5 days after it is discontinued." 3. "This medication will require frequent blood work to monitor its effects." 4. "I cannot take aspirin or any aspirin-containing medications while I'm on this medication."

1 Warfarin is an anticoagulant. Bleeding is a concern while the client is taking this medication. Orange urine indicates blood in the urine from an overdose of the medication. Bleeding also may be identified by urine that turns red, smoky, or black. The half-life of the medication is 2 days, the peak effect is between 1 and 3 days, and the anticoagulation effect extends 4 to 5 days after discontinuation. The prothrombin time or international normalized ratio is determined to monitor the clotting mechanism. Aspirin is an antiplatelet agent and would increase the risk of bleeding.

The nurse is preparing discharge instructions for a client receiving baclofen. Which instruction should be included in the teaching plan? 1. Restrict fluid intake. 2. Avoid the use of alcohol. 3. Stop the medication if diarrhea occurs. 4. Notify the health care provider (HCP) if fatigue occurs.

2 Baclofen is a skeletal muscle relaxant. The client should be cautioned against the use of alcohol and other central nervous system depressants because baclofen potentiates the depressant activity of these agents. Constipation rather than diarrhea is a side effect. Restriction of fluids is not necessary, but the client should be warned that urinary retention can occur. Fatigue is related to a central nervous system effect that is most intense during the early phase of therapy and diminishes with continued medication use. The client does not need to notify the HCP about fatigue.

A client taking rifampin reports, "My urine has blood in it." When the nurse assesses the urine, it is brown. Which is the nurse's best action? 1. Notify the health care provider (HCP). 2. Chart the finding as a normal response to the rifampin. 3. Immediately start prescribed intravenous (IV) fluids to prevent shock. 4. Get the client into bed, and put the bed in modified Trendelenburg's position.

2 Brown-tinged urine is a normal finding associated with rifampin; thus, there is no need to notify the HCP. There is no indication that the client is in shock, so eliminate the options that indicate to start prescribed IV fluids and to place the client in modified Trendelenburg's position. The nurse should also inform the client that his is a harmless side effect.

The nurse is caring for a client receiving mannitol via intravenous (IV) infusion. A vial is sent from the pharmacy, and in preparing the medication the nurse notes that the vial contains crystals. What is the most appropriate nursing action? 1. Discard the vial. 2. Place the vial in warm water. 3. Send the vial back to the pharmacy. 4. Shake the vial to dissolve the crystals.

2 Crystals form in a mannitol solution if the solution is cooled, but they will quickly dissolve if the container is placed in warm water and then cooled to body temperature before administration. However, if crystals remain after the warming procedure, the medication should not be used and should be returned to the pharmacy. The nurse would not discard the medication. The medication is not initially returned to the pharmacy because it is not defective. Shaking the vial should not be done and will not dissolve the crystals.

The nurse is teaching a client about the effects of diphenhydramine, an ingredient in the cough suppressant prescribed for the client. The nurse should plan to tell the client to take which measure while taking this medication? 1. Take it on an empty stomach. 2. Avoid activities requiring mental alertness. 3. Use alcohol for additional effect in reducing cough. 4. Avoid chewing sugarless gum or using oral rinses mouth.

2 Diphenhydramine has several uses, including antihistamine, antitussive, antidyskinetic, and sedative-hypnotic. Because the medication causes drowsiness, the client should avoid use of alcohol or central nervous system depressants, operating a car, or engaging in other activities that require mental acuity. It should be taken with food or milk to decrease gastrointestinal upset, and oral rinses, sugarless gum, or hard candy may be used to minimize dry mouth.

A client is taking a prescribed course of therapy with ethambutol. The home health nurse assesses the client at each home visit for which adverse effect of this medication? 1. Orange urine 2. Visual disturbances 3. Hearing disturbances 4. Gastrointestinal (GI) upset

2 Ethambutol causes optic neuritis, which decreases visual acuity and impairs the ability to discriminate between red and green. This form of color blindness poses a potential safety hazard in driving a motor vehicle. The client is taught to report this symptom immediately. The client also is taught to take the medication with food if GI upset occurs. Impaired hearing results from antituberculosis therapy with streptomycin. Orange-red discoloration of secretions occurs with rifampin.

