Pharm EAQs
Which microorganism is directly affected by acyclovir? 1 Herpes zoster 2 Proteus vulgaris 3 Pneumocystis carinii 4 Staphylococcus aureus
1 Acyclovir in its oral form is used as prophylaxis for and in the treatment of Herpes zoster. Proteus vulgaris, Pneumocystis carinii, and Staphylococcus aureus are not cured with acyclovir. There are other antiviral remedies for P. vulgaris, P. carinii, and S. aureus. P. vulgaris is treated with antibiotics such as sulfonamides. P. carinii is treated with antiprotozoal drugs such as atovaquone. Ciprofloxacin is used to treat S. aureus.
The nurse is assessing a patient with pneumonia who is prescribed amikacin. After reviewing the medication history, the nurse finds that the patient is taking anticoagulants. For what should the nurse primarily monitor in the patient? 1 Abnormal bleeding 2 Venous thrombosis 3 Impaired consciousness 4 Burning sensation of feet
1 Anticoagulants are given to prevent the formation of a clot or thrombus. When they are combined with an aminoglycoside they cause anticoagulant toxicity by inhibiting the action of vitamin K in the body. Therefore, the nurse should check for abnormal bleeding in a patient who is administered both amikacin and anticoagulants. Formation of a thrombus is prevented by anticoagulants, and their effects are not decreased by the concomitant administration of amikacin. Loss of consciousness is not caused by amikacin or by a drug interaction with anticoagulants. A burning sensation of the feet is a symptom of paresthesia, which is a rare side effect caused by prolonged use of amikacin but it is not related to anticoagulants.
Which anxiolytic drug promotes agonistic activity at both the serotonin and dopamine receptors? 1 Buspirone 2 Alprazolam 3 Lorazepam 4 Amitriptyline
1 Buspirone is an anxiolytic drug, which has agonist activity at both the serotonin and dopamine receptors to exert its antianxiety effect. Alprazolam is a benzodiazepine that is commonly used as an anxiolytic. The drug elicits its effects by increasing the activity of gamma-aminobutyric acid (GABA) receptors that block nerve transmission in the central nervous system. Lorazepam is an intermediate-acting benzodiazepine that increases the activity of the GABA receptors. Amitriptyline is the most commonly used tricyclic antidepressant.
When planning care for a patient receiving a sulfonamide antibiotic, which is a primary intervention? 1 Force fluids to at least 2000 mL/day. 2 Encourage liquids that produce acidic urine. 3 Encourage a diet that causes an alkaline ash. 4 Insert a Foley catheter for accurate input and output measurement
1 Forcing fluids will help prevent crystallization in the urine and kidney stone formation associated with sulfonamide antibiotics, regardless of the type of fluid consumed. Consuming a specific type of diet will not decrease the risk of crystallization. It is outside the nurse's scope of practice to decide to insert a Foley catheter.
A nurse is administering intravenous (IV) acyclovir to a patient. What should the nurse remember to ensure safe administration of the drug? 1 Monitor the IV site. 2 Avoid diluting the drug. 3 Limit fluid intake during therapy. 4 Administer the drug as an IV push
1 Intravenous acyclovir can cause venous irritation and phlebitis. Therefore, the nurse should monitor the IV site for redness, heat, pain, swelling, or red streaks. The drug should be adequately diluted to prevent venous irritation. The nurse should ensure adequate hydration during therapy to prevent renal toxicity. The drug should be given diluted over more than an hour to prevent renal tubular damage.
The nurse notes lithium on a patient's drug history upon admission. Which condition would the nurse suspect that this patient has been diagnosed with? 1 Bipolar disorder 2 Absence seizures 3 Paranoid schizophrenia 4 Obsessive-compulsive disorder
1 Lithium is an antimanic drug used to treat manic episodes associated with bipolar disorder. Therapeutic effects of the mood stabilizer lithium are decreased mania and stabilization of the patient's mood. Lithium is not used to treat absence seizures, paranoid schizophrenia, or obsessive-compulsive disorder.
The primary health care provider prescribes pentobarbital for a patient who has seizures. On assessment, the nurse finds that the patient is using oral contraceptive medication on a regular basis. What intervention by the nurse is most suitable in this situation? 1 Suggest an alternate contraceptive method to the patient. 2 Request a prescription to increase the dosage of pentobarbital. 3 Instruct the patient to increase the dosage of the contraceptive drug. 4 Recommend discussing an alternative drug for seizures with the primary health care provider
1 Pentobarbital is known to increase the metabolism of oral contraceptive drugs. Thus, there is a risk of unwanted pregnancy. The nurse should advise the patient to use an alternate contraceptive method while using pentobarbital. The dose of pentobarbital should not be increased, because this may lead to various adverse effects and toxicity in the patient. Increasing the dose of the contraceptive medicine ensures the increase in the drug available after metabolism, but the dose increase may lead to adverse effects in the patient. The nurse cannot suggest that the patient take an alternative drug for seizures unless prescribed by the primary health care provider.
