pharm exam 3
A 17-year-old male patient asks about treatment options for Chlamydia trachomatis infection. Which response by the nurse is appropriate?
"Chlamydia is bacterial and is treated with azithromycin [Zithromax]."
A nurse is teaching a client about clindamycin. Which statement by the patient indicates correct understanding of possible adverse effects from this medication?
"Diarrhea may occur however I should call my provider if the diarrhea becomes excessive."
The order for chemotherapy reads: "Give asparaginase (Elspar) IV 200 units/kg/day." The patient weighs 297 lb. The pharmacy department will prepare the medication for intravenous infusion. How much drug will be given per dose?
27000 units
The patient is ordered divided doses of vancomyocin (Q 12 hours). The patient is to receive the next dose at 4 pm. When should the nurse obtain the trough level?
3:59 pm
Patients with a history of myocardial infarction should take which medications indefinitely? (Select all that apply.) a. ACE inhibitors b. Alteplase c. Aspirin d. Beta blockers e. Clopidogrel
A, C, D Patients who have had an MI should take ACE inhibitors, ASA, and beta blockers indefinitely to prevent recurrence and to minimize continuing cardiac remodeling. Alteplase is given during acute management, and clopidogrel is used during acute management and as an adjunct to reperfusion therapy.
A patient will be taking amiodarone [Cordarone]. Which baseline tests are necessary before this medication is started? (Select all that apply.) a. Chest radiograph and pulmonary function tests b. Complete blood count with differential c. Ophthalmologic examination d. Renal function tests e. Thyroid function tests
A, C, E Amiodarone has many potential toxic side effects, including pulmonary toxicity, ophthalmic effects, and thyroid toxicity, so these systems should be evaluated at baseline and periodically while the patient is taking the drug. A complete blood count is not indicated. Renal function tests are not indicated.
A patient is diagnosed with an infection caused by Staphylococcus aureus, and the prescriber orders intravenous gentamicin and penicillin (PCN). Both drugs will be given twice daily. What will the nurse do?
Administer gentamicin, flush the line, and then give the penicillin
A nurse is caring for a patient who is receiving amphotericin B [Abelcet] for a systemic fungal infection. In spite of receiving diphenhydramine and acetaminophen before initiation of treatment, the patient has fever and chills with rigors. The nurse will contact the provider to discuss the addition of which drug? a. Aspirin b. Dantrolene c. Hydrocortisone d. Omeprazole
B Patients receiving amphotericin frequently experience infusion reactions, with fever, chills, rigors, nausea, and headache. Pretreatment with diphenhydramine and acetaminophen can reduce mild reactions. If rigors occur, the patient should receive dantrolene or meperidine. Aspirin would be effective for pretreatment but can increase kidney damage. Hydrocortisone is also effective, but it causes immune suppression. Omeprazole is not indicated.
Which statement about the BCG vaccine does the nurse identify as true?
BCG vaccine can be used to treat carcinoma of the bladder.
A nurse is reviewing the culture results of a patient receiving an aminoglycoside. The report reveals an anaerobic organism as the cause of infection. What will the nurse do? a. Contact the provider to discuss an increased risk of aminoglycoside toxicity. b. Continue giving the aminoglycoside as ordered. c. Request an order for a different class of antibiotic. d. Suggest adding a penicillin to the patient's drug regimen.
C Aminoglycosides are not effective against anaerobic microbes, so another class of antibiotics is indicated. There is no associated increase in aminoglycoside toxicity with anaerobic infection. The aminoglycoside will not be effective, so continuing to administer this drug is not indicated. Adding another antibiotic is not useful, because the aminoglycoside is not necessary.
A hospitalized patient complains of acute chest pain. The nurse administers a 0.3-mg sublingual nitroglycerin tablet, but the patient continues to complain of pain. Vital signs remain stable. What is the nurse's next step? a. Apply a nitroglycerin transdermal patch. b. Continue dosing at 10-minute intervals. c. Give a second dose of nitroglycerin in 5 minutes. d. Request an order for intravenous nitroglycerin.
C An initial dose of sublingual nitroglycerin is taken, and if the chest pain persists, as in this case, the patient should take another dose in 5 minutes. Transdermal delivery systems are not useful for terminating an ongoing attack. Dosing at 10-minute intervals is incorrect. If the patient fails to respond or if the pain intensifies, intravenous nitroglycerin may be indicated.
A patient recently began receiving clindamycin [Cleocin] to treat an infection. After 8 days of treatment, the patient reports having 10 to 15 watery stools per day. What will the nurse tell this patient? a. The provider may increase the clindamycin dose to treat this infection. b. This is a known side effect of clindamycin, and the patient should consume extra fluids. c. The patient should stop taking the clindamycin now and contact the provider immediately d. The patient should try taking Lomotil or a bulk laxative to minimize the diarrheal symptoms.