The nurse is providing medication instructions to a client with breast cancer who is receiving cyclophosphamide. The nurse should tell the client to take which action? 1. Take the medication with food. 2. Increase fluid intake to 2000 to 3000 mL daily. 3. Decrease sodium intake while taking the medication. 4. Increase potassium intake while taking the medication.

2 Hemorrhagic cystitis is an adverse effect that can occur with the use of cyclophosphamide. The client needs to be instructed to drink copious amounts of fluid during the administration of this medication. Clients also should monitor urine output for hematuria. The medication should be taken on an empty stomach, unless gastrointestinal upset occurs. Hyperkalemia can result from the use of the medication; therefore, the client would not be told to increase potassium intake. The client would not be instructed to alter sodium intake.

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

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

The clinic nurse is providing medication instructions to a client who will be receiving hydroxychloroquine sulfate. The nurse instructs the client about the importance of returning to the clinic in 6 months for which follow-up test? 1. Sigmoidoscopy 2. Eye examination 3. Chest radiograph 4. Dental examination

2 Hydroxychloroquine sulfate is an antimalarial medication used to prevent or treat malaria. It is also used to treat symptoms of rheumatoid arthritis ans discoid and systemic lupus erythematosus. Ocular toxicity is an adverse effect with the use of hydroxychloroquine sulfate. An eye examination should be performed when medication therapy is started and after 6 months of therapy. The diagnostics and examination mentioned in the remaining options are unrelated to the use of this medication.

The nurse would anticipate that the health care provider (HCP) would add which medication to the regimen of the client receiving isoniazid? 1. Niacin 2. Pyridoxine 3. Gabapentin 4. Cyanocobalamin

2 Isoniazid is an antituberculosis medication. Clients receiving isoniazid can develop neuropathy, and the agent of choice to help prevent this adverse effect is pyridoxine, vitamin B6. Niacin is used to lower the cholesterol level. Gabapentin is used to prevent seizures and for peripheral neuropathy, and cyanocobalamin is used to treat anemia.

Which is the nurse's priority assessment for monitoring for adverse effects for the client taking isoniazid? 1. Skin color 2. Urine color 3. Hydration status 4. Respiratory effort

2 Isoniazid is an antituberculosis medication. The most serious adverse effect associated with isoniazid is hepatic injury, which on rare occasions has been fatal; therefore, monitoring of liver function tests and for signs and symptoms of liver injury is the priority. Dark urine is a sign of liver injury and the client should be taught to report this, and the nurse should assess for this. Skin color, hydration status, and respiratory effort are not directly related to adverse effects of this medication.

A client is to begin a 6-month course of therapy with isoniazid. The nurse should plan to teach the client to take which action? 1. Use alcohol in small amounts only. 2. Report yellow eyes or skin immediately. 3. Increase intake of Swiss or aged cheeses. 4. Avoid vitamin supplements during therapy.

2 Isoniazid is hepatotoxic, and therefore the client is taught to report signs and symptoms of hepatitis immediately, which include yellow skin and sclera. For the same reason, alcohol should be avoided during therapy. The client should avoid intake of Swiss cheese, fish such as tuna, and foods containing tyramine because they may cause a reaction characterized by redness and itching of the skin, flushing, sweating, tachycardia, headache, or lightheadedness. The client can avoid developing peripheral neuritis by increasing the intake of pyridoxine (vitamin B6) during the course of isoniazid therapy.

A client has been prescribed benztropine. The nurse should assess for which gastrointestinal (GI) problems as a side or adverse effect of this medication? 1. Diarrhea 2. Dry mouth 3. Increased appetite 4. Hyperactive bowel sounds

2 This medication is classified as an anticholinergic medication and is used to treat Parkinson's disease. Common GI side effects of benztropine therapy include constipation, dry mouth, and nausea. An adverse effect is ileus. These effects are the result of the anticholinergic properties of the medication.

A client receiving therapy with carbidopa/levodopa is upset and tells the home health nurse that his urine has turned a darker color since he started taking this medication. The client wants to discontinue its use. In formulating a response to the client's concerns, the nurse interprets that this change is indicative of which condition? 1. Developing toxicity 2. A harmless side effect of the medication 3. A result of taking the medication with milk 4. A sign of interaction with another medication

2 With carbidopa/levodopa therapy, a darkening of the urine or sweat may occur. The client should be reassured that this is a harmless effect of the medication, and its use should be continued. Darkened urine is not indicative of carbidopa/levodopa toxicity, the result of taking the medication with milk, or a sign of interaction with another medication.