Which drug is used to manage viral pneumonia in a patient with respiratory syncytial virus? 1 Ribavirin 2 Flucytosine 3 Amantadine 4 Griseofulvin
1 Ribavirin is indicated for serious viral pneumonia caused by the respiratory syncytial virus. Flucytosine and griseofulvin are used as antifungal drugs. Amantadine is used as a dopamine modulator.
Which antiepileptic drug may cause gingival hyperplasia in patients? 1 Phenytoin 2 Gabapentin 3 Phenobarbital 4 Levetiracetam
1 The antiepileptic drug phenytoin may cause gingival hyperplasia. Gingival hyperplasia refers to an increase in the size of the gums. Gabapentin, which is an antiepileptic drug, may cause visual and speech changes, edema, and dizziness. The antiepileptic drug phenobarbital may cause apnea and hypotension. Levetiracetam, an antiepileptic drug, may cause hyperactivity and behavioral changes, such as anxiety, hostility, agitation, or suicidal ideation.
What intervention is appropriate to include in discharge teaching for a patient prescribed phenytoin therapy? 1 Perform good oral hygiene. 2 See a physical therapist for tremors. 3 Report headaches to your health care provider. 4 Report drowsiness to your health care provider.
1 The patient should perform good oral hygiene to help prevent the development of gingival hyperplasia. Drowsiness is a common side effect of antiseizure medication and should not be reported. Headaches can occur due to many different things and therefore it is not appropriate to report the occurrence to the health care provider.
The nurse is caring for multiple patients receiving antibiotics. Which patient will the nurse assess first? 1 The patient who is taking amikacin with furosemide 2 The patient who is taking ciprofloxacin and is 18 years old 3 The patient who is taking clindamycin and has gastric upset 4 The patient who just started azithromycin therapy and has a fever
1 The risk of ototoxicity with amikacin is increased for patients taking furosemide. The nurse should assess this patient first. Ciprofloxacin is recommended for patients 18 years and older. Gastric upset is common with this antibiotic. A patient who has started antibiotic therapy would be expected to have a fever.
Which microbe is included in the spectrum of antimicrobial activity for the drug amikacin? 1 Yersinia pestis 2 Escherichia coli 3 Salmonella species 4 Citrobacter species
2 Amikacin is active against Escherichia coli and Acinetobacter species. Streptomycin is active against Yersinia pestis. Gentamicin is active against Salmonella species. Tobramycin is active against Citrobacter species.
The nurse administers ampicillin to a patient who also receives tobramycin. Which condition may occur with this concomitant pharmacotherapy? 1 Red man syndrome 2 Impaired renal function 3 Drug-resistant organism 4 Infusion site inflammation
2 Ampicillin and tobramycin have a tendency to cause renal dysfunction. Administering both medications at the same time can lead to renal impairment through enterococcal infection. Vancomycin is responsible for causing red man syndrome. Properly administered combination therapy with penicillin and an aminoglycoside is not associated with the development of drug-resistant organisms; however, prevention of the development of drug-resistant organisms is always a nursing goal. The nurse ensures that the infusion site remains protected to help prevent interruptions in therapy.
The primary health care provider has asked the nurse to administer diazepam to a patient who has symptoms of alcohol withdrawal. Why does the primary health care provider select this drug for the patient? 1 The patient may need to be sedated to relieve symptoms of alcohol withdrawal. 2 The drug acts on benzodiazepine receptors that play a role in alcohol addiction. 3 The drug may reduce the memory of painful symptoms related to alcohol withdrawal. 4 The drug acts on gamma-aminobutyric acid (GABA) receptors in the central nervous system (CNS)
2 Because the receptors for benzodiazepines and alcohol addiction are present in the same area in the CNS, some benzodiazepines such as diazepam and chlordiazepoxide are used for alcohol withdrawal. Sedation is not required for a patient who has symptoms of alcohol withdrawal. Benzodiazepines are combined with anesthetics, analgesics, and neuromuscular blocking agents for their amnesic properties, but this does not help in treating alcohol withdrawal. Benzodiazepines produce sedation by acting on GABA receptors, but this does not reduce the symptoms of alcohol withdrawal.