C Clostridium difficile-associated diarrhea (CDAD) is the most severe toxicity of clindamycin; if severe diarrhea occurs, the patient should be told to stop taking clindamycin immediately and to contact the provider so that treatment with vancomycin or metronidazole can be initiated. Increasing the dose of clindamycin will not treat this infection. Consuming extra fluids while still taking the clindamycin is not correct, because CDAD can be fatal if not treated. Taking Lomotil or bulk laxatives only slows the transit of the stools and does not treat the cause.
A nursing student asks about the differences between cell-cycle phase-specific chemotherapeutic agents and those that are cell-cycle phase nonspecific. What will the nurse explain?
Cell-cycle phase-specific drugs do not harm "resting" cells
A university student who is agitated and restless and has tremors is brought to the emergency department. The patient's heart rate is 110 beats per minute, the respiratory rate is 18 breaths per minute, and the blood pressure is 160/95 mm Hg. The patient reports using concentrated energy drinks to stay awake during finals week. What complication will the nurse monitor for in this patient? a. CNS depression b. Cardiac arrest c. Respiratory failure d. Seizures
D In large doses, caffeine produces nervousness and tremors; in very large doses, it can cause seizures. This patient has been drinking concentrated energy drinks which are high in caffeine. Caffeine is a stimulant and produces CNS excitation, not depression. Although cardiac side effects are common with caffeine, cardiac arrest is not. Respiratory failure is not an effect of caffeine toxicity.
A patient who takes over-the counter-diphenhydramine [Benadryl] for seasonal allergy symptoms complains of drowsiness. What should the nurse do?
Tell the patient to take fexofenadine [Allegra] instead of diphenhydramine.
The nurse working on a high-acuity medical-surgical unit is prioritizing care for four patients who were just admitted. Which patient should the nurse assess first?
The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units of 70/30 Novolin insulin
The nurse is caring for a patient receiving chemotherapy. The nurse knows certain antineoplastic medications are more toxic to the body as a whole based on the specificity of the medication. Which of the following medications would be part of the drug class which is more toxic to the body as a whole?
cyclophosphamide
Levofloxacin is a second line agent used to treat TB disease which is caused by which organism?
multi-drug resistant organisms
A child is diagnosed with attention-deficit/hyperactivity disorder (ADHD). The prescriber orders a central nervous system stimulant. Which statement by the child's parent indicates a need for further teaching?
"This drug will make him less impulsive while he's at school."
A patient newly diagnosed with tuberculosis asks the nurse why oral medications must be given in the clinic. The nurse will tell the patient that medications are given in the clinic so that: a. clinic staff can observe adherence to drug regimens. b. nurses can monitor for drug toxicities. c. providers can adjust doses as needed. d. the staff can ensure that the U.S. Food and Drug Administration (FDA) regulations are met.
A Adherence to drug regimens is a serious problem in the treatment of TB. Directly observed therapy (DOT) combined with intermittent dosing helps ensure adherence and increases the chance of success. Patients report drug side effects to providers; it is not necessary to give drugs in the clinic to monitor this. Doses are adjusted based on response to treatment and not on DOT. The FDA regulations do not require DOT.
A nurse is teaching a group of nursing students about antihistamines. Which statement by a student indicates an understanding of the mechanism of action of the antihistamines? a. "Antihistamines block H1 receptors to prevent actions of histamine at these sites." b. "Antihistamines block release of histamine from mast cells and basophils." c. "H1 antagonists can bind to H1 receptors, H2 receptors, and muscarinic receptors." d. "First-generation antihistamines are more selective than second-generation antihistamines."
A Antihistamines block H1 receptors to prevent the actions of histamine. They do not block the release of histamine. H1 antagonists do not bind to H2 receptors; they do bind to muscarinic receptors. Second-generation antihistamines are more selective than first-generation antihistamines.
A nurse is giving aspirin to a patient during acute management of STEMI. The patient asks why a chewable tablet is given. Which response by the nurse is correct? a. "Aspirin is absorbed more quickly when it is chewed." b. "Chewing aspirin prevents it from being metabolized by the liver." c. "Chewing aspirin prevents stomach irritation." d. "More of the drug is absorbed when aspirin is chewed."
A Aspirin should be chewed to allow rapid absorption across the buccal mucosa. Chewing aspirin does not affect hepatic metabolism, stomach irritation, or the amount absorbed.
A patient is about to begin therapy with ethambutol. The nurse knows that, before initiating treatment with this drug, it is important to obtain which test(s)? a. Color vision and visual acuity b. Complete blood cell (CBC) count c. Hearing testing and a tympanogram d. Hepatic function tests
A Optic neuritis is a dose-related adverse effect of ethambutol. Patients receiving this drug should have color vision and visual acuity testing before therapy starts and periodically thereafter. A CBC, hearing evaluations, and hepatic function testing are not recommended.