A client with acquired immunodeficiency syndrome (AIDS) has been started on therapy with zidovudine. The nurse should monitor the results of which laboratory blood study for adverse effects of therapy? 1. Creatinine level 2. Potassium concentration 3. Complete blood cell (CBC) count 4. Blood urea nitrogen (BUN) level

3 Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Common adverse effects of zidovudine are agranulocytopenia and anemia. The nurse should monitor the CBC count for these changes. Creatinine, potassium, and BUN are unrelated to this medication.

The nurse is preparing to ambulate a client with Parkinson's disease who has recently been started on levodopa/carbidopa. Before performing this activity with the client, the nurse should include which most important assessment in the client's plan of care? 1. History of falls 2. Use of assistive devices 3. Postural (orthostatic) vital signs 4. Degree of exhibited intention tremor

3 Clients with Parkinson's disease are at risk for postural (orthostatic) hypotension from the disease. This problem is exacerbated with the introduction of levodopa/carbidopa, which also can cause postural hypotension and increase the client's risk for falls. Although knowledge of the client's use of assistive devices and history of falls is helpful, neither of these options is the most important element of the assessment, based on the wording of this question. Clients with Parkinson's disease generally have resting tremor, not intention tremor.

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

3 Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Zidovudine is a nucleoside reverse transcriptase inhibitor that is used in combination with other antiretroviral agents to treat human immunodeficiency virus (HIV) infection. A contraindication to the medication is a history of hypersensitivity to this medication. Cautions include bone marrow suppression, renal and hepatic dysfunction, and conditions that cause decreased hepatic blood flow. A history of renal calculi, diarrhea, and complaints of abdominal discomfort are not contraindications or cautions related to this medication.

Zidovudine has been prescribed for a client. The nurse should tell the client that which blood test will be done periodically while the client is taking this medication? 1. Urea nitrogen level 2. Magnesium and calcium levels 3. Complete blood cell (CBC) count 4. Sedimentation rate and prothrombin time

3 Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Zidovudine is a nucleoside reverse transcriptase inhibitor that is used in combination with other antiretroviral agents to treat human immunodeficiency virus (HIV) infection. Because anemia and granulocytopenia can occur with this medication, a CBC count will be done periodically. A urea nitrogen level tests kidney function. A magnesium level and calcium level check electrolyte and mineral balance. A sedimentation rate and prothrombin time assessed for the presence of inflammation and coagulation ability.

A client with tuberculosis is being started on antituberculosis therapy with isoniazid. Before giving the client the first dose, the nurse should ensure that which baseline study has been completed? 1. Electrolyte levels 2. Coagulation times 3. Liver enzyme levels 4. Serum creatinine level

3 Isoniazid therapy can cause an elevation of hepatic enzyme levels and hepatitis. Therefore, liver enzyme levels are monitored when therapy is initiated and during the first 3 months of therapy. They may be monitored longer in the client who is older than 50 years or abuses alcohol. The laboratory tests in options 1, 2, and 4 are not necessary.

A client has been started on long-term therapy with rifampin. The nurse should provide which information to the client about the medication? 1. Should always be taken with food or antacids 2. Should be double-dosed if 1 dose is forgotten 3. Causes orange discoloration of sweat, tears, urine, and feces 4. May be discontinued independently if symptoms are gone in 3 months

3 Rifampin causes orange-red discoloration of body secretions and will stain soft contact lenses permanently. Rifampin should be taken exactly as directed. Doses should not be doubled or skipped. The client should not stop therapy until directed to do so by a health care provider. It is best to administer the medication on an empty stomach unless it causes gastrointestinal upset, and then it may be taken with food. Antacids, if prescribed, should be taken at least 1 hour before the medication.

A client diagnosed with active tuberculosis has been prescribed a combination of isoniazid and rifampin for treatment. The nurse teaches the client to perform which action? 1. Report any change in urine color. 2. Take both medications with food. 3. Take both medications together once a day. 4. Expect to take the medications for 2 to 3 weeks.