A primary health care provider prescribes a medication along with ampicillin to enhance the effectiveness of the antibiotic. Which medication will be added to enhance the effectiveness of the ampicillin? 1 Calcium citrate 2 Clavulanic acid 3 Acetaminophen 4 Carbamazepine
2 Clavulanic acid is a beta-lactamase inhibitor. Administered concurrently, it augments the therapeutic effect of antibiotics such as ampicillin. When ampicillin is administered by mouth, concurrent administration of calcium citrate can diminish its absorption. Acetaminophen and carbamazepine do not affect the pharmacokinetics of ampicillin.
What is the appropriate way for the nurse to prepare a dosage of a suspension medication for a pediatric patient? 1 Pour it into a teaspoon 2 Draw it up in an oral syringe 3 Pour it into a medication cup 4 Pour the suspension without shaking
2 In preparing a dosage of a medication in suspension form for a pediatric patient, the nurse should shake the container well and draw the dosage up with an oral syringe.
Why is a patient advised to drink at least 48 oz of liquids every day while taking indinavir? 1 To prevent lactic acidosis 2 To prevent nephrolithiasis 3 To prevent Kaposi's sarcoma 4 To prevent bone marrow suppression
2 Indinavir may cause nephrolithiasis, or the presence of calculi in the kidney; the patient is advised to drink at least 48 oz of liquids every day to prevent this. Lactic acidosis is caused by tenofovir, not indinavir. Kaposi's sarcoma is a tumor caused by infection with human herpesvirus and is treated with antiretroviral drugs. Bone marrow suppression is an adverse effect of zidovudine.
The nurse is teaching a patient about therapy for a newly diagnosed seizure disorder. What statement should the nurse include? 1 "You will only need to be on therapy for a few months." 2 "Your medication is chosen based on your type of seizure." 3 "You will be started on several drugs to control your seizures." 4 "Medication therapy is not essential to treat seizure disorders."
2 Medication therapy for seizures is matched to the seizure diagnosis. Therapy, in most cases, is lifelong unless used prophylactically. Single-drug therapy must fail before multiple-drug therapy is tried.
A patient who has acquired immune deficiency syndrome (AIDS) exhibits convulsions while receiving antiretroviral therapy that includes maraviroc. Which anticonvulsive drug is contraindicated in this patient because it is likely to decrease the effectiveness of the therapy? 1 Diazepam 2 Phenytoin 3 Topiramate 4 Phenobarbital
2 Phenytoin may decrease the effectiveness of maraviroc, because it is a cytochrome P3A4 hepatic enzyme inducer; this means that the metabolism of maraviroc occurs more quickly, leading to a lower concentrations circulating in the blood for a shorter period. Diazepam, topiramate, and phenobarbital may be indicated in the treatment of AIDS-associated convulsions.
Which instruction will the nurse include in the discharge teaching for a patient receiving tetracycline? 1 "Take the medication until you feel better." 2 "Use sunscreen and protective clothing when outdoors." 3 "Keep the remainder of the medication in case of recurrence." 4 "Take the medication with food or milk to minimize gastrointestinal upset."
2 Photosensitivity is a common side effect of tetracycline. Exposure to the sun can cause severe burns. The medication should not be taken with milk and should be completely finished.
Which patient is a potential candidate for antibiotic therapy involving aminoglycoside? 1 A patient with increased serum creatinine levels 2 A patient with Pseudomonas aeruginosa pneumonia 3 A patient with a history of neuromuscular dysfunction 4 A patient with elevated serum alanine aminotransferase
2 Pseudomonas aeruginosa pneumonia, or P. aeruginosa, is susceptible to treatment with amikacin, gentamicin, or tobramycin; the patient with this infection is a suitable candidate for aminoglycoside therapy. Neuromuscular dysfunction and increased serum creatinine levels are adverse effects of aminoglycoside therapy. Elevated serum alanine aminotransferase may indicate a liver problem; therefore, aminoglycoside therapy is contraindicated, because it may cause toxicity.
The health care provider is considering prescribing a patient ritonavir. The patient tells the nurse about recently being diagnosed with type 2 diabetes mellitus. What is the nurse's highest priority action? 1 Instruct the patient to keep an accurate glucose log. 2 Notify the health care provider of the new information. 3 Instruct the patient to monitor blood sugars more often. 4 Notify the pharmacist that a larger dose will be needed.
2 The health care provider should be notified of this new information. Patients with diabetes mellitus or hyperglycemia may experience an exacerbation of their condition during ritonavir treatment.
A patient has been prescribed tenofovir. After taking the drug for 3 days, the patient contacts the nurse to report experiencing muscle pain and weakness. What is the nurse's highest priority action? 1 Reassure the patient that the symptom is time limited and will resolve. 2 Instruct the patient to hold doses of the medication until further notice. 3 Reassure the patient that this is an expected side effect of the medication. 4 Instruct the patient to self-medicate with a nonsteroidal antiinflammatory medication.