A patient arrives in the emergency department complaining of chest pain that has lasted longer than 1 hour and is unrelieved by nitroglycerin. The patient's electrocardiogram reveals elevation of the ST segment. Initial cardiac troponin levels are negative. The patient is receiving oxygen via nasal cannula. Which drug should be given immediately? a. Aspirin 325 mg chewable b. Beta blocker given IV c. Ibuprofen 400 mg orally d. Morphine intravenously
A This patient shows signs of acute ST-elevation myocardial infarction (STEMI). Because cardiac troponin levels usually are not detectable until 2 to 4 hours after the onset of symptoms, treatment should begin as symptoms evolve. Chewable aspirin (ASA) should be given immediately to suppress platelet aggregation and produce an antithrombotic effect. Beta blockers are indicated but do not have to be given immediately. Ibuprofen is contraindicated. Morphine is indicated for pain management and should be administered after aspirin has been given.
Which patients may receive gentamicin safely? (Select all that apply.) a. A 6-day-old newborn b. A 5-year-old child c. A pregnant woman d. A woman breast-feeding an infant e. An elderly patient with renal disease
A, B Aminoglycosides may be safely given to infants younger than 8 days old and to children and adolescents. Use during pregnancy is not recommended because they may harm the fetus. Gentamicin is probably safe during lactation. Gentamicin is used with caution in older patients with reduced renal function.
A patient with asthma and depression develops stable angina. In addition to organic nitrites, which other medications will be used to treat this condition? (Select all that apply.) a. ACE inhibitors b. Antiplatelet drugs c. Beta blockers d. Calcium channel blockers e. Cholesterol-lowering drugs
A, B, D, E ACE inhibitors have shown benefit in reducing the incidence of adverse outcomes in patients with coronary artery disease (CAD) and are recommended as part of therapy. Antiplatelet drugs are recommended to reduce the risk of thrombus formation. CCBs are used as adjuncts to nitroglycerin and are safe in patients with asthma and depression. Cholesterol-lowering drugs are recommended to help slow the progression of CAD. Beta blockers are not recommended in patients with asthma or depression.
The nurse is administering efavirenz [Sustiva] to a patient with AIDS. What will the nurse do?
Administer the medication on am empty stomach at bedtime.
The nurse is providing care to a patient with a tracheostomy tube that has an inner cannula. Which intervention by the nurse follows proper procedure for tracheostomy tube care?
After scrubbing the inner cannula, rinses it with normal saline
Which medication is indicated for treatment of systemic fungal infections?
Amphotericin B
A nursing student asks the nurse what differentiates antiestrogen drugs from aromatase inhibitors in the treatment of breast cancer. What is the correct response by the nurse? a. Antiestrogen drugs decrease the risk for thromboembolic events. b. Antiestrogen drugs increase the risk for endometrial cancer. c. Aromatase inhibitors block the production of estrogen by the ovaries. d. Aromatase inhibitors can be used for tumor cells that lack estrogen receptors.
B Antiestrogen drugs cause proliferation of endometrial tissue by acting as receptor agonists at receptors in the uterus. Antiestrogen drugs increase the risk of thromboembolic events. Aromatase inhibitors block the production of estrogen from androgenic precursors, not by the ovaries. Aromatase inhibitors are used to treat ER-positive breast cancer.
A patient comes to a clinic for tuberculosis medications 2 weeks after beginning treatment with a four-drug induction phase. The patient's sputum culture remains positive, and no drug resistance is noted. At this point, the nurse will expect the provider to: a. change the regimen to a two-drug continuation phase. b. continue the four-drug regimen and recheck the sputum in 2 weeks. c. obtain a chest radiograph and consider adding another drug to the regimen. d. question the patient about adherence to the drug regimen.
B In patients with positive pretreatment sputum test results, sputum should be evaluated every 2 to 4 weeks until cultures are negative and then monthly thereafter. In the absence of drug resistance, treatment with the same regimen should continue. Sputum cultures should become negative in over 90% of patients in 3 or more months. The induction phase should last 2 months, so this patient should remain on a four-drug regimen. It is not necessary to order a chest radiograph or to add another drug at this stage of treatment. The patient is stable and has not developed symptoms that cause concern, so the patient does not need to be questioned about adherence.
A postpartum patient is receiving methylergonovine to prevent hemorrhage. The nurse assesses the patient and notes a heart rate of 76 beats per minute, a respiratory rate of 16 breaths per minute, and a blood pressure of 120/80 mm Hg. The patient's uterus is firm. The patient complains of mild to moderate cramping. Bleeding is minimal. What will the nurse do?
