PHARMACOLOGY MODULE 5
A patient asks, "Why am I getting three drugs for my cancer if they all do the same thing?" What is the nurse's best response? "Administering more than one drug prevents drug resistance." "More than one drug is administered in case you don't respond to one of them." "This makes your treatment more cost-effective." "We are not sure what drug will be the most effective, so this combination ensures success."
"Administering more than one drug prevents drug resistance." --Administering a combination of antineoplastic agents allows for smaller doses of each, which can minimize the severity of side effects and help prevent drug resistance.
A patient with Mycobacterium tuberculosis is prescribed ethambutol for long-term use. Which statement by the patient indicates understanding of the instructions? "Dizziness, drowsiness, and decreased urinary output are common with this drug, but they will subside over time." "Constipation will be a problem, so I will increase the fiber and fluids in my diet." "I will need to have my eyes checked regularly while I am taking this drug." "This medication may cause my bodily secretions to turn red-orange."
"I will need to have my eyes checked regularly while I am taking this drug." --Ethambutol can cause optic neuritis. Ophthalmologic examinations should be performed periodically to assess visual acuity.
The patient states that she has been prescribed prophylactic medication for tuberculosis for a period of 4 weeks. What is the nurse's best response? "Let me teach you about the medications." "We do not use medications prophylactically for tuberculosis." "You should be on the drugs for at least 6 months." "You should be on the medications for only 2 weeks."
"You should be on the drugs for at least 6 months." --Between 6 months and 1 year is sufficient time for prevention of active tuberculosis. Because the tuberculosis mycobacterium is slow-growing, shorter lengths of time may not sufficiently eradicate the organism.
Which value represents a normal absolute neutrophil count (ANC)? 5,000 3,500 1,500 500
1,500 --A normal ANC is over 1,500. An ANC of 500 to 1,500 is considered neutropenic, and an ANC less than 500 indicates severe neutropenia and significantly increases a person's risk for infection.
The nurse recognizes that compliance with ART regimens is often problematic for patients. What level of compliance is needed to help ensure ongoing success with this therapy? 50% 65% 80% 95%
95% --Adherence challenges are common with any drug therapy, but ART presents a greater challenge because patients are asked to achieve an adherence of 95% or greater. Nonadherence can result in HIV viral replication and can potentiate drug resistance.
A nurse is teaching a group of nurses about the importance of prophylactic antimicrobial therapy. Which of the following information should the nurse include in the teaching? (Select all that apply.) A. Administer prophylactic antimicrobial therapy to clients who report exposure to a sexually transmitted infection. B. Administer prophylactic antimicrobial therapy to clients who are having orthopedic surgery. C. Instruct clients who have a prosthetic heart valve about the need for prophylactic antimicrobial therapy before dental work. D. Consult the provider for prophylactic antimicrobial therapy for clients who have recurrent urinary tract infections. E. Instruct clients to request prophylactic antimicrobial therapy immediately when they have an upper respiratory infection.
A. Administer prophylactic antimicrobial therapy to clients who report exposure to a sexually transmitted infection. B. Administer prophylactic antimicrobial therapy to clients who are having orthopedic surgery. C. Instruct clients who have a prosthetic heart valve about the need for prophylactic antimicrobial therapy before dental work. D. Consult the provider for prophylactic antimicrobial therapy for clients who have recurrent urinary tract infections.
A nurse is caring for a client who has subacute bacterial endocarditis and is receiving several antibiotics, including streptomycin IM. For which of the following manifestations should the nurse monitor as an adverse effect of this medication? A. Ataxia B. Urinary retention C. Constipation D. Complex partial seizures
A. Ataxia Ataxia of the client's movement and coordination of the body is a common adverse effect of streptomycin. This medication treats infections in combination with other antibiotics or to treat severe infections when other antibiotics failed.
A nurse is caring for a client who has breast cancer and asks why the treatment plan contains a combination therapy of cyclophosphamide, methotrexate, and fluorouracil. The response by the nurse should include that combination chemotherapy is used to do which of the following? (Select all that apply.) A. Decrease medication resistance B. Attack cancer cells at different stages of cell growth C. Block chemotherapy agent from entering healthy cells D. Stimulate immune system E. Decrease injury to normal body cells
A. Decrease medication resistance B. Attack cancer cells at different stages of cell growth E. Decrease injury to normal body cells Medication resistance is decreased with combination therapy because the chance of developing resistance to several medication is less than to only one medication. Each medication kills cancer cells at a different stage of growth. A combination of medications can kill more cancer cells than only one medication. Injury to normal body cells can be decreased by combination therapy because the medications used have different toxicities.
A nurse is caring for a client who takes several antiretroviral medications, including the NRTI zidovudine, to treat HIV infection. The nurse should monitor for which of the following adverse effects of zidovudine? (Select all that apply.) A. Fatigue B. Blurred vision C. Ataxia D. Hyperventilation E. Vomiting
A. Fatigue D. Hyperventilation E. Vomiting Fatigue is a manifestation of anemia, an adverse effect of zidovudine. Neutropenia can also occur, causing a high risk for infection. Hyperventilation is a finding that can occur if the client develops lactic acidosis, a serious adverse effect of zidovudine. Vomiting and other GI effects are adverse effects of zidovudine.
A nurse reviewing a client's medication history notes an allergy to sulfonamides. This allergy is a contraindication for taking which of the following medications? (Select all that apply.) A. Hydrochlorothiazide B. Metoprolol C. Acetaminophen D. Glipizide E. Furosemide
A. Hydrochlorothiazide D. Glipizide E. Furosemide A sulfonamide allergy is a contraindication for taking hydrochlorothiazide. Hypersensitivity, including Stevens-Johnson syndrome, can result from taking hydrochlorothiazide and a sulfonamide concurrently. A sulfonamide allergy is a contraindication for taking some oral antidiabetes medications, including glipizide and glyburide. Hypersensitivity, including Stevens-Johnson syndrome, can result from taking glipizide and a sulfonamide concurrently. A sulfonamide allergy is a contraindication for taking loop diuretics (furosemide). Hypersensitivity, including Stevens-Johnson syndrome, can result from taking furosemide and a sulfonamide concurrently.