2 The patient should not take any more doses of the medication until the health care provider can evaluate the patient. Muscle pain and weakness may be related to lactic acidosis, a serious adverse effect of the medication. The nurse's scope of practice does not allow for adjusting the patient's medication regimen.
The nurse is assessing a patient who reports having insomnia. On further assessment, the nurse finds that the patient has been taking verapamil for hypertension. What type of medication does the nurse expect the primary health care provider to prescribe for the insomnia? 1 Alprazolam 2 Eszopiclone 3 Temazepam 4 Clonazepam
2 Verapamil, when administered with benzodiazepines, increases the drug concentrations of benzodiazepines, thereby causing toxicity. Therefore, a patient taking verapamil should be prescribed with a nonbenzodiazepine drug to treat the sleep disorder. Eszopiclone is a nonbenzodiazepine drug that should be prescribed for the patient in this case. Alprazolam, temazepam, and clonazepam are benzodiazepine drugs, which might cause toxicity in the patient when taken along with verapamil.
The nurse is assessing a patient who is being treated with amikacin. The patient has increased serum creatinine concentrations, for which loop diuretics are prescribed. What will the nurse primarily monitor in the patient? 1 Orientation 2 Hearing ability 3 Glucose concentrations 4 Serum bilirubin concentrations
2 When administered with aminoglycosides, loop diuretics may increase the risk of ototoxicity, so the nurse should monitor the patient's hearing ability. Orientation is not affected by the interaction of amikacin and loop diuretics. Glucose concentrations in the body are not altered by aminoglycosides or amikacin. Serum bilirubin is an indicator of liver function, which is not affected by amikacin or loop diuretics.
A patient receiving lamotrigine therapy has started using oral contraceptives. What is essential for the nurse to teach the patient? 1 "This combination may cause liver toxicity." 2 "With oral contraceptive use, you may need more lamotrigine." 3 "This medication may stop your oral contraceptive from working." 4 "This medication, together with oral contraceptives, may cause toxicity."
2 When given with oral contraceptives, lamotrigine [1] [2] may need an increased dose to be effective because the oral contraceptives also compete for the CYP450 enzyme pathway. The combination should not cause liver toxicity or toxic drug levels. The medication combination should not cause the oral contraceptive to quit working.
Which type of interaction is associated with the use of zidovudine along with acyclovir? 1 Increased risk for seizures 2 Increased risk for neurotoxicity 3 Increased risk for hematologic toxicity 4 Increased adverse anticholinergic effects
2 Zidovudine, when administered along with acyclovir, increases the patient's risk for neurotoxicity because of drug interactions. Imipenem, when administered along with ganciclovir, increases the patient's risk for seizures. Zidovudine, when administered along with ganciclovir, increases the patient's risk for hematologic toxicity. Anticholinergic drugs, when administered along with amantadine, increase adverse anticholinergic effects.
Which patient should the nurse assess first? 1 The patient taking valproic acid with an increased appetite. 2 The patient taking carbamazepine who has bruises on his arms. 3 The patient taking carbamazepine who is not oriented to place or time. 4 The patient taking valproic acid who has lost 2 pounds since starting therapy
3 Any patient who is not oriented has a potential risk to his safety. The patient who is not oriented and taking carbamazepine could be experiencing adverse effects of therapy. This is the patient the nurse should assess first. The other patients are not experiencing adverse effects.
The nurse is administering morning medications. Which administration technique is in error? 1 The nurse administers intravenous phenytoin with a filter. 2 The nurse administers phenobarbital elixir with fruit juice. 3 The nurse administers carbamazepine with grapefruit juice. 4 The nurse administers gabapentin without checking when the patient ate
3 Carbamazepine is not to be given with grapefruit juice, because this can lead to increased toxicity of the drug. Phenytoin is administered intravenously with a filter. Phenobarbital elixir can be administered with fruit juice, but the oral pill form of the drug should be given with water. Gabapentin can safely be given without regard to meals.