Continue to monitor and tell the patient to report increased cramping
A patient is about to begin treatment with isoniazid. The nurse learns that the patient also takes phenytoin [Dilantin] for seizures. The nurse will contact the provider to discuss: a. increasing the phenytoin dose. b. reducing the isoniazid dose. c. monitoring isoniazid levels. d. monitoring phenytoin levels.
D Isoniazid is a strong inhibitor of three cytochrome P450 enzymes, and inhibition of these enzymes can raise the levels of other drugs, including phenytoin. Patients taking phenytoin should have the levels of this drug monitored, and the dose should be reduced if appropriate. Reducing the dose of isoniazid is not indicated. It is not necessary to monitor isoniazid levels.
A patient who has drug-sensitive tuberculosis has completed 2 months of the standard four-drug therapy and asks the nurse how long he will have to take medication. Which response by the nurse is correct? a. "As long as you remain symptomatic, you will not have to take more medication. b. "The four-drug regimen will continue for 3 more months." c. "You will have to take maintenance drugs indefinitely." d. "You will need to take only two drugs for the next 4 months."
D Patients with drug-sensitive tuberculosis take four drugs for 2 months during the induction phase, followed by two drugs for 4 months in the continuation phase. Drug therapy does not stop after the induction phase, even for asymptomatic patients. Although drug therapy is prolonged, it is not indefinite.
The nurse is caring for a patient who is HIV positive and is taking zidovudine [Retrovir]. Before administering the medication, the nurse should monitor which laboratory values? a. Ketones in the urine and blood b. Serum immunoglobulin levels c. Serum lactate dehydrogenase d. Complete blood count (CBC)
D The nurse should monitor the patient's CBC to determine whether the patient has anemia and neutropenia. Ketones are not an adverse effect of zidovudine. Nothing indicates a need to monitor the immunoglobulin levels or serum lactate dehydrogenase
The nurse is preparing to discharge a patient with HIV who will continue to take enfuvirtide [Fuzeon] at home. The nurse is providing patient education about the medication. What information about the administration of enfuvirtide is most appropriate for this patient regarding enfuvirtide?
How to reconstitute and self-administer a subcutaneous injection
Which medication is indicated for treatment of vancomycin-resistant enterococci and methicillin resistant Staphylococcus aureus?
Linezolid
A nurse is caring for a patient in the immediate postoperative period after surgery in which a spinal anesthetic was used. The patient has not voided and complains of headache. The patient has a pulse of 62 beats per minute, a respiratory rate of 16 breaths per minute, and a blood pressure of 92/48 mm Hg. Which action by the nurse is appropriate?
Lower the head of the bed to a 10- to 15-degree head-down position.
Which medications are used to treat the rigors associated with administration of amphotericin B?
Meperidine or dantrolene
A patient is receiving chemotherapy. Which laboratory result will most likely require chemotherapy to be withheld?
Neutrophil count of 375/mm3
Which statement regarding antihistamine administration to older adults does the nurse identify as true?
Older men with benign prostatic hypertrophy can experience worse symptoms when taking antihistamines.
A patient who is taking digoxin is admitted to the hospital for treatment of congestive heart failure. The prescriber has ordered furosemide [Lasix]. The nurse notes an irregular heart rate of 86 beats per minute, a respiratory rate of 22 breaths per minute, and a blood pressure of 130/82 mm Hg. The nurse auscultates crackles in both lungs. Which laboratory value causes the nurse the most concern and why is this lab of concern?
Potassium level of 3.5 mEq/L
A patient with type 2 diabetes mellitus takes glipizide. The patient develops a urinary tract infection, and the prescriber orders TMP/SMZ. What will the nurse tell the patient?
The patient should check the blood glucose level more often while taking TMP/SMZ.
The nurse is caring for a patient receiving intravenous gentamicin for a severe bacterial infection. Which assessment finding by the nurse indicates the patient is experiencing an adverse effect of gentamycin therapy?
Tinnitus
A patient with non-Hodgkin's lymphoma is prescribed cyclophosphamide [Cytoxan]. It is most important for the nurse to teach the patient what?
To increase fluid intake to prevent kidney damage
Which information should the nurse include when teaching a patient about inhaled glucocorticoids?
Use of a spacer can minimize side effects.
A nurse is obtaining a medication history from a client who is to receive imipenem-cilastatin IV to treat an infection. Which of the following medications the client also receives put him at risk for a medication interaction?
Valproic acid
A patient who has undergone surgical removal of a solid tumor has just begun chemotherapy. The patient experiences severe nausea and vomiting as well as alopecia. The nurse will expect the provider to: a. continue the chemotherapeutic agent at the same dose. b. decrease the dose of chemotherapy to minimize side effects. c. order lab tests to evaluate for the presence of residual cancer cells. d. stop the chemotherapy because the tumor has been removed.