A nurse is teaching a group of nurses about antimicrobial therapy. The nurse should instruct that effective penetration of antibiotics can be impeded by which of the following conditions? A. Meningitis B. An infected abscess C. Endocarditis D. Pneumonia E. Pyelonephritis
A. Meningitis B. An infected abscess C. Endocarditis The blood brain barrier can block antibiotics from reaching the infective microorganisms in clients who have meningitis. Purulent drainage and poor vascularity can impede penetration of an antibiotic to an infected abscess. Clients who have endocarditis might develop a bacterial vegetation which can impede penetration of an antibiotic.
A nurse is teaching a client who has a new prescription for nitrofurantoin. Which of the following information should the nurse include? (Select all that apply.) A. Observe for bruising on the skin. B. Take the medication with milk or meals. C. Expect brown discoloration of urine. D. Crush the medication if it is difficult to swallow. E. Expect insomnia when taking it.
A. Observe for bruising on the skin. B. Take the medication with milk or meals. C. Expect brown discoloration of urine. Bruising can indicate a blood dyscrasia, and the client should notify the provider if this occurs. Taking the medication with milk or meals minimizes GI discomfort from nausea, vomiting, anorexia, and diarrhea. A brown discoloration of urine is a common adverse effect of nitrofurantoin.
A nurse is teaching a client who has a severe UTI about ciprofloxacin. Which of the following information about adverse reactions should the nurse include? (Select all that apply.) A. Observe for pain and swelling of the Achilles tendon. B. Watch for a vaginal yeast infection. C. Expect excessive nighttime perspiration. D. Inspect the mouth for cottage cheese-like lesions. E. Take the medication with a dairy product.
A. Observe for pain and swelling of the Achilles tendon. B. Watch for a vaginal yeast infection. D. Inspect the mouth for cottage cheese-like lesions. Pain and swelling of the Achilles tendon indicate an adverse effect of ciprofloxacin to report to the provider. A vaginal yeast infection is an overgrowth of Candida albicans, which commonly occurs when taking ciprofloxacin. Cottage cheese-like lesions in the mouth indicate an overgrowth of Candida albicans, a common adverse effect when taking ciprofloxacin.
A nurse is preparing to administer cyclophosphamide IV to a client who has Hodgkin's disease. Which of the following medications should the nurse expect to administer concurrently with the chemotherapy to prevent an adverse effect of cyclophosphamide? A. Protectant agent, such as mesna B. Opioid, such as morphine C. Loop diuretic, such as furosemide D. H1 receptor antagonist, such as diphenhydramine
A. Protectant agent, such as mesna Mesna is a uroprotectant agent that can help prevent hemorrhagic cystitis when administered IV with a nitrogen mustard chemotherapy medication.
A nurse is caring for a client who is starting a course of gentamicin IV for a serious respiratory infection. For which of the following manifestations should the nurse monitor as an adverse effect of this medication? (Select all that apply.) A. Pruritus B. Hematuria C. Muscle weakness D. Difficulty swallowing E. Vertigo
A. Pruritus B. Hematuria C. Muscle weakness E. Vertigo Pruritus can indicate hypersensitivity. Hematuria is an indication of nephrotoxicity. Muscle weakness can occur as a result of neuromuscular blockade. Vertigo can indicate ototoxicity.
In an effort to prevent cytokine release syndrome associated with antirejection drugs, the nurse would anticipate the premedication with which agents? Select all that apply. Acetaminophen Corticosteroids Antihistamines Phenothiazines H2 antagonists
Acetaminophen Corticosteroids Antihistamines --Premedication with corticosteroids or acetaminophen plus an antihistamine has been reported to be effective in reducing the severity of symptoms caused by cytokine release.
The nurse is caring for a patient who has been diagnosed with genital herpes. Which medication is the drug of choice for this patient? Acyclovir Amantadine Ribavirin Zidovudine
Acyclovir --Acyclovir is the drug of choice to treat herpes simplex infections. Ribavirin is effective against respiratory syncytial virus (RSV); zidovudine is effective against HIV; amantadine is effective against H. influenzae type A.
The nurse is monitoring a patient receiving doxorubicin. What intervention is a priority for this patient? Administering dexrazoxane Encouraging fluids to 3 L/day Keeping patient away from crowds Administering antiemetic 60 min before infusion
Administering dexrazoxane --Patients receiving doxorubicin need to be monitored for cardiac toxicity. Dexrazoxane is a cytoprotective (chemoprotective) agent that may be given to help prevent cardiac toxicities associated with doxorubicin administration.
The nurse is caring for a patient receiving high-dose methotrexate (MTX) therapy. What intervention is a priority for this patient? Administering bleomycin immediately after treatment with MTX Infusing IV dextrose at 100 mL/h throughout the drug therapy Encouraging oral fluids to 4 L/day while being treated with MTX Administering leucovorin within 2 days of treatment with MTX
Administering leucovorin within 2 days of treatment with MTX --Leucovorin calcium is given within the first 24-42 h of starting methotrexate to block the systemic toxic effect of high-dose MTX. It is a form of folic acid that does not require dihydrofolate reductase to produce folic acid. Therefore, it is used to prevent or treat toxicity induced by methotrexate, a folic acid antagonist. Bleomycin is not administered with MTX; IV dextrose is not necessary with MTX therapy, and increased fluids to this degree are not necessary with MTX.
The health care provider has ordered ribavirin for the patient with respiratory syncytial virus (RSV). The nurse recognizes that which route is the most effective way to administer this medication to the patient? Intravenously over 1 hour Orally at regular intervals By subcutaneous injection Aerosol inhalation
Aerosol inhalation --Ribavirin should be administered by aerosol inhalation.
When teaching a patient receiving paclitaxel, the nurse plans to instruct the patient to monitor for which side effect? Arthralgias Hypertension Vertigo Weight gain
Arthralgias --Myalgias (muscle pains) and arthralgias (joint pains) are a common side effect of paclitaxel that the patient should be prepared to expect.