Which antibiotic can be used against several anaerobic organisms? 1 Daptomycin 2 Quinupristin 3 Clindamycin 4 Nitrofurantoin
3 Clindamycin is active against several anaerobic organisms. Daptomycin is used for treatment of infections caused by gram-positive organisms. Quinupristin is used for skin infections caused by streptococcal and staphylococcal infections. Nitrofurantoin is used for urinary tract infections caused by gram-negative organisms and Staphylococcus aureus.3
The nurse erroneously administers a high dose of a benzodiazepine to a patient who has insomnia. What drug will the nurse expect the primary health care provider to prescribe to treat this potential overdose? 1 Rifampin 2 Verapamil 3 Flumazenil 4 Olanzapine
3 Flumazenil, a benzodiazepine antidote, antagonizes the action of benzodiazepine by blocking the central nervous system for benzodiazepines. Rifampin and olanzapine interact with benzodiazepines and increase their serum concentrations. If these drugs were administered, the toxic effects of benzodiazepine would aggravate. Thus, they should be avoided. Verapamil prolongs benzodiazepine action by decreasing the metabolism of benzodiazepine; hence it is not used to treat benzodiazepine toxicity.
Which assessment is a priority for the patient starting on gabapentin therapy for a seizure disorder? 1 Cardiac assessment 2 Urologic assessment 3 Neurologic assessment 4 Respiratory assessment
3 Gabapentin requires a thorough neurologic assessment, including baseline energy levels, vision level, sensory and motor functioning, and any changes in speech. Cardiac, urologic, and respiratory assessment are not the priority for the patient starting on gabapentin therapy for a seizure disorder.
The nurse is assessing a patient with depression who has been prescribed nortriptyline. Following the assessment, the nurse finds that the patient has constipation and urinary retention due to interaction between the prescribed medications. Which class of medication found in the patient's prescription is responsible for these effects? 1 Diuretics 2 Anxiolytics 3 Anticholinergics 4 Antihypertensives
3 Nortriptyline is a tricyclic antidepressant. These medications interact with anticholinergics and potentiate the effects by blocking the cholinergic receptors. This can in turn lead to constipation and urinary retention. Diuretics cause increased urinary outflow; they do not lead to constipation or urinary retention. Anxiolytics may cause increased sedation and hypnosis in the patient. Antihypertensive drugs may cause hypotension in the patient. Therefore diuretics, anxiolytics, and antihypertensive medications will not cause constipation and urinary retention.
Which is the characteristic feature of rapid eye movement (REM) rebound sleep? 1 Bedwetting 2 Sleepwalking 3 Vivid dreams 4 Daytime fatigue
3 REM rebound is an abnormally large amount of REM sleep that often leads to frequent and vivid dreams. Bedwetting and sleepwalking may occur in stage 4 non-REM sleep. At this stage, it is very difficult to wake a person. Daytime fatigue occurs in cases of REM interference, which is a reduction in the cumulative amount of REM sleep as a result of prolonged sedative-hypnotic use.
Which action should the nurse take if a patient receiving intravenous vancomycin complains of facial pruritus? 1 Give diphenhydramine with the infusion 2 Wrap the infusion in foil to protect it from light 3 Program the vancomycin to infuse at a slower rate 4 Document that the patient has a hypersensitivity reaction
3 The nurse infuses vancomycin over at least 1 hour, because rapid infusion can cause red man syndrome. It is indicated by flushing or itching of the face, neck, and trunk, as well as more serious problems like tachycardia and hypotension. Diphenhydramine is an anticholinergic drug used for treating histamine-mediated allergies and motion sickness and to promote sleep. Orally disintegrating medicines are wrapped in foils that, once administered, dissolve on the patient's tongue. Pruritus in a patient taking vancomycin is more an indication of red man syndrome than hypersensitivity.
The nurse has administered the morning dose of tobramycin to a patient according to the prescription. In the evening, the nurse collects a blood sample from the patient and observes that the serum drug concentration is greater than 2 mcg/mL. What does the nurse infer from this? 1 The patient is at risk for heartburn. 2 The patient is at risk for nasal congestion. 3 The patient is at risk for renal dysfunction. 4 The patient is at risk for red man syndrome
3 The safe therapeutic serum concentration of tobramycin is less than or equal to 1 mcg/mL (which is undetectable in blood tests). Serum concentration of the drug greater than 2 mcg/mL is associated with greater risk for both ototoxicity and nephrotoxicity (renal dysfunction). Increased serum concentrations of this drug cause increased serum creatinine concentrations. This indicates declining renal function. Heartburn is an adverse effect of quinolones. The use of metronidazole is associated with nasal congestion and red man syndrome, which is characterized by flushing and/or itching of the head, face, neck, and upper trunk area and is an adverse effect of vancomycin.
What is the result of a potential drug interaction between benzodiazepines and rifampin? 1 Increased daytime sleepiness 2 Prolonged benzodiazepine action 3 Decreased benzodiazepine effects 4 Increased central nervous system (CNS) depression
3 When a benzodiazepine and rifampin are administered simultaneously, rifampin decreases the benzodiazepine's effect by increasing its metabolism. Daytime sleepiness is sometimes observed in elderly patients who are on benzodiazepine therapy. However, it is not an effect of a drug interaction between benzodiazepines and rifampin. Administering macrolide antibiotics or azole antifungals with benzodiazepines prolongs the effects of the benzodiazepines. Simultaneously administering CNS depressants and benzodiazepines promotes CNS depression.