A Cure of cancer requires 100% cell kill. Solid tumors, which often respond poorly to chemotherapeutic agents, can be "debulked" with surgery and then treated with cytotoxic drugs, because the remaining cells often re-enter the cell cycle and become sensitive to the drugs. Chemotherapeutic drugs must be given at the same dose throughout therapy because of the kinetics of drug-induced cell kill. Because chemotherapy has just begun, it is still necessary; moreover, cell counts of fewer than 1 billion cells are no longer detectable and treatment must continue until all cells are eradicated, so lab tests will not yield useful information. Stopping the chemotherapy right after surgery is not indicated.
A nursing student asks a nurse why chemotherapeutic agents are given intermittently instead of continuously. The nurse will tell the student that intermittent dosing: a. allows normal cells to recover and repopulate. b. catches malignant cells in latent phases. c. increases cancer cell kill and speeds up treatment. d. suppresses drug resistance in tumor cells.
A Intermittent chemotherapy allows normal cells to repopulate between rounds of therapy. Cells in latent phases do not generally respond to chemotherapy. Intermittent therapy does not speed up treatment or increase tumor cell kill. Intermittent therapy does not suppress drug resistance in tumor cells.
A patient who has a brain tumor will receive a nitrosourea agent. A nursing student asks why this type of drug is used for this type of cancer. The nurse will tell the student that nitrosoureas are useful because they: a. are lipophilic. b. are bifunctional alkylating agents. c. have a broad spectrum of antineoplastic characteristics. d. have delayed bone marrow suppression.
A Nitrosoureas are lipophilic and thus are able to cross the blood-brain barrier, making them more effective against solid tumors in the brain. They are alkylating agents with a broad spectrum of antineoplastic activity, but these are not the deciding factors in their use for brain tumors. Delayed bone marrow suppression is their major dose-limiting toxicity.
A prescriber has ordered propranolol [Inderal] for a patient with recurrent ventricular tachycardia. The nurse preparing to administer this drug will be concerned about what in the patient's history? a. Asthma b. Exercise-induced tachyarrhythmias c. Hypertension d. Paroxysmal atrial tachycardia associated with emotion
A Propranolol is contraindicated in patients with asthma, because it is a nonselective beta-adrenergic antagonist and can cause bronchoconstriction and exacerbate asthma. It is used to treat tachyarrhythmias and paroxysmal atrial tachycardia evoked by emotion, so it is not contraindicated for patients with these conditions. It lowers blood pressure, so it would be helpful in patients with hypertension.
A patient with high-risk factors for tuberculosis will begin therapy for latent TB with isoniazid and rifampin. The nurse learns that this patient takes oral contraceptives. The nurse will counsel this patient to discuss ____ with her provider. a. another birth control method b. reducing the rifampin dose c. reducing the isoniazid dose d. increasing the oral contraceptive dose
A Rifampin induces cytochrome P450 enzymes and can accelerate the metabolism of many drugs, including oral contraceptive pills (OCPs). Women taking OCPs should consider a nonhormonal form of birth control. Reducing the dose of rifampin or isoniazid is not indicated. Increasing the OCP dose is not recommended.
A patient has undergone liver transplantation. The provider orders cyclosporine [Sandimmune], prednisone, and sirolimus [Rapamune]. What will the nurse do? a. Question the order for sirolimus. b. Request an order for a serum glucose level. c. Request an order for a macrolide antibiotic. d. Suggest changing the cyclosporine to tacrolimus.
A Sirolimus is given to prevent rejection in renal transplantation; it has no proof of efficacy in patients with heart, lung, or liver transplants. A serum glucose level is not indicated; patients taking repaglinide for diabetes should be monitored closely while taking cyclosporine. Although antibiotic prophylaxis may be necessary, macrolide antibiotics increase the level of cyclosporine. Tacrolimus is more toxic than cyclosporine.
The nurse is caring for a patient receiving intravenous acyclovir [Zovirax]. To prevent nephrotoxicity associated with intravenous acyclovir, the nurse will: a. hydrate the patient during the infusion and for 2 hours after the infusion. b. increase the patient's intake of foods rich in vitamin C. c. monitor urinary output every 30 minutes. d. provide a low-protein diet for 1 day before and 2 days after the acyclovir infusion.
A The nurse should ensure that the patient is hydrated during the acyclovir infusion and for 2 hours after the infusion to prevent nephrotoxicity. Increasing vitamin C would not help prevent nephrotoxicity. Monitoring urine output is important but would not help prevent nephrotoxicity. A low-protein diet is not indicated after an acyclovir infusion.
Which information should the nurse include when teaching a patient about isoniazid (INH) therapy?
An adverse effect of isoniazid therapy is peripheral neuropathy, which can be reversed with pyridoxine.