The patient is being treated with intravenous amphotericin B. What is the nurse's primary intervention? Encourage the patient to drink at least a liter of fluid per shift. Assess the IV site for infiltration. Administer with dextrose. Assess blood urea nitrogen and creatinine.
Assess blood urea nitrogen and creatinine. --Amphotericin B is considered highly toxic and can cause nephrotoxicity and electrolyte imbalance, especially hypokalemia and hypomagnesemia (low serum potassium and magnesium levels). Urinary output, blood urea nitrogen, and serum creatinine levels need to be closely monitored.
A 22-year-old female patient is put on amoxicillin. Which is the most important intervention for this patient? Instruct the patient to not take the medication before meals. Assess if the patient is on oral contraceptives. Inform the patient about possible superinfections. Assess the patient for cross sensitivity.
Assess if the patient is on oral contraceptives. --This medication may decrease the effectiveness of oral contraceptives. The nurse needs to assess whether or not the patient is on oral contraceptives and whether or not the patient is sexually active.
The nurse is working with a patient who will be traveling to a country where the incidence of malaria is high. The nurse anticipates that the health care provider is most likely to place the patient on which medication? Artemether/lumefantrine Amantadine HCl Atovaquone/proguanil Praziquantel
Atovaquone/proguanil --Of the drugs listed, atovaquone/proguanil is the drug of choice for prevention of malaria.
Which instruction should be included in the education of a patient beginning therapy with metronidazole for diarrhea due to a clostridium infection? Take with food. Monitor pulse daily. Use sunscreen or wear long sleeves. Avoid alcohol and products containing alcohol.
Avoid alcohol and products containing alcohol. --Patients taking metronidazole should avoid alcohol and products containing alcohol.
A nurse is teaching a client who has active tuberculosis about the treatment regimen. The client asks why four different medications are necessary. Which of the following responses should the nurse make? A. "Four medications decrease the risk for a severe allergic reaction." B. "Four medications reduce the chance that the bacteria will become resistant." C. "Four medications reduce the risk for adverse reactions" D. "Four medications decrease the chance of having a positive tuberculin skin test."
B. "Four medications reduce the chance that the bacteria will become resistant." If the client took only one medication to treat active tuberculosis, resistance to the medication would occur quickly. Taking three or four medications decreases the possibility of resistance.
A nurse is teaching a client about taking tetracycline to treat a GI infection due to Helicobacter pylori. Which of the following statements should the nurse identify as an indication that the client understands the instructions? A. "I will take this medication with 8 ounces of milk." B. "I will let my doctor know if I start having diarrhea." C. "I can stop taking this medication when I feel completely well." D. "I can take this medication just before bedtime."
B. "I will let my doctor know if I start having diarrhea." Diarrhea can indicate that the client is developing a superinfection, which can be very serious. The client should notify the provider if diarrhea occurs.
A nurse is administering gentamicin by IV infusion at 0900. The medication will take 1 hr to infuse. When should the nurse plan to obtain a blood sample for a peak blood level of gentamicin? A. 1000 B. 1030 C. 1100 D. 1130
B. 1030 Obtain the blood specimen for the peak blood level at 1030, 30 min after the end of the IV infusion. For the trough level, collect the blood sample just before starting the infusion.
A nurse is teaching a client who has breast cancer about tamoxifen. Which of the following adverse effects of tamoxifen should the nurse discuss with the client? A. Irregular heart beat B. Abnormal uterine bleeding C. Yellow sclera or dark-colored urine. D. Difficulty swallowing
B. Abnormal uterine bleeding Vaginal discharge and bleeding are adverse effects of tamoxifen. The client who takes tamoxifen is also at increased risk for endometrial cancer, so any abnormal uterine bleeding should be carefully monitored and evaluated.
A nurse is preparing to administer nafcillin IM to an adult client who has an infection. Which of the following actions should the nurse plan to take? (Select all that apply.) A. Select a 25-gauge, ½-inch needle for the injection. B. Administer the medication deeply into the ventrogluteal muscle. C. Ask the client about an allergy to penicillin before administering the medication. D. Monitor the client for 30 min following the injection. E. Tell the client to expect a temporary rash to develop following the injection.
B. Administer the medication deeply into the ventrogluteal muscle. C. Ask the client about an allergy to penicillin before administering the medication. D. Monitor the client for 30 min following the injection.
A nurse is caring for a group of clients who are receiving antimicrobial therapy. The nurse should identify that which of the following clients is at risk for medication toxicity? A. A young adult client who has a sinus infection B. An older adult client who has prostatitis C. A client who is postpartum and has mastitis D. A middle adult client who has a urinary tract infection
B. An older adult client who has prostatitis An older adult client who has prostatitis and is receiving antibiotics is at risk for toxicity due to the age-related reduction in medication metabolism and excretion.
A nurse is planning to administer ciprofloxacin IV to a client who has cystitis. Which of the following actions should the nurse take? A. Administer a concentrated solution. B. Infuse the medication over 60 min. C. Infuse the solution through the primary IV fluid's tubing. D. Choose a small peripheral vein for administration.
B. Infuse the medication over 60 min. Administer ciprofloxacin IV over 60 min to minimize irritation of the vein.
A nurse is caring for a client who is being treated with interferon alfa-2b for malignant melanoma. For which of the following adverse effects should the nurse monitor? (Select all that apply.) A. Tinnitus B. Muscle aches C. Peripheral neuropathy D. Bone loss E. Depression
B. Muscle aches C. Peripheral neuropathy E. Depression Muscle aches and other flu-like manifestations are common adverse effects of interferon alfa-2b. Acetaminophen may be prescribed to relieve these manifestations. Peripheral neuropathy, dizziness, and fatigue are CNS effects that can occur when taking interferon alfa-2b. These should be reported to the provider, and teach the client to prevent injury from falls. Depression and mental status changes can occur with interferon alfa-2b treatment. Assess the client for suicidal thoughts.