3 Rifampin in combination with isoniazid prevents the emergence of medication-resistant organisms. This combination, taken together daily, eliminates the tubercle bacilli from the sputum and improves clinical status. Rifampin produces a harmless red-orange color in all body fluids and should be taken along with the isoniazid 1 hour before or 2 hours after eating to maximize absorption. The treatment regimen is maintained for at least 6 months for effectiveness, and the therapeutic effect may be evident in 2 to 3 weeks.

A client with tuberculosis (TB) has a prescription for rifampin. What instruction should the nurse include in the client's teaching plan? 1. Yellow-colored skin is common with this medication. 2. The medication must always be taken on an empty stomach. 3. Wearing glasses instead of soft contact lenses will be necessary. 4. As soon as the cultures come back negative, the medication may be stopped.

3 Soft contact lenses may be permanently damaged by the orange discoloration in body fluids caused by rifampin. Any sign of possible jaundice (yellow-colored skin) should always be reported. If rifampin is not tolerated on an empty stomach, it may be taken with food. The client may be on the medication for 12 months even if cultures give negative results.

Megestrol acetate, an antineoplastic medication, is prescribed for a client with metastatic endometrial carcinoma. The nurse reviews the client's history and should contact the health care provider if which diagnosis is documented in the client's history? 1. Gout 2. Asthma 3. Myocardial infarction 4. Venous thromboembolism

4

The nurse provides discharge instructions to a client who is taking warfarin sodium. Which statement, by the client, reflects the need for further teaching? 1. "I will avoid alcohol consumption." 2. "I will take my pills every day at the same time." 3. "I have already called my family to pick up a MedicAlert bracelet." 4. "I will take coated aspirin for my headaches because it will coat my stomach."

4 Aspirin-containing products need to be avoided when a client is taking this medication. Alcohol consumption should be avoided by a client taking warfarin sodium. Taking the prescribed medication at the same time each day increases client compliance. The MedicAlert bracelet provides health care personnel with emergency information.

The nurse is reviewing the medical record of a newly assigned client and notes that the client is receiving cyclobenzaprine hydrochloride for the treatment of muscle spasms. The nurse questions the prescription if which disorder is noted in the admission history? 1. Hypothyroidism 2. Chronic bronchitis 3. Recurrent pneumonia 4. Angle-closure glaucoma

4 Because cyclobenzaprine has anticholinergic effects, it should be used cautiously in clients with a history of urinary retention, angle-closure glaucoma, and increased intraocular pressure. It is intended for short-term (2- to 3-week) therapy. The conditions of hypothyroidism, chronic bronchitis, and recurrent pneumonia are not a concern with this medication.

A client with a documented exposure to tuberculosis is on medication therapy with isoniazid. The nurse is monitoring laboratory results and determines that which laboratory value indicates the need for follow-up? 1. Platelet count 325,000 mm3 (325 × 109/L) 2. Serum creatinine 1.0 mg/dL (88.3 mcmol/L) 3. Blood urea nitrogen (BUN) 20 mg/dL (7.1 mmol/L) 4. Aspartate aminotransferase (AST) 55 U/L (55 U/L)

4 Because isoniazid therapy can cause elevated hepatic enzymes and hepatitis, liver enzymes are monitored when therapy is initiated and during the first 3 months of therapy. They may be monitored longer in the client who is older than 50 years of age or who abuses alcohol. The normal AST level is 0 to 35 U/L (0 to 30 U/L). The other options are not monitored routinely and are also normal.

The clinic nurse develops a plan of care for a client with emphysema who will be started on long-term corticosteroid therapy. Which specific instruction should the nurse include in the plan of care? 1. Instruct the client to maintain a low-potassium diet. 2. Encourage the client to consume a fluid intake of 3000 mL/day. 3. Encourage the client to increase the amount of sodium intake in the diet. 4. Instruct the client to return to the clinic for monitoring of blood glucose levels.

4 Corticosteroid therapy can cause calcium and potassium depletion, sodium retention, and glucose intolerance. The client should be monitored for hyperglycemia. Also, an increase in potassium and a decrease in sodium intake are recommended to prevent potassium depletion and sodium retention while taking the corticosteroid. Although increased fluids are important for the client with emphysema to maintain thin respiratory secretions, this action is not specific to the use of corticosteroids.