A patient who has been taking alprazolam [Xanax] to treat generalized anxiety disorder (GAD) reports recently stopping the medication after symptoms have improved but reports having feelings of panic and paranoia. Which initial action by the nurse is correct?
Ask the patient if the medication was stopped abruptly
A patient has been taking levothyroxine for several years and reports that "for the past 2 weeks, the drug doesn't seem to work as well as before." What will the nurse do?
Ask the patient when the prescription was last refilled
A nurse is teaching the parents of a child who has attention-deficit/hyperactivity disorder about methylphenidate [Concerta]. Which statement by the child's parents indicates understanding of the teaching? a. "The effects of this drug will wear off in 4 to 6 hours." b. "The tablet needs to be swallowed whole, not crushed or chewed." c. "This medication has fewer side effects than amphetamines." d. "We should call the provider if we see parts of the medicine in our child's stools."
B Concerta tablets must be swallowed whole and should not be crushed, chewed, or dissolved in liquids. This is a long-duration preparation with effects that last 10 to 12 hours. Methylphenidate has the same actions and adverse effects as amphetamines. The tablet shell may not fully dissolve in the gastrointestinal (GI) tract; therefore, tablet "ghosts" in the stool are normal.
A patient with new-onset exertional angina has taken three nitroglycerin sublingual tablets at 5-minute intervals, but the pain has intensified. The nurse notes that the patient has a heart rate of 76 beats per minute and a blood pressure of 120/82 mm Hg. The electrocardiogram is normal. The patient's lips and nail beds are pink, and there is no respiratory distress. The nurse will anticipate providing: a. an angiotensin-converting enzyme (ACE) inhibitor. b. intravenous nitroglycerin and a beta blocker. c. ranolazine (Ranexa) and quinidine. d. supplemental oxygen and intravenous morphine.
B This patient has unstable angina, and the next step, when pain is unrelieved by sublingual nitroglycerin, is to give intravenous nitroglycerin and a beta blocker. ACE inhibitors should be given to patients with persistent hypertension if they have left ventricular dysfunction or congestive heart failure (CHF). Ranolazine is a first-line angina drug, but it should not be given with quinidine because of the risk of increasing the QT interval. Supplemental oxygen is indicated if cyanosis or respiratory distress is present. IV morphine may be given if the pain is unrelieved by nitroglycerin.
A nurse is providing education to a group of patients regarding amphetamines. To evaluate the group's understanding, the nurse asks a participant what effects amphetamines would have on her. The participant shows that she understands the effects of these drugs if she gives which answers? (Select all that apply.) a. "Amphetamines increase fatigue." b. "Amphetamines suppress the perception of pain." c. "Amphetamines increase appetite." d. "Amphetamines increase the heart rate." e. "Amphetamines elevate mood."
B, D, E At customary doses, amphetamines increase wakefulness and alertness, reduce fatigue, elevate mood, and augment self-confidence and initiative. Amphetamines also suppress appetite and the perception of pain and increase the heart rate. Amphetamines do not increase fatigue or appetite.
The nurse is administering medications to a patient who is receiving cyclosporine [Sandimmune]. Which medication, when administered concurrently with cyclosporine, would warrant a reduction in the dosage of cyclosporine? a. Phenytoin [Dilantin] b. Prednisone c. Ketoconazole [Nizoral] d. Trimethoprim/sulfamethoxazole [Bactrim]
C Concurrent use of ketoconazole would warrant a reduction in the dosage of cyclosporine. Ketoconazole often is given concurrently with cyclosporine so that the patient's dosage of cyclosporine, which is costly, can be reduced. Phenytoin would cause a decrease in cyclosporine levels. Prednisone often is given concurrently with cyclosporine to suppress the immune response. Trimethoprim/sulfamethoxazole reduces levels of cyclosporine in the body.
A newborn infant has been given erythromycin ophthalmic ointment as a routine postpartum medication. The infant's mother learns that she has a C. trachomatis infection and asks the nurse if her baby will need to be treated. Which response by the nurse is correct? a. "The erythromycin ointment will prevent your baby from developing conjunctivitis." b. "Without additional treatment, your baby could develop blindness." c. "Your baby will need to be treated with oral erythromycin." d. "Your baby will need to take doxycycline [Vibramycin] for 10 days."
C Infants born to women with cervical C. trachomatis are at risk for conjunctivitis and pneumonia. Topical erythromycin may help prevent conjunctivitis, but it is not completely effective and does not prevent pneumonia; therefore, this infant will need treatment with oral erythromycin. Blindness will not occur as a result of C. trachomatis conjunctivitis. Doxycycline is contraindicated, because it causes staining of the teeth in children under 8 years of age.
