Nursing Pharm Exam 4
A 31-year-old woman is 20 weeks pregnant and has sought care because of a vaginal yeast infection. She has requested fluconazole from her care provider, citing the successful treatment of previous cases of candida vaginitis with this drug. How should her care provider respond? "Fluconazole has actually been linked to severe birth defects, so you should certainly avoid it while you're pregnant." "You can safely take fluconazole while you're pregnant, but you'll need lower doses for a longer time than you would otherwise." "Yes, you can take fluconazole because it doesn't cross your placenta and get to your baby." "Fluconazole is contraindicated during pregnancy, so it is not a good treatment option.
"Fluconazole is contraindicated during pregnancy, so it is not a good treatment option.
After teaching a client who is prescribed oral erythromycin, the nurse determines that the teaching was successful when the client states which of the following? "I need to take the medicine with a meal so I don't get an upset stomach." "I should drink a full 8-oz glass of water when I take the medicine." "I might have some bloody diarrhea after using this medicine." "I only need to take one pill every day for this medicine to work."
"I should drink a full 8-oz glass of water when I take the medicine."
The client, recently diagnosed with HIV, is waiting for results of his lab work to determine his T cell count and says to the nurse, "What exactly is a T cell?" What is the nurse's best response? "T cells are monocytes, which are a type of white blood cell that helps to fight off infections and other foreign bodies that enter the body." "T cells are neutrophils, which are a type of white blood cell that helps to fight off infections and other foreign bodies that enter the body." "T cells are lymphocytes, which are a type of white blood cell that helps to fight off infections and other foreign bodies that enter the body." "T cells are basophils, which are a type of white blood cell that helps to fight off infections and other foreign bodies that enter the body."
"T cells are lymphocytes, which are a type of white blood cell that helps to fight off infections and other foreign bodies that enter the body."
The nurse is giving discharge instruction to a client who has been prescribed efavirenz as treatment for HIV. Which instruction is most important for the nurse to give this client to minimize the CNS adverse effects of this medication? "Take the medication at bedtime." "Take the medication with a high-fat meal." "Take the medication with orange juice." "Take the medication with herbal tea."
"Take the medication at bedtime."
How long should an infusion of vancomycin be programmed to run to minimize the client's risk of developing symptoms associated with excessive histamine release? 3 to 4 hours 2 to 4 hours 1 to 2 hours 30 minutes
1 to 2 hours
Bacteriocidal Antibiotics:
1. Ciprofloxacin 2. Metrondiazole 3. Penicillins 4. Cephalosporins 5. Vancomycin 6. aminoglycosides
What drugs are you supposed to take on an empty stomach?
1. Penicillin 2. Erythromycin 3. Cipro (very important! no zinc, iron, calcium, dairy)
Bacterostatic antibiotics
1. Tetracycline 2. Sulfonamides 3. Erythromycin can be either
It would be most important for a nurse to monitor which client for ototoxicity while on gentamicin therapy? A 43-year-old male with Parkinson disease A 32-year-old mother who is breast-feeding A 25-year-old male who has a hearing impairment A 22-year-old female who has just found out she is pregnant
A 25-year-old male who has a hearing impairment
The nurse is caring for four clients on a medical floor. For which client would the nurse suspect the health care provider might order a sulfonamide? A 65-year-old woman admitted with a urinary tract infection and history of chronic renal failure A 26-year-old man with an ear infection and a history of bronchial asthma A 35-year-old woman with a urinary tract infection and a history of ulcerative colitis A 48-year-old man with pneumonia and a history of liver disease
A 35-year-old woman with a urinary tract infection and a history of ulcerative colitis
A patient is required to be administered vancomycin for treatment of an abdominal abscess. What should the nurse ensure when monitoring the IV infusion of vancomycin in the patient when caring for him? Administer each dose over 60 minutes. Report an increase in blood pressure. Report increase in the urinary output. Observe for signs of headache.
Administer each dose over 60 minutes.
A patient taking erythromycin (E-mycin) is having difficulty hearing the nurse. How should the nurse proceed? Ask about the patient's hearing prior to medication therapy. Talk louder. Look in the patient's ears with an otoscope. Make certain to stand in front of the patient.