Carbidopa-levodopa is prescribed for a client with Parkinson's disease. The nurse monitors the client for side and adverse effects of the medication. Which finding indicates that the client is experiencing an adverse effect? 1. Pruritus 2. Tachycardia 3. Hypertension 4. Impaired voluntary movements

4 Dyskinesia and impaired voluntary movements may occur with high carbidopa-levodopa dosages. Nausea, anorexia, dizziness, orthostatic hypotension, bradycardia, and akinesia are frequent side effects of the medication.

The nurse has given a client taking ethambutol information about the medication. The nurse determines that the client understands the instructions if the client states that he or she will immediately report which finding? 1. Impaired sense of hearing 2. Gastrointestinal side effects 3. Orange-red discoloration of body secretions 4. Difficulty in discriminating the color red from green

4 Ethambutol causes optic neuritis, which decreases visual acuity and the ability to discriminate between the colors red and green. This poses a potential safety hazard when a client is driving a motor vehicle. The client is taught to report this symptom immediately. The client also is taught to take the medication with food if gastrointestinal upset occurs. Impaired hearing results from antitubercular therapy with streptomycin. Orange-red discoloration of secretions occurs with rifampin.

Isoniazid is prescribed for a child with human immunodeficiency virus (HIV) infection who has a positive tuberculin skin test result. The mother of the child asks the nurse how long the child will need to take the medication. For how long should the nurse tell the mother the medication will need to be taken? 1. 4 months 2. 6 months 3. 9 months 4. 12 months

4 For children with HIV infection who demonstrate a positive tuberculin skin test result, a minimum of 12 months of treatment with isoniazid is recommended.

Zidovudine has been prescribed for a client who asks the nurse about the action of the medication. The nurse responds that this medication performs which function? 1. Increases neutrophils 2. Kills bacteria and fungi 3. Promotes the function of natural killer cells 4. Slows the replication of human immunodeficiency virus (HIV)

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

The nurse is collecting subjective and objective data from a client and notes that the client is taking zidovudine. The nurse determines that this medication has been prescribed to treat which condition? 1. Ulcerative colitis 2. Hyperthyroidism 3. Addison's disease 4. Human immunodeficiency virus (HIV) infection

4 Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Zidovudine is a nucleoside reverse transcriptase inhibitor that is used in combination with other antiretroviral agents to treat HIV infection. It is not used to treat ulcerative colitis, hyperthyroidism, or Addison's disease.

Zidovudine has been prescribed for a client, and the nurse provides instructions to the client about expected effects with this medication. Which statement by the client indicates the need for further instruction? 1. "I need to monitor my temperature." 2. "This medication can cause some nausea." 3. "I will have to have blood tests done periodically." 4. "If I experience diarrhea, I need to contact my health care provider."

4 Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Zidovudine is a nucleoside reverse transcriptase inhibitor that is used in combination with other retroviral agents to treat human immunodeficiency virus (HIV) infection. Diarrhea is an occasional side effect of the medication and does not warrant notification of the health care provider. Monitoring temperature, knowing that nausea can occur, and understanding the need for periodic blood tests reflect an understanding of the medication instructions.

A client who experiences allergic rhinitis asks the nurse about a nasal corticosteroid. How should the nurse reply? 1. "Clear the nasal passages after use." 2. "Take the medication only as needed." 3. "The medication should start to work immediately." 4. "The medication works locally and decreases inflammation."

4 Intranasal corticosteroids may be used to treat allergic rhinitis. The medication works locally and decreases inflammation. The client should be instructed to clear the nasal passages before use for best medication effectiveness. The client should take the medication regularly as prescribed in order for the effect to be achieved. The medication may take several days to achieve maximal effect because it works by decreasing inflammation.

The nurse is caring for a client with an exacerbation of multiple sclerosis. Which medication(s) will the nurse expect to be prescribed to hasten recovery from the exacerbation? 1. Carbamazepine and phenytoin by mouth 2. Lioresal by mouth and diazepam intravenously 3. Phenytoin intravenously, then tapered to oral route 4. Methylprednisolone and cyclophosphamide intravenously

4 Intravenous methylprednisolone or adrenocorticotropic hormone in combination with cyclophosphamide may be prescribed to accelerate recovery from an exacerbation of multiple sclerosis. Carbamazepine may be prescribed for trigeminal neuralgia, and phenytoin may be prescribed to control seizures. Lioresal and diazepam are used to treat muscle spasticity.