A nurse is implementing a plan of care for a client who has a wound infection. Which of the following actions is the nurse's priority? A. Administer antibiotic medication. B. Obtain a wound specimen for culture. C. Monitor the client for a superinfection. D. Teach the client about wound care.
B. Obtain a wound specimen for culture. When using the urgent vs. nonurgent approach to care, the nurse's priority action is to obtain a culture of the wound before initiating antibiotic therapy.
What will the nurse monitor to evaluate the effectiveness of antiviral agents administered to treat human immunodeficiency virus infection? Megakaryocyte counts Lymphocyte counts Red blood cell counts Viral load
Viral load --All antiretroviral agents work to reduce the viral load, which is the number of viral RNA copies per milliliter of blood.
A nurse is caring for a client who has a new prescription for enfuvirtide to treat HIV infection. The nurse should monitor the client for which of the adverse reactions of this medication? (Select all that apply.) A. Bleeding B. Pneumonia C. Cerebral edema D. Localized erythema E. Hypotension
B. Pneumonia D. Localized erythema E. Hypotension Bacterial pneumonia with fever, cough, and difficulty breathing are manifestations of an adverse reaction to enfuvirtide. Assess breath sounds regularly. Enfuvirtide is administered subcutaneously. Injection-site reactions (redness, itching, and bruising) are common. A systemic allergic reaction can occur when taking enfuvirtide. Manifestations of hypersensitivity include rash, hypotension, fever, and chills.
A nurse is caring for a client who has diabetes mellitus, pulmonary tuberculosis, and a new prescription for isoniazid. Which of the following supplements should the nurse expect to administer to prevent an adverse effect of INH? A. Ascorbic acid B. Pyridoxine C. Folic acid D. Cyanocobalamin
B. Pyridoxine Pyridoxine is frequently prescribed along with INH to prevent peripheral neuropathy for clients who have increased risk factors (diabetes mellitus or alcohol use disorder.)
The nurse is caring for a patient taking a polymyxin. What should the nurse monitor to identify potential side effects of this medication? Hemoglobin and hematocrit Blood urea nitrogen and creatinine Platelets Stool guaiac
Blood urea nitrogen and creatinine --Polymyxins can cause kidney damage. Blood urea nitrogen and creatinine should be closely monitored
A nurse is teaching a client who has a new prescription for combination oral NRTIs (abacavir, lamivudine, and dolutegravir) for treatment of HIV. Which of the following statements should the nurse include? A. "These medications work by blocking HIV entry into cells." B. "These medications work by weakening the cell wall of the HIV virus." C. "These medications work by inhibiting enzymes to prevent HIV replication." D. "These medications work by preventing protein synthesis within the HIV cell."
C. "These medications work by inhibiting enzymes to prevent HIV replication." The NRTI antiretroviral medications this client takes work by inhibiting DNA synthesis and thus viral replication.
A nurse is teaching a client who is beginning a course of metronidazole to treat an infection. For which of the following findings of an adverse effect should the nurse instruct the client as a priority to stop taking metronidazole and notify the provider? A. Metallic taste B. Nausea C. Ataxia D. Dark-colored urine
C. Ataxia Using the urgent vs. nonurgent approach to client care, the priority adverse effect to report to the provider is ataxia, tremors, paresthesias of the extremities, and seizures, which are manifestations of CNS toxicity.
A nurse is caring for a client who receives rituximab to treat non-Hodgkin's leukemia and who asks the nurse how rituximab works. Which of the following should the nurse include? A. Blocks hormone receptors B. Increases immune response C. Binds with specific antigens on tumor cells D. Stops DNA replication during cell division
C. Binds with specific antigens on tumor cells Rituximab is a monoclonal antibody that binds to specific antigens on B-lymphocytes and then destroying cancer cells.
A nurse is administering IV amphotericin B to a client who has a systemic fungal infection. The nurse should monitor which of the following laboratory values? (Select all that apply.) A. Blood albumin B. Blood amylase C. Blood potassium D. Hematocrit E. Blood creatinine
C. Blood potassium D. Hematocrit E. Blood creatinine Hypokalemia is a serious adverse effect of amphotericin B. Monitor blood potassium values for hypokalemia. Amphotericin B can cause bone marrow suppression. Monitor CBC and platelet count periodically. Amphotericin B can cause nephrotoxicity. Monitor kidney function (with blood creatinine, BUN, and creatinine clearance).
A nurse is caring for a client who has a cerebrospinal fluid infection with gram-negative bacteria. Which of the following cephalosporin antibiotics should the nurse expect to administer IV to treat this infection? A. Cefaclor B. Cefazolin C. Cefepime D. Cephalexin
C. Cefepime Cefepime, a fourth-generation cephalosporin, is more likely to be effective against this infection than the other medications, which are from the first or second generation. Medications from each progressive generation of cephalosporins are more effective against gram-negative bacteria, more resistant to destruction by beta-lactamase, and more able to reach cerebrospinal fluid.
A nurse is assessing a client who has a severe infection and has been receiving cefotaxime for the past week. Which of the following findings indicates a potentially serious adverse reaction to this medication that the nurse should report to the provider? A. Diaphoresis B. Epistaxis C. Diarrhea D. Alopecia
C. Diarrhea Diarrhea is an adverse effect of cefotaxime and other cephalosporins that requires reporting to the provider. Severe diarrhea might indicate that the client has developed antibiotic-associated pseudomembranous colitis, which could be life-threatening.
A nurse is infusing IV amphotericin B to a client who has a systemic fungal infection. The nurse should monitor the client for which of the following manifestations as an adverse effect of this medication? A. Hypoglycemia B. Constipation C. Fever D. Hyperkalemia
C. Fever Amphotericin B can cause fever, chills, and nausea during the infusion. Pretreatment with diphenhydramine and acetaminophen can reduce these effects.