The patient was started on an antiepileptic medication 6 weeks ago. The nurse notes that the patient's blood level of the medication is very low after 6 weeks of therapy. How will the nurse interpret this result? 1 The patient has received a toxic amount of the drug. 2 The patient should be placed on a different medication. 3 The patient may not be taking the medication as ordered. 4 The patient is experiencing an allergic reaction to the drug
3 the patient's blood level of the drug is very low, it may be because the patient has not been taking the medication as scheduled. It will not be extremely low as a result of a toxic amount of the drug, because it is not effective, or because the patient is experiencing an allergic reaction to the medication.
Which nursing intervention may be particularly beneficial to an African-American patient with insomnia? 1 Teaching the patient about meditation 2 Encouraging the patient to maintain a well-balanced diet 3 Instructing the patient to take low doses of benzodiazepines 4 Recommending that the patient consume a glass of warm lactose-free milk at bedtime
4 African Americans have a high incidence of lactose intolerance; if the patient drinks warm milk at bedtime to promote sleep, it may lead to gastrointestinal distress, abdominal cramping, and bloating. Therefore, the nurse should advise the patient to consume a glass of warm lactose-free milk at bedtime to promote sleep. Some Asian-American patients believe in yin and yang and may practice meditation. Some Hispanics believe that a well-balanced diet and physical exercise help promote sleep. Chinese patients may require lower doses of benzodiazepines to treat insomnia.
While reviewing the blood reports of a patient who is receiving amikacin therapy, the nurse finds that the serum drug concentration is 4 mcg/mL. What additional laboratory reports will the nurse check to ensure the patient's safety? 1 Blood platelet count 2 Blood glucose concentration 3 Serum thyroxine concentration 4 Serum creatinine concentration
4 Amikacin is an aminoglycoside antibiotic. Aminoglycosides have the potential to cause nephrotoxicity, so the patient's serum drug concentrations should be monitored regularly. The usual serum drug concentration of aminoglycosides is expected to be less than or equal to 1 mcg/mL (considered as the safe range). Concentrations higher than this may cause adverse effects. Therefore, the nurse should check the serum creatinine concentration to evaluate proper renal function. Aminoglycosides do not affect blood glucose concentration. This means that the nurse does not need to check the patient's blood glucose concentration. Aminoglycosides do not affect platelet count. Therefore, the nurse need not check the patient's platelet count. Aminoglycosides do not affect thyroxine hormone concentration. Therefore, the nurse need not check the patient's serum thyroxine concentration.
The patient has been ordered azithromycin and asks the nurse why the medication does not have to be taken as often as other antibiotics that have previously been ordered. What is the nurse's best response? 1 "You'll need to ask your health care provider questions like that." 2 "I'll call the pharmacy and ask about the chemical makeup of the drug." 3 "This is a much more effective drug than what you received previously." 4 "This drug has a longer duration of action than some of the other antibiotics."
4 Azithromycin is one of the newer macrolide antibiotics. It has a longer duration of action, as well as fewer and less severe gastrointestinal side effects than erythromycin. The other responses do not address the patient's question, which was why azithromycin does not have to be taken as often.
A patient with multiple sclerosis participates in a rehabilitation program. The patient takes baclofen to help manage muscle spasticity. How will the baclofen interfere with the patient's rehabilitation activities? 1 By causing gastrointestinal distress 2 By impairing coordinated movements 3 By increasing pain associated with activities 4 By producing drowsiness, lethargy, and blurred vision
4 Baclofen falls under the barbiturates category, and drowsiness, lethargy, and blurred vision are adverse effects of baclofen, which will make it difficult for this patient to participate actively in rehabilitation activities. Gastrointestinal distress is one of the adverse effects of niacin, which is an antilipemic drug. Another adverse effect of antilipemic drugs is increased muscle pain associated with activity. Impaired physical mobility is an adverse effect related to antiemetic and antinausea drugs.
Which antibiotic is the drug of choice for the treatment of anthrax? 1 Gentamicin 2 Daptomycin 3 Vancomycin 4 Ciprofloxacin
4 Ciprofloxacin is the drug of choice for the treatment of anthrax, which is caused by Bacillus anthracis. Gentamicin is the drug of choice for the treatment of staphylococcal infections. Daptomycin is used to treat complicated skin and soft-tissue infections caused by susceptible gram-positive bacteria. Vancomycin is the antibiotic of choice for the treatment of methicillin-resistant Staphylococcus aureus infection and infections caused by many other gram-positive bacteria.
