★ The nurse is caring for a client who has been ordered cefazolin sodium (Ancef). Which nursing assessment is the priority?
A) 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.
★ A client who is on antibiotic therapy is complaining of pain in the mouth. When instructing a client about antibiotic therapy, the nurse explains that which condition occurs when the normal flora are disturbed during antibiotic therapy?
A) 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.
★ While instructing a client about antibiotic therapy, the nurse explains to the client that bacterial resistance to antibiotics can occur when what happens? (Select all that apply.)
A) Clients stop taking an antibiotic after they feel better.
B) Environmental dispersion of antibiotic liquid occurs.
C) Antibiotics are prescribed according to culture and sensitivity reports.
D) Antibiotics are prescribed to treat a viral infection.
E) Antibiotics are taken with water or juice. F) Antibiotics are taken with ascorbic acid (vitamin C).
A, B, & D
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.
★ A client on antibiotic therapy needs peak levels drawn. What is the nurse's best course of action?
A) Draw blood 10 minutes before administration of the intravenous antibiotic.
B) Draw blood 30 minutes after beginning administration of the intravenous antibiotic.
C) Draw blood 60 minutes after completion of the intravenous antibiotic infusion.
D) Draw blood 90 minutes after the intravenous antibiotic is scheduled to be administered.
C
Peak serum drug levels should be drawn 30 to 60 minutes after the medication is infused. Trough levels are drawn just before infusion. The nurse should document the time drug administration is started and completed and the exact time a peak and/or trough level is drawn.
★ A 22-year-old client is put on amoxicillin. What is the most important intervention for this client?
A) Instruct the client to not take the medication before meals.
B) Assess if the client is on oral contraceptives.
C) Inform the client about possible superinfections.
D) Assess the client for cross sensitivity.
B
This medication may decrease the effectiveness of oral contraceptives. The nurse needs to assess whether or not the client is on oral contraceptives and whether or not the client is sexually active.
★ Discharge teaching by the nurse for a client receiving tetracycline should include what instruction?
A) “Take the medication until you feel better.”
B) “Use sunscreen and protective clothing when outdoors.”
C) “Keep the remainder of the medication in case of recurrence.”
D) “Take the medication with food or milk to minimize gastrointestinal upset."
B
Photosensitivity is a common side effect of tetracycline. Exposure to the sun can cause severe burns.
★ The nurse should question the order of tetracycline for which client?
A) A 6-year old client with Haemophilus influenzae
B) A client with a history of diabetes mellitus
C) A client with a history of hypertension
D) A client diagnosed with rickettsiae
A
Tetracycline is contraindicated in children younger than 8 years because it can cause permanent discoloration of the teeth.
Tetracycline is not contraindicated for clients diagnosed with diabetes mellitus or hypertension.
Tetracycline is used to treat rickettsiae.
★ Which client will the nurse assess first?
A) The client who just started azithromycin therapy with a fever
B) The client who is taking clindamycin (Cleocin) and has gastric upset
C) The client who is taking vancomycin (Vancocin) with furosemide (Lasix)
D) The client who is taking telithromycin (Ketek) and is 18 years old
C
The risk of ototoxicity with vancomycin is increased for clients taking furosemide. The nurse should assess this client first.
A client who has started antibiotic therapy would be expected to have a fever. Gastric upset is common with this antibiotic. This medication is recommended for clients 18 years and older.
A client is prescribed telithromycin and is also taking simvastatin. What is the nurse's best action?
A) Hold the medication and call the health care provider.
B) Administer the medications as prescribed.
C) Separate the medications by 6 hours.
D) Have the client take the medications with food or milk.
A
This medication should not be taken with simvastatin owing to the risk of serious side effects.
Separating the medications by 6 hours or taking the medication with milk or food will not lessen the risk of side effects.
The nurse should not administer these medications.
★ When teaching a client being discharged on linezolid (Zyvox) to treat methicillin-resistant Staphylococcus aureus (MRSA), what will the nurse emphasize?
A) Reporting the occurrence of constipation
B) Avoiding ingestion of food containing tyramine
C) Stopping the drug as soon as he or she feels better
D) Taking the medication with an antacid to avoid gastrointestinal upset.
B
Acute hypertension may occur in clients consuming large amounts of tyramine while taking linezolid. Linezolid causes diarrhea, not constipation, and should be taken with food to decrease gastrointestinal distress. An antacid would interfere with absorption and should not be taken with the medication.
A client prescribed azithromycin (Zithromax) expresses concern regarding gastrointestinal upset that she experienced when taking erythromycin. What will the nurse tell this client?
A) “I will call the doctor and ask for a different antibiotic.”
B) “This drug is like erythromycin but has less severe gastrointestinal side effects.”
C) “You need this medication and will have to tolerate the nausea.”
D) “I will ask the doctor for a prescription for an antiemetic in case this drug makes you sick.”