Ask about the patient's hearing prior to medication therapy.
How do aminoglycosides elicit their bactericidal effects? Select all that apply. Inhibit bacterial DNA gyrase. Block a step in bacterial protein synthesis. Disrupt the functional ability of the bacterial cell wall. Block bacterial RNA synthesis. Inhibit bacterial binding to the host cell.
Block a step in bacterial protein synthesis. Disrupt the functional ability of the bacterial cell wall. Block bacterial RNA synthesis.
A client with previously good health has become severely ill with a viral infection. Diagnostic testing suggests that the client has had an inadequate immune response. What phenomenon could best account for this inadequate immune response? Body cells that are infected by the virus are being ignored by the immune system The viral wall possesses the human leukocyte antigen The virus is replicated with no involvement from body cells The virus is able to stimulate release of tumor necrosis factor (TNF)
Body cells that are infected by the virus are being ignored by the immune system
What accurately describes effector or cytotoxic T-cells? Cells that are programmed to identify specific proteins or antigens. Cells that can either destroy a foreign cell or mark it for aggressive destruction. Cells that respond to chemical indicators of immune activity and stimulate other lymphocytes to be more aggressive and responsive. Cells that respond to rising levels of chemicals associated with an immune response to suppress or slow the reaction.
Cells that can either destroy a foreign cell or mark it for aggressive destruction.
A client presents to the clinic reporting severe polyuria and dysuria. What medication would the nurse expect this client to be prescribed? Vancomycin (Vancocin) 500 mg PO q6hrs x 3 days Ciprofloxacin (Cipro) 250 mg PO BID x 3 days Amoxicillin (Amoxil) 500 mg TID x 3 days Gentamycin (Garamycin) 250 mg PO BID x 3 days
Ciprofloxacin (Cipro) 250 mg PO BID x 3 days Cipro is a fluoroquinolone and therefore the only medication listed that is used to treat both gram-negative and gram-positive bacteria. Because it will take up to 48 hours for the urine culture to identify the exact bacteria, empirically treating this client with a broad-spectrum antibiotic is the best course of action.
The nurse instructs a client on sulfonamide therapy to drink a full glass of water when taking the medication and to also drink at least 8 large glasses of water each day until therapy is finished. The nurse is trying to prevent which complication associated with sulfonamide therapy? Dehydration Anuria Crystalluria Proteinuria
Crystalluria
A 28-year-old patient has been prescribed penicillin for the first time. While providing education for this patient, the nurse determines that the patient may be at high risk for noncompliance. What nursing diagnosis would be most appropriate for this patient? Acute pain related to GI effects of the drug Deficient knowledge regarding drug therapy Imbalance nutrition: Less than body requirements related to multiple GI effects of the drug Constipation
Deficient knowledge regarding drug therapy
Cytokine receptors are not always expressed on a cell before an antigen-activated event occurs. What is cytokine activation limited to? Detecting and eliminating foreign substances Mediating self, non-self disease processes Destruction of foreign cells by cytotoxic T lymphocytes Adaptive immunity acquired prior to birth.
Destruction of foreign cells by cytotoxic T lymphocytes
Which of the following clients should not be prescribed fluoroquinolones? Male 19 years of age with pneumonia Female 79 years of age with a urinary tract infection Female 12 years of age with a respiratory infection Male 54 years of age with prostatitis
Female 12 years of age with a respiratory infection Fluoroquinolones are contraindicated in children under 18 years of age. Fluoroquinolones are used to treat respiratory infections and prostatitis.