A patient with histoplasmosis is being treated with itraconazole [Sporanox]. The nurse will teach this patient to report which symptoms? a. Gynecomastia and decreased libido b. Headache and rash c. Nausea, vomiting, and anorexia d. Visual disturbances
C Itraconazole is associated with rare cases of liver failure, some of which were fatal. Patients should be instructed to reports signs of liver toxicity, including nausea, vomiting, and anorexia. Ketoconazole is associated with gynecomastia and libido changes. Headache and rash are associated with fluconazole. Visual disturbances may occur with voriconazole.
A patient who has been taking linezolid [Zyvox] for 6 months develops vision problems. What will the nurse do? a. Reassure the patient that this is a harmless side effect of this drug. b. Tell the patient that blindness is likely to occur with this drug. c. Tell the patient that this symptom is reversible when the drug is discontinued. d. Tell the patient to take tyramine supplements to minimize this effect.
C Linezolid is associated with neuropathy, including optic neuropathy. This is a reversible effect that will stop when the drug is withdrawn. Reassuring the patient that this is a harmless side effect is not correct. It is not an indication that blindness will occur. Tyramine supplements are not indicated.
An 18-month-old child develops an urticarial reaction after a transfusion. The prescriber orders intravenous promethazine [Phenergan]. What will the nurse do? a. Give the medication as ordered. b. Monitor the child for bronchoconstriction. c. Question the order. d. Request an order to give the drug orally.
C Promethazine can cause severe respiratory depression, especially in very young patients; it is contraindicated in children younger than 2 years. The medication should not be given as ordered. It is not safe to give the drug and then monitor for bronchoconstriction. The drug is not safe in this age group when given orally.
A nursing student asks a nurse to explain the differences between amphotericin B [Abelcet] and the azoles group of antifungal agents. Which statement by the nurse is correct? a. "Amphotericin B can be given orally or intravenously." b. "Amphotericin B increases the levels of many other drugs." c. "Azoles have lower toxicity than amphotericin B." d. "Only the azoles are broad-spectrum antifungal agents."
C The azoles class of antifungals is less toxic than amphotericin B. Amphotericin B may only be given parenterally. The azoles, not amphotericin B, inhibit hepatic P450 drug-metabolizing enzymes, so they increase the levels of many other drugs. Both classes are broad-spectrum antifungal agents.
A patient is receiving tobramycin 3 times daily. The provider has ordered a trough level with the 8:00 AM dose. The nurse will ensure that the level is drawn at what time? a. 4:00 AM b. 7:00 AM c. 7:45 AM d. 8:45 AM
C When a patient is receiving divided doses of an aminoglycoside, the trough level should be drawn just before the next dose; therefore, 7:45 AM would be the appropriate time. It would not be appropriate to draw a trough at the other times listed.
A patient will begin receiving vincristine [Oncovin] to treat Hodgkin's lymphoma. Which side effect(s) will the nurse tell the patient to report immediately? a. Diarrhea, nausea, and vomiting b. Hair loss c. Headaches d. Tingling of the extremities
D Peripheral neuropathy is the major dose-limiting toxicity of vincristine. Patients should be counseled to report tingling of the extremities. Diarrhea, nausea, vomiting, and hair loss may occur but are expected. Headaches are not likely.
A patient is taking digoxin [Lanoxin] and quinidine to treat sustained ventricular tachycardia. Before giving medications, the nurse reviews the patient's electrocardiogram (ECG) and notes a QRS complex that has widened by 50% from the baseline ECG. What will the nurse do? a. Administer the medications as ordered, because this indicates improvement. b. Contact the provider to discuss reducing the digoxin dose. c. Contact the provider to request an increase in the quinidine dose. d. Withhold the quinidine and contact the provider to report the ECG finding.
D Quinidine widens the QRS complex by slowing depolarization of the ventricles. As cardiotoxicity develops as a result of quinidine toxicity, the QRS complex widens excessively. Any widening of the QRS complex of 50% or more warrants notifying the provider, so the nurse should withhold the medication and contact the provider. Widening of the QRS complex by more than 50% of baseline indicates cardiotoxicity. Quinidine can double digoxin levels, so it is not likely that the digoxin dose would need to be increased, and an increase in the QRS complex does not indicate a need for more digoxin. The quinidine dose should not be increased, because the findings indicate cardiotoxicity from the quinidine.
A female patient who has hepatitis C is being treated with pegylated interferon alfa and ribavirin [Ribasphere]. It will be important for the nurse to teach this patient that: a. if she gets pregnant, she should use the inhaled form of ribavirin [Virazole]. b. if she is taking oral contraceptives, she should also take a protease inhibitor. c. she should use a hormonal contraceptive to avoid pregnancy. d. she will need a monthly pregnancy test during her treatment.