B
Azithromycin (Zithromax) is one of the newer macrolide antibiotics. It has a longer duration of action as well as fewer and less severe gastrointestinal side effects than erythromycin.
When planning care for a client receiving a sulfonamide antibiotic, what is a primary intervention?
A) Encourage liquids that produce acidic urine.
B) Encourage a diet that causes an alkaline ash.
C) Force fluids to at least 3000 mL/day.
D) Insert a Foley catheter for accurate input and output measurement.
C
Forcing fluids will help prevent nephrotoxicity associated with sulfonamide antibiotics.
A client with type 2 diabetes mellitus is started on co-trimoxazole (TMP-SMZ). Which nursing intervention is a priority for this client?
D)
Cotrimoxazole increases the hypoglycemic response when taken with sulfonylureas (oral hypoglycemic agents). The nurse should assess blood sugar and determine what oral hypoglycemic the client is taking.
TMP-SMZ (Bactrim, Septra) is ordered for the client and is being administered four times a day. What is the nurse's best action?
B)
The half-life of this drug is 8 to 12 hours, and the client should receive it twice a day. The nurse should call the health care provider to clarify this order.
The medication should not be scheduled four times a day,
is not expected to cause ototoxicity,
and should not have an interaction with milk.
A client has been prescribed trimethoprim-sulfamethoxazole. What is the nurse's primary intervention for this client?
D)
Increased fluid intake is highly recommended to avoid complications such as crystallization in the urine. The course of therapy is not always 14 days; the client does not have to take the drug on a full stomach; and the drug is not prescribed only for urinary tract infections.
A client has been on sulfonamides repeatedly for recurrent urinary tract infections. The nurse assesses the client in the clinic and finds bruises on her legs and arms. What is the nurse's best action?
D)
Blood disorders such as hemolytic anemia, aplastic anemia, and low white blood cell and platelet counts could result from prolonged use and high dosages. The nurse should assess the client before assuming vitamin K deficiency, potential abuse, or frequent falls.
What should the nurse teach a client who is taking isoniazid (INH)?
B)
Isoniazid (INH) can cause neurotoxicity. Pyridoxine (vitamin B6) is the drug of choice to prevent this adverse reaction. It is not an antiinfective 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 clients; and INH with pyridoxine is not multidrug therapy
The nurse is caring for a client who is taking rifampin (Mycobutin) for treatment of Mycobacterium tuberculosis. The client 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?
B)
Red-orange discoloration of body fluids is a common side effect of rifampin (Mycobutin), but it is not harmful and does not indicate infection. There is no need to call the health care provider or have a 24-hour urine collection.
A client with Mycobacterium tuberculosis is prescribed ethambutol (Myambutol) for long-term use. Which client statement indicates understanding of the instructions?
B)
Ethambutol (Myambutol) can cause optic neuritis. Ophthalmologic examinations should be performed periodically to assess visual acuity.
The client states that she has been prescribed prophylactic medication for tuberculosis for 4 weeks. How should the nurse respond?
C)
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.
A client is diagnosed with an oral candidal infection. Which intervention is best?
D)
Nystatin (Mycostatin) is an antifungal ointment that is used for a variety of candidal infections. The client needs to be taught how to "swish and swallow" to treat this infection.
Before administration of intravenous amphotericin B (Fungizone), what will the nurse do?
A)
Almost all clients given intravenous amphotericin B (Fungizone) develop fever, chills, nausea and vomiting, and hypotension. Pretreatment with an antipyretic, antihistamine, and antiemetic can minimize or prevent these adverse reactions.
The client is receiving intravenous amphotericin. What is the nurse's primary intervention?
B)
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.
Which statement indicates to the nurse that the client understands the medication instructions regarding ketoconazole (Nizoral) for treatment of candidiasis?
C)
Taking this medication with food will help minimize gastrointestinal upset. Ketoconazole (Nizoral) 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.
When assessing for adverse reactions to Rifamate (combination isoniazid and rifampin), what should the nurse monitor? (Select all that apply.)
A) Blood urea nitrogen
B) Complete blood count
C) C-reactive protein levels
D) Hemoglobin levels
E) Liver function tests
F) Sputum cultures
A, B, D, E
Rifamate (combination isoniazid and rifampin) may cause impairment of liver function as well as hematologic disorders, and serum uric acid levels have been reported along with decreased hemoglobin levels. Elevations in blood urea nitrogen have also been reported. Assessment of sputum cultures confirms the diagnosis but is not related to adverse effects. C-reactive protein levels are not affected by this drug.
What is the primary assessment the nurse should make for a client who is taking ganciclovir sodium (Cytovene)?
C)
Bone marrow suppression is a dose-limiting toxicity of ganciclovir (Cytovene), and a complete blood count should be monitored.