A client is prescribed ciprofloxacin for an acute sinus infection. The nurse knows that this anti-infective medication belongs to which drug category? Penicillins Cephalosporins Tetracyclines Fluoroquinolones
Fluoroquinolones
The nursing student correctly identifies the class of drugs that exerts their bactericidal effect by interfering with the synthesis of bacterial DNA, thus preventing cell reproduction and leading to death of the bacteria, as which of the following groups? Penicillins Cephalosporins Fluoroquinolones Sulfonamides
Fluoroquinolones
You know that penicillins are more effective when used on what type of bacteria? Gram-positive bacteria Gram-negative viruses Gram-negative bacteria Fungal infections
Gram-positive bacteria
What is the B cell immunity called when the B cells are programmed to identify specific proteins, or antigens? T-cell immunity Autoimmunity Passive immunity Humoral immunity
Humoral immunity
The nurse is administering penicillin to a client who has strep throat. Which of the following statements accurately describe the action of penicillin? It is effective against gram-positive organisms It is not effective against gram-negative organisms It has many side effects, especially in large doses It is metabolized in the liver
It is effective against gram-positive organisms
Which of the following medications is contraindicated in children? Amikacin Cefazolin Streptomycin Levofloxacin
Levofloxacin flouriquinolones are contraindicated in children
A 43-year-old man has been diagnosed with active TB. He is prescribed a multiple drug therapy, including INH and rifampin. A priority assessment by the nurse will be to monitor which combination of laboratory test results? Serum alanine transaminase, aspartate transaminase, and bilirubin Red blood count, white blood count, and differential Thyroid-stimulating hormone, thyroxine, and triiodothyronine levels Fasting blood sugar and 2-hour postprandial blood sugar
Serum alanine transaminase, aspartate transaminase, and bilirubin
A client became ill with an influenza virus several days ago. Today, the client describes being free of symptoms. What component of the immune system will be predominant today? Suppressor T cells Complement proteins Interleukins Cytokines
Suppressor T cells
The nurse is caring for a patient newly diagnosed with multiple sclerosis. The patient asks why MS is called an autoimmune disease. What would be the nurse's best response? The body responds to specific self-antigens to produce antibodies or cell-mediated immune responses against its own cells. A result of response to a cell that was invaded by a bacteria, leading to antibody production to similar cells. Production of autoantibodies is a normal process that goes on all the time, but in a state of immunosuppression the suppressor B cells do not suppress autoantibody production. People with multiple sclerosis have a genetic predisposition to destroy autoantibodies.
The body responds to specific self-antigens to produce antibodies or cell-mediated immune responses against its own cells.
A client is experiencing an immune response and the only immunoglobulin that is currently in circulation is IgM. How should the nurse best interpret this fact? The client has very recently been exposed to the antigen The client has neutropenia The client has a very low CD4 count The client is experiencing an autoimmune disease
The client has very recently been exposed to the antigen
Within an infected wound bed, many cell types are involved in protecting the host and eliminating the "foreign invaders" to promote wound healing. How does the identification of body tissues from foreign substances occur? Via the immune system Via the inflammatory system Via the hemodynamic system Via the cellular system
Via the immune system
The nurse should advise the client to avoid taking which medication at the same time as a fluoroquinolone? antacids antihypertensives antidiabetic agents oral contraceptives
antacids
A client is being treated for a herpes outbreak and the health care provider has prescribed acyclovir. In order to screen for potential problems with the client's excretion of the drug, the nurse should review the client's: nutritional status. GGT, AST, ALT and bilirubin levels. blood urea nitrogen and creatinine levels. complete blood count and WBC differential.
blood urea nitrogen and creatinine levels.
Beta-lactam antibiotics, such as penicillins and cephalosporins, fight infection by inhibiting development of the causative bacteria. What specific component development do these drugs affect? DNA replication Cell division Cell wall synthesis Protein synthesis
cell wall synthesis
Bacterias have readily evolved. Which type of bacteria are most commonly resistant to vancomycin (Vancocin)? Enterococci Escherichia coli Pseudomonas Spirochetes
entercocci
After teaching a group of students about the indications for use for aminoglycosides, the instructor determines that the teaching was successful when the students identify which type of infection as a primary indication? gram-negative infections gram-positive infections fungal infections viral infections
gram negative infections
After teaching a group of students about the indications for use for aminoglycosides, the instructor determines that the teaching was successful when the students identify which type of infection as a primary indication? gram-negative infections gram-positive infections fungal infections viral infections
gram-negative infections
As a nursing student, you have been immunized against several viruses. Hepatic viruses, for which there are effective vaccines, include: Herpes zoster and hepatitis A. Hepatitis A and B. Influenza A and B. HPV and HIV.
hepatitis A and B
The client has been prescribed a fluoroquinolone. The nurse knows that nursing interventions for clients taking fluoroquinolones include which? restrict fluid intake. restrict sodium intake. increase sodium intake. increase fluid intake.
increase fluid intake.