A nurse is administering IV acyclovir to a client who has varicella. Which of the following actions should the nurse take? A. Administer a stool softener. B. Decrease fluid intake following infusion. C. Infuse acyclovir over 1 hr. D. Monitor for a for hypotension
C. Infuse acyclovir over 1 hr. Administer IV acyclovir slowly, over at least 1 hr, to prevent nephrotoxicity.
A nurse is preparing to administer penicillin V to a client who has a streptococcal infection. The client reports difficulty swallowing tablets and doesn't "do well" with liquid or chewable medications because of the taste, even when the nurse mixes the medication with food. The nurse should request a prescription for which of the following medications? A. Fosfomycin B. Amoxicillin C. Nafcillin D. Cefaclor
C. Nafcillin Nafcillin is an acceptable alternative within the penicillin classification because it is available for IM or IV use.
A nurse is caring for a client who is undergoing preparation for extensive colorectal surgery. Which of the following oral antibiotics should the nurse expect to administer specifically to suppress normal flora in the GI tract? A. Kanamycin B. Gentamicin C. Neomycin D. Tobramycin
C. Neomycin Expect to administer neomycin, an aminoglycoside antibiotic, orally prior to GI surgery to rid the large intestine of normal flora.
A nurse is planning discharge teaching for a female client who has a new prescription for trimethoprim-sulfamethoxazole. Which of the following information should the nurse include? A. Take the medication even if pregnant. B. Maintain a fluid restriction while taking it. C. Take it on an empty stomach. D. Stop taking it when manifestations subside.
C. Take it on an empty stomach. Inform the client that the medication can be taken the medication with or without food.
A nurse is teaching a client who is beginning highly active antiretroviral therapy (HAART) for HIV infection about ways to prevent medication resistance. Which of the following information should the nurse teach the client about resistance? A. Taking low dosages of antiretroviral medication minimizes resistance. B. Taking one antiretroviral medication at a time minimizes resistance. C. Taking medication at the same times daily without missing doses minimizes resistance. D. Changing the medication regimen when adverse effects occur minimizes resistance.
C. Taking medication at the same times daily without missing doses minimizes resistance. Emphasize the importance of taking each dose of medication exactly as prescribed. Missing even a few doses of antiretroviral medication can promote medication resistance, which can cause treatment failure.
A nurse is teaching a client who has manifestations of a urinary tract infection. The nurse should instruct the client that which of the following tests is needed to determine which microorganism is causing the infection? A. Blood WBC B. Blood creatinine C. Urine culture D. Urine specific gravity
C. Urine culture A urine culture is used to identify the causative microorganism and the sensitivity is used to identify an effective antibiotic to prescribe.
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 increases the risk for a medication interaction? A. Regular insulin B. Furosemide C. Valproic acid D. Ferrous sulfate
C. Valproic acid Imipenem-cilastatin decreases the blood levels of valproic acid, an antiseizure medication, putting the client at risk for increased seizure activity. If the client must take these two medications concurrently, monitor for seizures.
A patient is receiving antiretroviral therapy (ART). Which outcome indicates a therapeutic response to the medication therapy? Elevation of HIV RNA levels CD4 T-cell increase Decreased T-cell reactivity Increased immune system functioning
CD4 T-cell increase --The expected outcome of ART is a suppression of HIV RNA levels and CD4 T-cell increases in patients. Elevated HIV RNA levels, decreased T-cell reactivity, and increased immune system functioning are not indicative of a therapeutic response to medication therapy.
What is the primary assessment the nurse should make for a patient who is taking ganciclovir sodium? Blood urea nitrogen Bowel elimination Complete blood count Input and output
Complete blood count --Bone marrow suppression is a dose-limiting toxicity of ganciclovir, and a complete blood count should be monitored.
A nurse is preparing to administer leucovorin to a client who has cancer and is receiving chemotherapy with methotrexate. Which of the following responses should the nurse use when the client asks why leucovorin is being given? A. "Leucovorin reduces the risk of a transfusion reaction from methotrexate." B. "Leucovorin increases platelet production and prevents bleeding." C. "Leucovorin potentiates the cytotoxic effects of methotrexate." D. "Leucovorin protects healthy cells from methotrexate's toxic effect."
D. "Leucovorin protects healthy cells from methotrexate's toxic effect." Leucovorin, a folic acid derivative and an antagonist to methotrexate, is given within 12 hr of high doses of methotrexate to protect healthy cells from the toxic effects of methotrexate
A nurse is caring for a client who is taking ritonavir, a protease inhibitor, to treat HIV infection. The nurse should monitor for which of the following adverse effects of this medication? A. Increased TSH level B. Decreased ALT level C. Hypoglycemia D. Hyperlipidemia
D. Hyperlipidemia Hyperlipidemia with increased cholesterol and triglyceride levels can occur as an adverse effect of ritonavir.
The patient has been ordered lincomycin. The patient reports to the nurse that the patient has experienced reduced renal function in the past. The nurse anticipates that the health care provider will take which action? Place the medication on hold until renal function improves. Increase the original dosage of the medication. Decrease the original dosage of the medication. Continue with the medication as originally ordered.
Decrease the original dosage of the medication. --Rather than place the medication on hold because of the patient's decreased renal function, the health care provider will likely opt to decrease the originally ordered dosage to accommodate the change in function.
Which point should the nurse include in providing teaching regarding corticosteroid therapy? Select all that apply. Delayed wound healing may occur. Do not stop medication abruptly. Do not receive live vaccines. Monitor pulse daily. Risk for infection decreases.
Delayed wound healing may occur. Do not stop medication abruptly. Do not receive live vaccines. --Long-term use may lead to impaired wound healing, skin atrophy, and decreased response to infections. Live vaccines could lead to significant infections and should be avoided. Sudden cessation of corticosteroids may lead to withdrawal symptoms with high doses or long-term use and the onset of Addison's crisis. Pulse rates should not be affected, and risk for infection increases. Long-term use may lead to impaired wound healing, skin atrophy, Cushing syndrome, glaucoma and cataracts, Kaposi sarcoma, and growth suppression in children. Cessation of corticosteroids may lead to withdrawal symptoms with high doses or long-term use. Pulse rates should not be affected, and risk for infection increases.