A client with myasthenia gravis has difficulty chewing and has received a prescription for pyridostigmine. The nurse should check to see that the client takes the medication at what time? 1. With meals 2. Between meals 3. Just after meals 4. 30 minutes before meals

4 Pyridostigmine is a cholinergic medication used to increase muscle strength in the client with myasthenia gravis. For the client who has difficulty chewing, the medication should be administered 30 minutes before meals to enhance the client's ability to eat. The times noted in the remaining options will not be helpful to the client.

A client with Parkinson's disease has begun therapy with levodopa/carbidopa. The nurse determines that the client understands the action of the medication if he or she verbalizes that results may not be apparent for how long? 1. 1 week 2. 24 hours 3. 2 to 3 days 4. 2 to 3 weeks

4 Signs and symptoms of Parkinson's disease usually begin to resolve within 2 to 3 weeks of starting therapy, although in some clients marked improvement may not be seen for up to 6 months. The client needs to understand this concept to aid in compliance with medication therapy.

A client with an exacerbation of chronic obstructive pulmonary disease (COPD) has been on oral glucocorticoids and is currently being weaned to triamcinolone by inhalation. The nurse determines that the client understands the potential adverse effects to watch for during this medication change when the client states the need to report which signs and symptoms? 1. Chills, fever, and generalized rash 2. Vomiting, diarrhea, and increased thirst 3. Blurred vision, headache, and insomnia 4. Anorexia, nausea, weakness, and fatigue

4 The client being changed from oral to inhalation glucocorticoids could experience signs of adrenal insufficiency. The nurse teaches the client to report anorexia, nausea, weakness, and fatigue. Other signs that can be detected and are objective include hypotension and hypoglycemia.

The nurse is providing instructions to a client with a diagnosis of Addison's disease regarding the administration of prescribed glucocorticoids. The nurse should provide which instruction to the client? 1. To stop the medication if side effects occur 2. To avoid taking the medication if nausea occurs 3. That minimal side effects will occur with use of this medication 4. That an increased dose of medication may be needed during times of stress

4 The client with Addison's disease will require lifelong replacement of adrenal hormones. The medications must be taken daily, and an alternate route of administration must be used if the client cannot take oral medications for any reason, such as nausea and vomiting. Additional doses of glucocorticoids will be needed during times of stress. The nurse must emphasize that the client must call the health care provider (HCP) to obtain a prescription for a dosage increase when experiencing stressful situations. Abrupt withdrawal of this medication can result in addisonian crisis. Although side effects are mild at lower doses, more severe side effects occur with long-term glucocorticoid administration. It is very unsafe to stop taking the medication without first consulting the HCP.

A client with muscle spasms in the lumbar area of the spine has been started on cyclobenzaprine. The nurse should monitor for which most frequent side effect of the medication? 1. Weakness 2. Confusion 3. Excitability 4. Drowsiness

4 The most common side effects of cyclobenzaprine are drowsiness, dizziness, and dry mouth. This medication is a centrally acting skeletal muscle relaxant used in the management of muscle spasm due to a variety of conditions. Weakness, confusion, and excitability are less frequent central nervous system effects of cyclobenzaprine.

A client with chronic obstructive pulmonary disease (COPD) is being changed from an oral glucocorticoid to triamcinolone by inhalation. The client asks why this change is necessary. Which statement by the nurse to the client is accurate? 1. "Inhaled glucocorticoids cure the condition." 2. "Inhaled glucocorticoids treat this condition more effectively." 3. "Inhaled glucocorticoids decrease the symptoms more quickly." 4. "Inhaled glucocorticoids are preferred because of decreased adverse effects."

4 Triamcinolone is an adrenocorticosteroid. Inhaled glucocorticoids are preferable for long-term management because there is a decreased incidence of adverse effects since the medication is not absorbed systemically. COPD is a progressive condition and cannot be cured. Options 2 and 3 are incorrect.

A client is being discharged on warfarin sodium, and the nurse provides instructions to the client regarding the medication. Which statement, if made by the client, indicates to the nurse that the client understands the teaching provided? 1. "I'll stop my medication if I see bruising." 2. "Stiff joints are common while taking warfarin." 3. "This medication will prevent me from having a stroke." 4. "If I notice blood-tinged urine, I will call the health care provider."