A nursing instructor is preparing a teaching plan for a nursing pharmacology class on the action of fluoroquinolones. Which action would the instructor most likely include? interfering with DNA synthesis in the bacterial cell interfering with protein synthesis disrupting the bacterial cell wall blocking ribosomal reading of mRNA
interfering with DNA synthesis in the bacterial cell (DNA gyrase is involved in DNA replication)
A nurse is caring for a client with severe and life-threatening pseudomembranous colitis caused by C. difficile. Which drug would the nurse expect the client's provider to order? Linezolid Tigecycline Daptomycin Oral vancomycin
oral vancomycin
Cephalosporins are structurally and chemically related to which classes of antibiotics? Fluoroquinolones Aminoglycosides Tetracyclines Penicillins
penicillins
A client is receiving azithromycin (Zithromax). What assessment best indicates the medication is therapeutic? Absence of fever All medication is taken The client's WBC decreased The sputum culture is negative
sputum culture is negative
While discussing tuberculosis, the nursing instructor explains that treatment is typically divided into two phases. What is the second phase called? The continuation phase The intensive phase The management phase The eradication phase
the continuation phase
During client teaching, the nurse instructs a client who is taking an antifungal drug to report: unusual bruising and bleeding. constipation or diarrhea. red and dry eyes. increased appetite with weight gain.
unusual bruising and bleeding.
A client has a low white blood cell count and is concerned about acquiring an infection. The client will not sign the informed consent due to a knowledge deficit about the CSF. How should the nurse respond? "Chemotherapy kills cancer cells as well as good cells needed to prevent and control infection. The cells are called white blood cells that grow in stages but are not effective until the cell is in the adult stage. A colony-stimulating drug acts on these cells to stimulate growth to the mature adult white blood cell stage, so that the cells can go to work to help protect you from infection." "Chemotherapy kills cancer cells but has no effect on white cells that fight infection. A colony-stimulating drug acts on white cells to stimulate growth to the mature adult stage to help protect you from infection." "Chemotherapy kills cancer cells as well as good cells needed to prevent and control infection. These cells are called white blood cells that grow in stages but are not effective until the cell is in the immature stage. A colony-stimulating drug acts on the cell to stimulate growth to the immature white blood cell stage so the cells can help protect you from infection." "Chemotherapy kills cancer cells as well as good cells needed to prevent and control infection. The cells are called white blood cells that grow in stages, but are not effective until the cell is in the adult, mature stage. But a colony-stimulating drug has no affect on white cell stimulation in the body. "
"Chemotherapy kills cancer cells as well as good cells needed to prevent and control infection. The cells are called white blood cells that grow in stages but are not effective until the cell is in the adult stage. A colony-stimulating drug acts on these cells to stimulate growth to the mature adult white blood cell stage, so that the cells can go to work to help protect you from infection."
A client has been diagnosed with a sinus infection and the client has been given a prescription for amoxicillin. What teaching point is most appropriate for this client? "Make sure you tell your prescriber if you're feeling particularly tired." "Avoid taking the medication right before bed so it doesn't cause frequent trips to the bathroom." "Take your medication every 8 hours, as it's been prescribed." "This might cause crystals in your urine, so drink plenty of fluids."
"Take your medication every 8 hours, as it's been prescribed."
When learning about the different classes of cephalosporins, the nurse correctly identifies which of the following statements? A first-generation cephalosporin is more useful than a third-generation cephalosporin against gram-positive microorganisms. Cephalosporins are completely different chemically from penicillin. Cephalosporins are divided into three different groups. Cephalosporins are limited in treating many types of bacteria.
A first-generation cephalosporin is more useful than a third-generation cephalosporin against gram-positive microorganisms.