D Ribavirin causes severe fetal injury and is contraindicated during pregnancy. Women taking ribavirin must rule out pregnancy before starting the drug, monthly during treatment, and monthly for 6 months after stopping treatment. Inhaled ribavirin is also embryo lethal and teratogenic. Adding a protease inhibitor will reduce the efficacy of oral contraceptives. Women using ribavirin should use two reliable forms of birth control.
The nurse is preparing to administer medication to a patient receiving cyclophosphamide [Cytoxan]. To protect against the side effect of hemorrhagic cystitis, the nurse would expect to administer which drug? a. Decadron b. Diphenhydramine [Benadryl] c. Leucovorin d. Mesna [Mesnex]
D Cyclophosphamide can cause acute hemorrhagic cystitis; to prevent this, the nurse should expect to administer mesna, which is a protective agent. Decadron, diphenhydramine, and leucovorin are indicated for the prevention of side effects associated with different anticancer agents.
Which statement about alkylating agents does the nurse identify as true?
Development of resistance to alkylating agents is common.
The male client with chronic hepatitis C is being prescribed ribavarin. Which medication should the nurse discuss with the client?
Discuss the importance of using 2 reliable forms of birth control.
Hydroxyzine is an example of which type of antihistamine?
H1 antagonist: first generation
Which statement will the nurse include when teaching a patient with HIV about management of the disease?
HIV is considered a chronic disease.
The nurse is performing a physical assessment on a patient who is receiving treatment with abacavir, zidovudine, and lamivudine [Trizivir]. The patient complains of fatigue. Upon further assessment, the nurse finds a rash and notes that the patient has a temperature of 101.1°F. What is the nurse's best course of action?
Have the patient hold the medications and arrange for an immediate evaluation by the prescriber.
Which serum levels increases risk for nephrotoxicity and ototoxicity from administration of gentamicin?
High total cumulative and trough levels
A patient with congestive heart failure is admitted to the hospital. During the admission assessment, the nurse learns that the patient is taking a thiazide diuretic. The nurse notes that the admission electrolyte levels include a sodium level of 142 mEq/L, a chloride level of 95 mEq/L, and a potassium level of 3 mEq/L. The prescriber has ordered digoxin to be given immediately. What will the nurse do initially?
Hold the digoxin and report the laboratory values to the provider.
The nurse administers filgrastim [Neupogen] daily to a patient after completion of chemotherapy. After 4 weeks, the patient's neutrophil count is 11,500/mm3. The nurse should take which action?
Hold the filgrastim and notify the provider.
A nurse is caring for an older adult patient who has Alzheimer's disease. The patient is taking a cholinesterase inhibitor drug. Which side effects would concern the nurse?
Slowed heart rate and lightheadedness
If extravasation of an antineoplastic drug occurs, what will the nurse do first?
Stop the drug infusion without removing the intra-venous catheter
After receiving an allograft liver transplant, a patient is prescribed cyclosporine [Sandimmune] oral solution. What is the most critical component of patient teaching that the nurse should stress?
The medication will be taken every day for life.
A patient with HIV is prescribed lopinavir/ritonavir. It is most important for the nurse to monitor which laboratory value?
blood glucose levels
The nurse monitors a patient who is experiencing thrombocytopenia from severe bone marrow suppression by looking for
excessive bleeding and bruising.
The nurse is assessing a patient who has developed anemia after two rounds of chemotherapy. Which of these may be indications of anemia? (Select all that apply.)
fatigue hypoxia
A patient with heart failure has received a new prescription for oprelvekin. Which adverse effect would require this patient to immediately notify the provider?
fluid retention
There are currently 5 types of antiretroviral drugs for HIV treatment. Which of the drug classes blocks viral entry into cells?
fusion inhibitors and CCR5 antagonists
A patient is taking tamoxifen [Nolvadex] for treatment of breast cancer with metastatic bone cancer. It is most important for the nurse to assess the patient for the development of what?
hypercalcemia
A patient is receiving androgen deprivation therapy for treatment of prostate cancer. The nurse identifies all as adverse effects of androgen deprivation therapy except which?
increased muscle mass
Immunosuppressant use results in an increased risk of
neoplasms
A patient asks a nurse how nitroglycerin works to relieve anginal pain. The nurse correctly states, "Nitroglycerin
promotes vasodilation, which reduces preload and oxygen demand."
A patient is prescribed codeine as an antitussive. Which symptom will the nurse observe for as an adverse effect of this medication?
respiratory depression
A patient is prescribed sirolimus [Rapamune] and cyclosporine [Sandimmune] after renal transplantation. It is most important for the nurse to closely monitor which value?
serum creatinine
The rise and fall of water levels in a water-seal chamber (chest tube drainage system) with respiratory effort is known as
tidaling
Which of the following medications is the drug of choice to prevent mother to child HIV transmission during labor and delivery?
zidovudine