The nurse is teaching a group of nursing students about the stages of non-rapid eye movement (non-REM) sleep. Which is the third stage of sleep? 1 Dozing 2 Relaxation 3 Deep sleep 4 Sleepwalking
4 Deep sleep is the third stage of sleep. The person finds it difficult to wake, and the respiratory rate, pulse rate, and blood pressure may decrease. Dozing is the first stage of sleep. The person has feelings of drifting off to sleep. Relaxation is the second stage of sleep. The person can easily be awakened. In the fourth stage of sleep, it is very difficult to wake the person up, and sleepwalking may occur during this stage.
The nurse is caring for a patient taking foscarnet. What will the nurse monitor to identify potential side effects of this medication? 1 Platelets 2 Stool guaiac 3 Hemoglobin and hematocrit 4 Blood urea nitrogen and creatinine
4 Foscarnet can cause kidney damage. Blood urea nitrogen and creatinine should be closely monitored. Platelets, stool guaiac, and hemoglobin and hematocrit would not be monitored to identify potential side effects of this medication.
Which antibiotic may cause hemolysis in a patient who has glucose-6-phosphate dehydrogenase (G6PD) deficiency? 1 Penicillin 2 Quinolone 3 Tetracycline 4 Sulfonamide
4 G6PD deficiency is an inherited disorder in which the red blood cells are partially or completely deficient in the enzyme G6PD. It is an enzyme that is required in the metabolism of glucose. Sulfonamide antibiotics may cause hemolysis in a patient who has G6PD deficiency. Penicillin antibiotics, quinolone antibiotics, and tetracycline antibiotics do not cause hemolysis in patients who have G6PD deficiency.
A patient is admitted to the emergency department after an overdose of oxazepam. Which antagonist may be used to treat this patient? 1 Naloxone 2 Naltrexone 3 Nalmefene 4 Flumazenil
4 Oxazepam is a benzodiazepine drug. Flumazenil is an antidote for benzodiazepine overdoses. Naloxone, naltrexone, and nalmefene are not antidotes for benzodiazepine overdoses.4
The nurse is assessing a pregnant patient who has active herpes simplex virus type 2 (HSV-2). What precautions should the nurse suggest to the patient to ensure the newborn's safety? 1 To receive a vaccination 2 To take antiviral therapy in first trimester 3 To increase the intake of iron supplements 4 To give birth via cesarean section (C-section)
4 Patients infected with HSV-2 are usually recommended to give birth via C-section to prevent the baby from contracting the infection. Herpes vaccination and antiviral medications are contraindicated in pregnancy, because they may have teratogenic effects. Iron supplements would not help to prevent infection in the baby.
Which medication increases the rate of urinary elimination of tricyclic antidepressants (TCAs) in the event of an overdose? 1 Diazepam 2 Antidysrhythmic 3 Activated charcoal 4 Sodium bicarbonate
4 Sodium bicarbonate alkalizes the urine and enhances the elimination of medication; therefore it is used to speed up the elimination of high doses of TCAs. Diazepam is used to reduce central nervous system damage associated with high doses of TCAs. Antidysrhythmics are drugs used to treat cardiovascular events that occur as a result of an overdose of TCAs. The administration of activated charcoal reduces the absorption of TCAs.
How does superinfection occur in a patient? 1 When the serum level of an antibiotic is too high 2 When the patient has a gram-positive bacterial infection 3 When the patient has a gram-negative bacterial infection 4 When the antibiotic eliminates the normal bacterial flora
4 The normal bacterial flora consists of certain bacteria and fungi that are needed to maintain normal function in various organs. Superinfection can occur when antibiotics completely eliminate the normal bacterial flora. When these bacteria or fungi are killed by antibiotics, then other bacteria or fungi cause infection, which is known as superinfection. When the serum level of the antibiotic is too high, it causes a toxic reaction. Gram-positive and gram-negative bacterial infections do not cause superinfection.
A patient asks the nurse how long it will take for escitalopram to be completely effective. Which time frame should the nurse include in patient teaching? 1 1 week 2 2 or 3 days 3 2 or 3 months 4 Several weeks
4 The nurse instructs the patient to adhere to therapy for several weeks to determine whether escitalopram will be an effective antidepressant. Escitalopram is a selective serotonin reuptake inhibitor (SSRI), and a delay in therapeutic effectiveness is characteristic of SSRIs. Such drugs do not become effective in 1 week or 2 to 3 days. The effect occurs long before 2 to 3 months.