4 Warfarin is an anticoagulant that is used for long-term prophylaxis of thrombosis. Clients must receive detailed instructions on the signs of bleeding. Hematuria is a sign of bleeding, which the client should report. Bruising is a common side effect associated with anticoagulant therapy and is almost unavoidable. The client, however, should not stop the medication if bruising occurs. Stiff joints are unrelated to the use of warfarin, and prevention of a stroke cannot be guaranteed, although risk for thrombotic stroke may be reduced.

A client with acquired immunodeficiency syndrome who is taking zidovudine 200 mg orally 3 times daily has severe neutropenia noted on follow-up laboratory studies. The nurse interprets that which change is likely to occur at this point? 1. The medication dose probably will be reduced. 2. Prednisone probably will be added to the medication regimen. 3. Epoetin alfa probably will be added to the medication regimen. 4. The medication probably will be discontinued until laboratory results indicate bone marrow recovery.

4 Zidovudine is a nucleoside-nucleotide reverse transcriptase inhibitor. Hematological monitoring should be done every 2 weeks in the client taking zidovudine. If severe anemia or severe neutropenia develops, treatment should be discontinued until evidence of bone marrow recovery is noted. If anemia or neutropenia is mild, a reduction in dosage may be sufficient. The administration of prednisone may further alter the immune function. Epoetin alfa is administered to clients experiencing anemia.

An adult client is taking diphenhydramine for symptoms of allergic rhinitis. For which of the following adverse reactions should the nurse teach the client to watch? (SATA) A. Dry mouth B. Nonproductive cough C. Skin rash D. Diarrhea E. Urinary hesitation

A & E Dry mouth is an anticholinergic symptom that can occur when a client takes Diphenhydramine. Urinary hesitation is an anticholenergic symptom that can occur when a client takes dphenhydramine.

A nurse is teaching a client who has began taking oral Baclofen TID to treat muscle spasms cause by a spinal chord injury. Which of the following statements by the client indicates a need for further teaching? A. "I will stop taking this medication right away if I develop dizziness." B. "I know the Dr. will gradually increase my dose of this medication for a while." C. "I'll make sure that I empty my bladder completely while taking this medication." D. "I won't be able to drink alcohol while taking this medication."

A. "I will stop taking this medication right away if I develop dizziness."

A nurse is assessing a client who has chronic neutropenia and who has been receiving filgrastim. Which of the following actions should the nurse take to assess for an adverse effect of Filgrastim. A. Assess for bone pain B. Assess for RLQ pain C. Auscultate for crackles in the base of the lungs D. Auscultate the chest for a hear murmur.

A. Assess for bone pain

A nurse is preparing to administer cyclophosphamide IV to a client who has Hodgkin's Disease. Which of the following medications should the nurse expect to administer concurrently with the chemotherapy to prevent an adverse effect with cyclophosphamide? A. Unprotected agent, such as mesna. B. Opiods such as morphine C. Loop diuretic such as furosemide. D. H1 receptor antagonist, such as Diphenhydramine.

A. Unprotected agent, such as mesna

A nurse is caring for a client who has diabetes mellitus and pulmonary TB and has a new prescription for isoniazid. Which of the following supplements should the use expect to administer to prevent an adverse effect of isoniazid? A. Ascorbic acid B. Pyridoxine C. Folic Acid D. Cyanocobalamin

B. Pyridoxine Pyridoxine (vitamin b6) is frequently prescribed along with isoniazid to prevent peripheral nephropathy for clients who have increased risk factors such as diabetes mellitus or alcohol use disorder.

A nurse is teaching a client who has active TB about his treatment regimen. The client asks why he must take four different medications. which of the following replies by the nurse is appropriate? ...."Taking multiple antituberculosis medications: A. Decreases the chance for a severe allergic reaction to any of the medications B. Reduces the chance that the TB bacteria will become resistant to the medications. C. Minimizes the chance of adverse effects caused by any of the medications. D. Lessens the chance that you will have a positive tuberculin test indefinitely

B. Reduces the chance that the TB bacteria will become resistant to the medications. If the client took only one medication to treat active tuberculosis, resistance to the medication would occur quickly. Taking three or four different medications decreases the possibility of resistance.