The nurse is caring for a patient who is taking rifampin. The patient has a heart rate of 90 beats/min, blood pressure of 100/89 mm Hg, and red-orange urine. What is the nurse's best action? Document the findings and teach the patient. Call the health care provider. Collect a urine culture. Discard the first void and start a 24-hour urine collection.
Document the findings and teach the patient. --Red-orange discoloration of body fluids is a common side effect of rifampin, but it is not harmful and does not indicate infection. There is no need to call the health care provider, collect a urine culture, or start 24-hour urine collection.
The nurse is caring for a patient receiving cyclophosphamide. What is a priority intervention for this patient? Assessing blood pressure hourly Encouraging fluids before, during, and after drug administration Drawing peak and trough levels Keeping patient isolated until drug is excreted
Encouraging fluids before, during, and after drug administration Patients receiving cyclophosphamide should drink at least 2-3 L of fluid before, during, and after administration to prevent hemorrhagic cystitis.
A patient is receiving IV cyclophosphamide. Which intervention is a priority for this patient? Ensuring that the patient is well hydrated Monitoring the white blood cell count Administering an antianxiety agent Running IV dextrose with the chemotherapy
Ensuring that the patient is well hydrated --The patient should be well hydrated while taking this drug to prevent hemorrhagic cystitis (bleeding as a result of severe bladder inflammation). Normal saline is used as the maintenance IV when administering chemotherapy. Although it is important to monitor the patient's white blood cell count while receiving chemotherapy, avoiding hemorrhagic cystitis is the priority because it can be life-threatening. Antianxiety agents can be used if needed for the patient but on an individual basis, not routinely.
The patient has been diagnosed with tinea pedis. The nurse recognizes that the patient is most likely to be ordered which drug? Terconazole Miconazole nitrate Butoconazole nitrate Griseofulvin
Griseofulvin --Of the drugs listed, the patient is most likely to be treated with griseofulvin. The other drugs treat candidiasis.
The nurse is caring for a patient who has been prescribed cefazolin sodium. Which nursing assessment is the priority? History, including allergies Cardiac assessment Neurological assessment History of immunizations
History, including allergies --Antibiotic allergy is one of the most common drug allergies. These allergies also have the potential to cause severe anaphylaxis and death and, therefore, have more importance than the other assessments listed.
The nurse is caring for a patient with a hemoglobin of 15 g/dL, platelet count of 450,000/mm3, and thrombocyte count of 8,000/mm3 who is to receive cyclophosphamide therapy. What is the nurse's priority intervention? Hold the cyclophosphamide therapy. Isolate the patient. Start platelet transfusion. Teach the patient effects of chemotherapy.
Hold the cyclophosphamide therapy. --Cyclophosphamide causes bone marrow suppression, which is evidenced by a decrease in red blood cells, white blood cells, and platelets. A thrombocyte count of 8000/mm3 is significantly lower than normal. The chemotherapy should be held.
The nurse has instructed a patient diagnosed with human immunodeficiency virus (HIV) on the use of zidovudine. Which patient statement demonstrates a need for additional teaching? I may get a headache from this medication. I might have difficulty sleeping with this medication. I do not need to use condoms as long as I take my medication as prescribed. I do not have to worry about taking the medication on an empty stomach or not.
I do not need to use condoms as long as I take my medication as prescribed. --Antiretroviral agents do not stop the transmission of HIV, and patients need to continue standard precautions. Zidovudine (Retrovir, AZT) is not known for causing headaches or producing insomnia and does not require being taken with food.
Which statement indicates to the nurse that the patient understands the medication instructions regarding ketoconazole for treatment of candidiasis? I will take this medication with orange juice for better absorption. I need to take this drug with food to minimize gastrointestinal distress. I can take this medication with antacids if it causes gastrointestinal discomfort. I can expect my skin to turn yellow from taking this drug.
I need to take this drug with food to minimize gastrointestinal distress. --Taking this medication with food will help minimize gastrointestinal upset. Ketoconazole should not be taken with coffee, tea, or acidic fruit juices. Additionally, it needs to be taken at least 2 hours before or after the ingestion of alkaline products or antacids.
In which of the following groups would the use of tetracycline be contraindicated? Select all that apply. Infants Pregnant women Older adults Adolescents Breastfeeding mothers
Infants Pregnant women --Women in the last trimester of pregnancy and children younger than 8 years of age should also not take tetracycline because it irreversibly discolors the permanent teeth.
The patient has been started on stavudine (d4T). After taking the drug for 3 days, the patient contacts the nurse to report that the patient has started experiencing muscle pain and weakness. What is the nurse's highest priority action? Instruct the patient to hold doses of the medication until further notice. Reassure the patient that this is an expected side effect of the medication. Instruct the patient to self-medicate with an NSAID medication. Reassure the patient that the symptom is time-limited and will resolve.
Instruct the patient to hold doses of the medication until further notice. --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 side effect of the medication. The nurse's scope of practice does not allow for adjusting the patient's medication regimen.
The health care provider has ordered amphotericin B for the patient. The nurse recognizes that which is the most effective way to administer this medication to the patient? Intravenously over 1 hour Orally at regular intervals By subcutaneous injection Intravenously over 2 to 6 hours
Intravenously over 2 to 6 hours --Amphotericin B should be administered by slow intravenous infusion.
A patient enters the emergency department with suspected influenza. Prior to starting the patient on the prescribed oseltamivir phosphate, what should the nurse determine? Allergies to antibiotics Over-the-counter medications taken in the last 48 hours Immunization history Length of time since onset of symptoms
Length of time since onset of symptoms --Oseltamivir phosphate inhibits the replication and spread of influenza if given within 48 hours of symptoms.
A patient is nauseated and vomiting after receiving chemotherapy. How will the nurse best intervene? Tell the patient to avoid eating any food during chemotherapy treatments. Inform the patient that the nausea will pass with time. Maintain hydration and nutrition and administer antinausea medications. Use antacids to relieve the irritation to the stomach, which should stop the nausea.
Maintain hydration and nutrition and administer antinausea medications. --It is very important for patients undergoing chemotherapy to maintain adequate nutrition and hydration. Several antiemetic drugs are available that are very successful in controlling this side effect. The patient will most likely remain nauseated even without food intake.