Which patient is most likely to have toxic effects of antiepileptic therapy? 1 The patient with a primidone level of 10 mcg/mL 2 The patient with a phenobarbital level of 8 mcg/mL 3 The patient with a valproic acid level of 50 mcg/mL 4 The patient with a carbamazepine level of 15 mcg/mL
4 The only value listed that is above therapeutic plasma levels is the carbamazepine, which has a therapeutic range of 4 to 12 mcg/mL; this patient is most likely to have toxic effects of therapy. The other patients have ranges within (valproic acid, primidone) or below (phenobarbital) the therapeutic range. Toxicity does not typically occur with values at or below the therapeutic level.
The patient taking carbamazepine should be instructed to avoid taking her dose with which beverage? 1 Grape juice 2 Apple juice 3 Orange juice 4 Grapefruit juice
4 The patient who is taking carbamazepine should avoid drinking grapefruit juice because it may lead to toxicity of the medication. There are no contraindications for grape, apple, or orange juice.
The nurse is caring for a patient with acute mania who has been prescribed lithium carbonate. The blood tests of the patient indicate the serum lithium level to be 1.2 mEq/L. What does the nurse interpret from this result? 1 The patient will have persistent manic symptoms. 2 The patient may have cardiac dysrhythmia and tremors. 3 The patient may have impaired liver and renal functioning. 4 The patient should have effective relief from the manic symptoms
4 There is a narrow therapeutic window between the therapeutic and toxic serum levels of lithium. A serum lithium level of 1 to 1.5 mEq/L is optimum for the treatment of acute mania. Therefore a serum lithium level of 1.2 mEq/L indicates that the patient will have effective relief from the manic symptoms. If the serum lithium level is less than 1 mEq/L, then the patient may have persistent manic symptoms. The adverse effects of lithium toxicity include cardiac dysrhythmia and tremors. If the lithium serum level is more than 1.5 mEq/L, then the patient may have lithium toxicity, which is characterized by impaired liver and renal functioning.
A patient is prescribed zidovudine. The nurse understands that the drug may cause esophageal ulceration if not taken properly. What instruction will the nurse give to the patient to prevent this adverse effect? 1 "Lie down after taking the drug." 2 "Avoid taking the drug with milk." 3 "Avoid taking the drug with food." 4 "Sit upright when taking the drug."
4 Zidovudine is an antiviral drug that may cause esophageal ulceration if regurgitated. Therefore, the patient should be instructed to sit upright or keep the head elevated when taking the drug. The patient should be instructed not to lie down immediately after taking the drug; the patient should sit upright for at least 30 minutes after taking the drug to prevent regurgitation. The drug can be taken with milk or food, because these do not interfere with absorption of the drug.
Which patient group should receive the Zostavax vaccine? 1 Children 2 Newborns 3 Pregnant patients 4 Patient 50 years of age and older
4 Zostavax is a herpes zoster vaccination given to older patients to prevent zoster lesions known as shingles. It is prescribed for patients who are 50 years of age or older. Children are not administered Zostavax; instead, varicella vaccination is given to prevent chickenpox. Zostavax is a live attenuated vaccine and is contraindicated in pregnant patients. Newborns should not receive the Zostavax vaccine.
Which mood-stabilizing drugs are used to treat bipolar disorder? Select all that apply. 1 Bupropion 2 Imipramine 3 Isocarboxazid 4 Oxcarbazepine 5 Lithium carbonate
4,5 Mood stabilizers are drugs that are used to treat the cycles of mania, hypomania, and depression by regulating the metabolism of catecholamines. Examples of mood stabilizers include oxcarbazepine and lithium carbonate. Imipramine is a tricyclic antidepressant, not a mood stabilizer. It is a second-line therapeutic drug for bipolar disorders. Bupropion is a drug that is categorized under a miscellaneous group and is used for the treatment of depression. Isocarboxazid is a monoamine oxidase inhibitor used for the treatment of depression. 4,5
What is the goal of antiepileptic therapy? 1 Reducing seizure occurrence to one per week. 2 Maximizing drug dosages to control seizure activity. 3 Maximally reducing seizure activity while minimizing side effects of medication therapy. 4 Eradicating all seizure activity and then weaning off medication once the patient is seizure-free for 3 months.
Antiepileptic medications have many adverse side effects. The goal of therapy is to control seizure activity while maintaining quality of life with minimal side effects. It is not appropriate to put a limit on the number of seizures expected, such as one or two per week. The absolute goal is to control seizure activity as completely as possible. The goal is directed towards controlling the seizure activity, not maximizing drug dosages. If the medication is controlling the seizure activity, the patient should not be weaned off of the medication, as then seizures will most likely recur.