A nurse is caring for a client who is beginning a new prescription for adalimumab for RA. Based on the route of administration of adalimumab, which of the following should the nurse plan to monitor? A. The client's vein for thrombophlebitiis during IV administration. B. The client's subcutaneous site for redness following injection. C. The client's oral mucosa for ulceration after oral administration. D. The client's skin for irritation following removal of transdermal patch.

B. The client's subcutaneous site for redness following injection.

A nurse is caring for a client who has a new diagnosis of HIV infection and is beginning combination oral NRTIs (zidovudine). The client asks how medications work to treat HIV. Which of the following responses by the nurse is appropriate? A. "These medications work by blocking HIV entry into cells." B. "these medications work by weakening the cell wall of the HIV virus." C. "These medications work by inhibiting enzymes to prevent HIV replication." D. "These medications work by preventing protein synthesis within the HIV cell."

C. "These medications work by inhibiting enzymes to prevent HIV replication."

A client who has increased intracranial pressure is receiving mannitol. Which of the following findings should the nurse report to the provider. A. Blood glucose 150 mg/dL B. Urine output 40 mL/hr C. Dyspnea D. headache

C. Dyspnea

A nurse is teaching a client to self-administer nasal drops for allergic rhinitis symptoms. The nurse should teach the client to lie in which of he following positions to obtain the best effect of the medication? A. supine with head flexed B. Sitting with head in neutral position C. Prone with head extended D. Lateral with head in low position

D. Lateral with head in low position Lying on the side with the head in a low position helps spread the nasal drops, allows the medication to be more effective, and prevents swallowing the medication.

A patient will be receiving long-term isoniazid therapy. What laboratory tests are most important for the nurse to monitor during therapy? a. Liver enzyme levels b. Hematocrit and hemoglobin level c. Creatinine level d. Platelet count

a. Liver enzyme levels

. A 50-year-old man has been taking prednisone as part of treatment for bronchitis. He notices that the dosage of the medication decreases. During a follow-up office visit, he asks the nurse why he must continue the medication and why he cannot just stop taking it now that he feels better. What is the rationale behind the tapering dosages? a. Sudden discontinuation of this medication may result in adrenal insufficiency. b. The patient would experience withdrawal symptoms if the drug were discontinued abruptly. c. Cushing's syndrome may develop as a reaction to a sudden drop in serum cortisone levels. d. When the symptoms have started to disappear, lower dosages are needed.

a. Sudden discontinuation of this medication may result in adrenal insufficiency.

The nurse should include which information in the teaching plan for a patient who is taking isoniazid (INH)? a. Urine and saliva may be reddish-orange. b. Pyridoxine (vitamin B6) may be needed to prevent neurotoxicity. c. Injection sites should be rotated daily. d. The medication should be taken with an antacid to reduce gastric distress.

b. Pyridoxine (vitamin B6) may be needed to prevent neurotoxicity.

The nurse is reviewing the use of oral glucocorticoids. Which of these is the preferred oral glucocorticoid for antiinflammatory or immunosuppressant purposes? a. Fludrocortisone b. Dexamethasone c. Prednisone d. Hydrocortisone

c. Prednisone

A nurse is teaching a client who is beginning highly active antiretroviral therapy (HAART) for HIV infection about ways to prevent medication resistance. Which of the following should the nurse teach the client about resistance? A. Taking low dosages of antiretrovial medication minimizes resistance. B. Taking one antiretroviral medication at a time minimizes resistance. c. Taking medication at the same time daily without skipping doses minimizes resistance. D. Changing the medication regimen when adverse effects occur minimizes resistance.

c. Taking medication at the same time daily without skipping doses minimizes resistance. Skipping even a few doses of antiretrovial medication can promote medication resistance, which may cause treatment failure. The nurse should emphasize the importance of taking each dose of medication exactly as prescribed.

The nurse administers warfarin to a patient who is concurrently taking a second drug that is highly protein bound. The nurse knows a drug-drug interaction could occur, which would result in a. both drugs being rendered useless. b. neither drug reaching a therapeutic level. c. the second drug increasing the action and toxicity of the first drug. d. only the protein bound drug being able to exit the vascular system

c. the second drug increasing the action and toxicity of the first drug.