The patient has been diagnosed with candidiasis. The nurse recognizes that the patient is most likely to be ordered which drug? Sulconazole Haloprogin Miconazole nitrate Tolnaftate
Miconazole nitrate --Miconazole nitrate can be ordered to treat candidiasis. The other drugs listed can be used to treat tinea pedis, corporis, and cruris.
The nurse is preparing to administer the morning medications, which includes a tetracycline. While preparing to administer the medication, the dietary staff delivers the patient's breakfast tray. Which item on the tray would most concern the nurse? Coffee Eggs Milk Whole wheat toast
Milk --Milk and foods high in calcium can inhibit tetracycline absorption. To avoid drug interaction, these should be taken at least 2 hours apart from tetracycline.
A patient diagnosed with human immunodeficiency virus (HIV) is in her first trimester of pregnancy. The nurse will teach this patient about which medication? Delavirdine Efavirenz Nevirapine Zidovudine
Nevirapine --Nevirapine may be used as an alternative therapy for women who are pregnant, especially in the first trimester of pregnancy. The other drug choices are not recommended for pregnant patients.
The health care provider is considering placing the patient on ritonavir. The patient tells the nurse that the patient has recently been diagnosed with type 2 diabetes mellitus. What is the nurse's highest priority action? Notify the pharmacist that a larger dose will be needed. Notify the health care provider of the new information. Instruct the patient to monitor blood sugars more often. Instruct the patient to keep an accurate glucose log.
Notify the health care provider of the new information. --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.
The nurse would identify which drug as the antibiotic of choice for fungal infections manifested as thrush in the mouth or esophagus? Amoxicillin Nystatin Amphotericin B Vancomycin
Nystatin --Transplant recipients use nystatin to prevent or treat thrush in the mouth and esophagus. This is usually given when the patient is on a high-dose immunosuppression regimen and is stopped when the steroid dose is reduced below 20 mg/day.
While instructing a patient about antibiotic therapy, the nurse explains to the patient that bacterial resistance to antibiotics can occur when what happens? Select all that apply. Patients stop taking an antibiotic after they feel better. Environmental dispersion of antibiotic liquid occurs. Antibiotics are prescribed according to culture and sensitivity reports. Antibiotics are prescribed to treat a viral infection. Antibiotics are taken with water or juice. Antibiotics are taken with ascorbic acid (vitamin C).
Patients stop taking an antibiotic after they feel better. Environmental dispersion of antibiotic liquid occurs. Antibiotics are prescribed to treat a viral infection. --Not completing a full course of antibiotic therapy can allow bacteria that are not killed but have been exposed to the antibiotic to adapt their physiology to become resistant to that antibiotic. The same thing can occur when bacteria are exposed to antibiotics in the environment or when antibiotics are erroneously used to treat a viral infection.
The nurse is working with a patient who has been diagnosed with tapeworms. The nurse anticipates that the health care provider is most likely to place the patient on which medication? Artemether/lumefantrine Amantadine HCl Atovaquone/proguanil Praziquantel
Praziquantel --Praziquantel is the drug of choice for the treatment of tapeworms.
Before administration of intravenous amphotericin B, what will the nurse do? Set up an IV solution with potassium. Premedicate the patient with an antipyretic, antihistamine, and antiemetic as prescribed. Administer insulin as prescribed to prevent severe hyperglycemia. Administer intravenous dextrose as prescribed to prevent severe hypoglycemia.
Premedicate the patient with an antipyretic, antihistamine, and antiemetic as prescribed. --Almost all patients given intravenous amphotericin B develop fever, chills, nausea and vomiting, and hypotension. Pretreatment with an antipyretic, antihistamine, and antiemetic can minimize or prevent these adverse reactions. There is no need to treat with IV potassium or administer insulin or IV dextrose.
What will the nurse teach a patient who is taking isoniazid (INH)? You will need to take vitamin C to potentiate the action of INH. You should not be on that drug. I will check with the health care provider. Pyridoxine (vitamin B6) will prevent numbness and tingling that can occur when taking isoniazid. Multidrug therapy is necessary to prevent the occurrence of resistant bacteria.
Pyridoxine (vitamin B6) will prevent numbness and tingling that can occur when taking isoniazid. --Isoniazid can cause neurotoxicity. Pyridoxine (vitamin B6) is the drug of choice to prevent this adverse reaction. It is not an anti-infective agent and thus will work to destroy the mycobacterium or prevent drug resistance. Vitamin C is not taken with this drug; the drug is appropriate for most patients, and INH with pyridoxine is not multidrug therapy.
The patient has been taking ritonavir for a week and informs the nurse that the patient is experiencing occasional episodes of abdominal discomfort. What patient teaching will the nurse provide to the patient? Select all that apply. Reassure the patient that this is an expected side effect of the medication. Instruct the patient to report episodes that increase in intensity or frequency. Instruct the patient to stop taking the medication. Instruct the patient to maintain a symptom diary. Take an over-the-counter h2 antagonist.
Reassure the patient that this is an expected side effect of the medication. Instruct the patient to report episodes that increase in intensity or frequency. Instruct the patient to maintain a symptom diary. --Abdominal discomfort is an expected side effect of the medication and is not indicative of any significant problem with the medication. However, the patient should certainly report episodes of discomfort that increase in intensity and/or frequency. Use of a symptom diary can assist with the reporting process. The patient should not add any over-the-counter medications.
Which order would the nurse question if added to the patient receiving belatacept as a portion of the patient's drug regimen? An antihistamine Acetaminophen Shingles vaccine Amphotericin B
Shingles vaccine --Transplant recipients receiving belatacept should not receive live vaccines because their immune response may be inadequate, and they are at risk for disseminated infection resulting from the live virus.
The nurse is completing an admission assessment for a patient admitted for treatment with doxorubicin (Adriamycin). The nurse plans to contact the health care provider if the patient is taking which supplement? Goldenrod leaves Grapefruit juice St. John's wort Vitamin D
St. John's wort --St. John's wort may decrease the concentration of doxorubicin (Adriamycin). Use of St. John's wort should be reported to the health care provider.