A nurse is caring for a client who has undergone organ transplant surgery. The client asks the nurse what antibodies are. What is the best response by the nurse? Body's ability to recognize and destroy specific pathogens Body's ability to prevent infectious diseases Any foreign substance or molecule entering the body that stimulates an immune response A protein substance that the body produces in response to an antigen
A protein substance that the body produces in response to an antigen
Ciprofloxacin (Cipro) can be used to treat which of the following? Gram-positive bacteria Gram-negative bacteria Both gram-positive bacteria and gram-negative bacteria Neither gram-positive nor gram-negative bacteria
Both gram-positive bacteria and gram-negative bacteria
There are many antiviral medications on the market. What is the clinical reason for this? Each medication is only effective against a small number of specific viral infections. It gives the provider many choices as to which medication can be prescribed. The client can help in the decision of which medication based on his or her insurance plan's coverage. Each medication is effective against a large number of viral infections.
Each medication is only effective against a small number of specific viral infections.
A client being treated for cellulitis with a cephalosporin asks what the essential difference is between generations of this medication. The nurse should respond to the client's question based on what fact? Each generation of cephalosporins has a different mechanism of action. The generations represent the order in which the drugs should be utilized clinically. Each successive generation is more effective against gram-negative microorganisms. The generations of cephalosporins represent formulations that produce fewer side effects.
Each successive generation is more effective against gram-negative microorganisms.
A non-nucleoside reverse transcriptase inhibitor has direct effects on the HIV virus activities within the cell. What drug is a non-nucleoside reverse transcriptase inhibitor? Econazole nitrate (Spectazole) Oxaliplatin (Eloxatin) Olanzapine (Zyprexa) Efavirenz (Sustiva)
Efavirenz (Sustiva)
Why must a client who is receiving aminoglycosides be kept well hydrated? Hydration increases drug concentration in serum and body tissues. Hydration decreases drug concentration in serum and body tissues. Hydration stabilizes peak serum levels. Hydration stabilizes trough serum levels.
Hydration decreases drug concentration in serum and body tissues
A school-aged client was vaccinated against varicella several years ago according to the recommended immunization schedule. The client has now been exposed to the virus by a classmate with chickenpox. What immune response will prevent the client's infection? IgG will be released by B memory cells Hageman factor will be activated and IgM released C D4 (helper) T cells will release the necessary antibodies Circulating levels of IgA will form antigen-antibody complex
IgG will be released by B memory cells
A nurse is caring for a client who is taking acyclovir. What is likely to be a priority nursing diagnoses for this client? Disturbed Body Image related to adverse drug effects Disturbed Sleep Pattern related to adverse drug effects Imbalanced Nutrition: Less than body requirements related to drug adverse effects Imbalanced Nutrition: More than body requirements related to drug adverse effects
Imbalanced Nutrition: Less than body requirements related to drug adverse effects Common adverse effects of acyclovir and other antiviral drugs include anorexia, nausea, and vomiting, all of which can interfere with the ckient's nutritional intake.
Penicillins and cephalosporins are used cautiously in neonates due to what factor? Immature liver function Immature immune function Immature kidney function Immature pancreatic function
Immature kidney function
The nursing student is studying about sulfonamides and learns that their which is their mode of action? Inhibit bacterial cell wall synthesis Inhibit the activity of folic acid in bacterial cell metabolism Bind to ribosomes 30S to prevent protein synthesis Alter their DNA so replication is hindered
Inhibit the activity of folic acid in bacterial cell metabolism
A female client's medical history includes type 2 diabetes, CVA, dysphasia, and chronic renal failure. She develops an infectious process. The health care provider orders erythromycin. Based on the client's medical history, why is erythromycin the drug of choice? It is metabolized in the liver. It is metabolized in the kidneys. It is excreted into the bloodstream. It is excreted into the GI tract.
It is metabolized in the liver. macrolides are generally considered safe... They are metabolized in the liver and excreted in the bile. They may be considered an alternative for patients with renal impairment
Which statement is true concerning macrolides? Macrolides are bacteriocidal or bacteriostatic. Macrolides are not absorbed well in body tissues. Macrolides are not absorbed in body fluids. Macrolides cannot kill gram-positive bacteria.
Macrolides are bacteriocidal or bacteriostatic.
Which of the following is true of macrolide antibiotics? Select all that apply. Macrolides are broad spectrum antibiotics. Macrolides are contraindicated in clients with renal dysfunction. Macrolides may cause visual disturbances. Macrolides can be used in clients allergic to penicillins. Macrolides can be used to treat acne vulgaris.