A patient who will be traveling to a malaria-infested country is receiving instructions on the prophylactic use of chloroquine. What instruction will the nurse give the patient? Start the medication 2 weeks before the trip. Take the medication for 4 weeks. After leaving the affected area, take the medication for a year. Do not take the medication until you are certain you do not have the disease.
Start the medication 2 weeks before the trip. --Treatment for malaria prophylaxis is usually started 2 weeks before travel and continued for 8 weeks after travel is completed.
When instructing a patient about antibiotic therapy, the nurse explains that which condition occurs when the normal flora are disturbed during antibiotic therapy? Hypersensitivity Rebound toxicity Organ toxicity Superinfection
Superinfection --Antibiotic therapy can destroy the normal flora of the body, which typically inhibit the overgrowth of fungi and yeast. When the normal flora are decreased, these organisms can overgrow and cause infections.
Which instruction should be included in the education of a patient beginning therapy with ivermectin for a helminth infection? Take with food. Monitor pulse daily. Take on an empty stomach. Use sunscreen or wear long sleeves.
Take on an empty stomach. --Ivermectin should be taken on an empty stomach with water. The pulse does not need to be monitored, and the drug does not produce photosensitivity.
A patient taking amantadine complains of depression and dizziness. What intervention will the nurse perform first? Evaluate the patient for other central nervous system effects from the medication. Order a consult for counseling. Take the patient's blood pressure sitting and standing. Call the health care provider.
Take the patient's blood pressure sitting and standing. --The side effects and adverse reactions to amantadine include central nervous system effects, such as insomnia, depression, anxiety, confusion, and ataxia; orthostatic hypotension; neurologic problems, such as weakness, dizziness, and slurred speech; and gastrointestinal disturbances, such as anorexia, nausea, vomiting, and diarrhea. The nurse should evaluate the patient for orthostatic hypotension first to address safety issues.
Which intervention is a priority for a patient who is taking ART? Increase fluids to 2400 mL/day. Teach adherence to the medication regimen. Refer the patient for preventive care measures. Teach hand washing to the patient.
Teach adherence to the medication regimen. --Although all of these interventions should be carried out, teaching adherence to the regimen is the highest priority.
A patient is diagnosed with an oral candidal infection. Which intervention is best? Start an IV so the patient does not have to eat by mouth. Instruct the patient to brush her teeth and gargle hourly. Teach the patient how to take nystatin. Administer valacyclovir hydrochloride and monitor lips and gums.
Teach the patient how to take nystatin. --Nystatin is an antifungal ointment that is used for a variety of candidal infections. The patient needs to be taught how to "swish and swallow" to treat this infection. There is no need to brush the teeth hourly or administer Valtrex, and starting an IV is an extreme measure.
A patient on antibiotic therapy needs trough levels drawn. Which is the most appropriate time for the nurse to draw the trough level? Ten minutes before administration of the intravenous antibiotic Thirty minutes after beginning administration of the intravenous antibiotic Sixty minutes after completion of the intravenous antibiotic infusion Ninety minutes after the intravenous antibiotic is scheduled to be administered
Ten minutes before administration of the intravenous antibiotic --Trough levels are drawn just before infusion. Peak serum drug levels should be drawn 30 to 60 minutes after the medication is infused. The nurse should document the time drug administration is started and completed and the exact time a peak and/or trough level is drawn.
Which factor is identified as the major barrier to the transplantation as a routine medical treatment option? Availability or organs State laws The body's immune system Lack of effective drugs
The body's immune system --The immune system remains the biggest barrier to transplantation as a routine medical treatment because it has effective mechanisms to fight off foreign organisms. These same mechanisms are involved in the rejection of transplanted organs, which are recognized as foreign by the recipient's immune system.
In order to protect against exposure to chemotherapy drugs when caring for patients receiving intravenous (IV) therapy, what will the nurse do? Wear gowns, gloves, masks, and headgear when administering all chemotherapy drugs. Wear a disposable gown when administering IV chemotherapy. Wear a mask when receiving the drug from the pharmacist. Administer IV chemotherapy only under the direct observation of the health care provider.
Wear a disposable gown when administering IV chemotherapy. --A disposable gown should be worn when administering IV chemotherapy. The combination of gowns, gloves, masks, and headgear is not necessary for all chemotherapy drugs. A mask is not necessary when the pharmacist is preparing the drug. Nurses can administer chemotherapy without the observation of the health care provider.
The nurse is caring for several patients receiving chemotherapy. What patient will the nurse assess first? The patient receiving doxorubicin with a history of angina The patient receiving fluorouracil (with an elevated platelet count) The patient taking cyclophosphamide who is urinating 100 mL/h The patient receiving mechlorethamine with pain at the IV insertion site
The patient receiving mechlorethamine with pain at the IV insertion site --Mechlorethamine (nitrogen mustard) is a severe vesicant and can cause tissue necrosis if it infiltrates into the tissues. Pain at the IV site is an indication of possible infiltration and needs to be addressed. History of angina is a concern because Adriamycin is cardiotoxic; however, this patient is not the priority.
Which assessment finding in the patient receiving gentamicin would alert the nurse to a possible adverse reaction? Tinnitus Diarrhea Runny nose White flakey spots on the tongue
Tinnitus --The aminoglycosides are ototoxic and the nurse must assess changes in patients' hearing, balance, and urinary output. Tinnitus may indicate ototoxicity. Diarrhea may occur but is not a sign of adverse reactions, nor is runny nose. White spots on the tongue may indicate superinfection.
The nurse would identify which drug as the antibiotic of choice for Pneumocystis jirovecii pneumonia (PJP)? Augmentin Trimethoprim-sulfamethoxazole Gentamycin Vancomycin
Trimethoprim-sulfamethoxazole --Pneumocystis jirovecii pneumonia (PJP) is a life-threatening illness in immunocompromised patients. Routine prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMZ) has significantly reduced the morbidity and mortality of PJP following transplantation.