Macrolides are broad spectrum antibiotics. Macrolides may cause visual disturbances. Macrolides can be used in clients allergic to penicillins. Macrolides can be used to treat acne vulgaris.
The nurse at a long-term care facility is admitting a new resident who is an older adult. The resident's current medication regimen includes nystatin 1,000,000 units PO t.i.d. The nurse should recognize the need to prioritize what aspect of this resident's care? Mouth care Encouraging fluid intake Protective isolation Daily use of an antibacterial shampoo
Mouth care
The student nurse has learned that HIV is a retrovirus. Reverse transcriptase is the enzyme it contains. The student understands this enzyme when making which statement? Reverse transcriptase is used to turn the DNA of the virus into RNA. Reverse transcriptase has no role in the retrovirus. Reverse transcriptase is used to turn the RNA of the virus into DNA. Reverse transcriptase is only important in regular viruses, and not retroviruses.
Reverse transcriptase is used to turn the RNA of the virus into DNA.
A client, being treated in the intensive care unit, has been diagnosed with ventilator-associated pneumonia. Culture and sensitivity testing of the client's sputum indicates that erythromycin is a treatment option. Which nursing assessment is most appropriate to rule out contraindications for this medication therapy? Review lab results to confirm normal liver function. Question the client about any history of gastrointestinal upset. Review the medical for a history of nephrotoxic signs or symptoms. Confirm the ability to safely swallow oral medication.
Review lab results to confirm normal liver function.
A client is prescribed ciprofloxacin for a urinary tract infection. The nurse is preparing to teach the client about the medication. What must the nurse include in the education plan? Take a missed dose, even if close to the next dose. Take precautions to prevent photosensitivity. Avoid foods high in sodium such as processed meats. Take the necessary vitamins along with the drug.
Take precautions to prevent photosensitivity.
Chest radiography and sputum sample microscopy have confirmed a diagnosis of TB in a 40-year-old man who has a history of type 1 diabetes and who currently has a diabetic foot ulcer. How should the nurse account for this patient's health status when planning care during INH treatment? The patient will require intramuscular, rather than oral, administration of INH. The patient will require oral antihyperglycemics because exogenous insulin will be contraindicated. The patient will require positive-pressure isolation because he will be immunocompromised. The patient will require vigilant monitoring of blood glucose levels.
The patient will require vigilant monitoring of blood glucose levels.
A client is being treated with saquinavir for AIDS. The client history includes a BMI of 37.98%, hyperlipidemia, and sleep apnea. Based on the client history, why would caution be used when the client is started on saquinavir? The drug is largely metabolized by the liver. It may cause an exacerbation requiring a dosage change. There are potential adverse effects associated with hyperlipidemia. Saquinavir has a possible association with cardiovascular events.
There are potential adverse effects associated with hyperlipidemia.
The nurse is working with the family of a client who has just been diagnosed with active tuberculosis (TB). Which instructions would the nurse give this family? You will have to take rifampin for 1 year to protect you from TB. You will have to take isoniazid for 6 to 12 months to protect you from TB. You will have to take a combination of 3 drugs for 6 to 12 months to protect you from TB. You will have to take streptomycin for 12 months to protect you from TB.
You will have to take isoniazid for 6 to 12 months to protect you from TB.
When describing the action of fluoroquinolones to treat infection to a group of nursing students, which action would the instructor most likely include? bactericidal bacteriostatic fungicidal fungistatic
bactericidal
A male client is NPO as a consequence of a cerebrovascular accident sustained 3 years ago. His care is managed at home by his wife, and he receives all medications via gastrostomy tube. The health care provider orders a fluoroquinolone for the client to treat an infection. The nurse would instruct the client's wife to administer the medication in what way? With the enteral feeding On a full stomach With antacids On an empty stomach
on an empty stomach
A client developed a pressure area on the hip that has become infected. If the wound culture reveals methicillin-resistant Staphylococcus aureus, which medication would the nurse expect to be prescribed? metronidazole penicillin vancomycin erythromycin
vancomycin