What action will the nurse take to evaluate the effectiveness of antiviral agents administered to treat human immunodeficiency virus infection?
D)
All antiretroviral agents work to reduce the viral load, which is the number of viral RNA copies per milliliter of blood.
A client who will be traveling to a malaria-infested country is receiving instruction on the prophylactic use of chloroquine (Aralen hydrochloride). What instruction is accurate for this client?
B)
Treatment for malaria prophylaxis is usually started 2 weeks before travel and continues for 8 weeks after travel is completed.
The nurse is caring for a client taking foscarnet (Foscavir). The nurse should monitor what laboratory value for potential side effects of this medication?
D)
This medication can cause kidney damage. Blood urea nitrogen and creatinine should be closely monitored.
A client enters the emergency department with suspected influenza. What is most important to determine before starting the client on oseltamivir phosphate (Tamiflu)?
A)
This medication inhibits the replication and spread of influenza if given within 48 hours of symptoms.
A client taking amantadine complains of depression and dizziness. What intervention will the nurse perform first?
B)
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 client for orthostatic hypotension first to address safety issues.
A client with a history of diabetes mellitus is prescribed nitrofurantoin (Macrodantin) for treatment of a urinary tract infection. Which instruction will the nurse include in the client's teaching plan?
C)
The nurse should instruct the client that the urine may turn a harmless brown color. Fluids should be increased, not decreased, because this helps minimize gastrointestinal upset. Antacids should be avoided because they interfere with drug absorption. Clients with diabetes mellitus should not use Clinitest for glucose testing because a false-positive result may occur owing to changes in the urine.
A client diagnosed with an atonic bladder and a peptic ulcer is prescribed bethanechol (Urecholine). What is the nurse's best intervention?
C)
Bethanechol (Urecholine, Duvoid, Urebeth) should not be taken if peptic ulcer is present. Bethanechol can cause epigastric distress, abdominal cramps, nausea, vomiting, diarrhea, and flatulence.
A client complains of "stomach pain" while taking nitrofurantoin. What will the nurse teach the client?
D)
The drug is usually taken with food to decrease gastrointestinal distress. Antacids decrease the absorption of this medication. Taking the medication on an empty stomach will not help the gastric pain. Discontinuing the medication is not recommended for this side effect.
The nurse is teaching a client who has been prescribed nitrofurantoin. The teaching plan for this client should include which interventions? (Select all that apply.)
A) Swish and swallow this medication.
B) Do not take the medication with an antacid.
C) Shake the suspension well before drinking.
D) Increase fluids while on the medication.
E) Take medication on an empty stomach.
B, C, D
The medication should not be taken with an antacid, because they interfere with drug absorption. The medication should be shaken well before drinking, and the client should increase fluids to help with nausea. This medication can stain the teeth, so swishing is not recommended. The medication can cause stomach upset and should be taken with food.
The nurse is caring for a client newly diagnosed with human immunodeficiency virus (HIV). The client asks the nurse why he has been put on "so many pills." What is the most important thing for the nurse to tell the client about his therapy?
A)
While combination therapy is effective to treat the infection, the therapy also prevents the development of resistant strains of the disease.
The nurse has instructed a client diagnosed with human immunodeficiency virus (HIV) on the use of zidovudine (AZT, Retrovir). Which client statement demonstrates a need for additional teaching?
C)
Antiretroviral agents do not stop the transmission of HIV, and clients need to continue standard precautions.
A client diagnosed with human immunodeficiency virus (HIV) is in her first trimester of pregnancy. Which medication will the nurse teach this client about?
A)
Nevirapine (Viramune) may be used as an alterative for women who are pregnant, especially in the first trimester of pregnancy.
A client is receiving HAART. Which outcome indicates a therapeutic response to the medication therapy?
D)
The expected outcome of HAART is a suppression of HIV RNA levels and CD4 T cell increases in clients.
Which intervention is a priority for a client who is taking HAART?
A)
Although all of these interventions should be carried out, teaching adherence to the regimen is the highest priority.
What information is important to include in follow-up teaching for a client after starting antiretroviral therapy?
B)
Clients may confuse side effects of therapy with new onset of symptoms.
A nurse is monitoring a client for side effects of azathioprine (Imuran). Which assessment is necessary? (Select all that apply.)
A) Assess for hair loss.
B) Monitor liver function tests.
C) Monitor complete blood count.
D) Monitor platelet count.
E) Monitor for tachycardia.
F) Assess bowel sounds frequently.
B, C, D
Common side effects of azathioprine (Imuran) include leukopenia, thrombocytopenia, and hepatotoxicity. Alopecia (hair loss) and tachycardia are not expected side effects. It is not necessary to assess bowel sounds frequently.
What should nurses do in order to protect against exposure to chemotherapy drugs when caring for clients receiving intravenous (IV) therapy?
D)
A disposable gown should be worn when administering IV chemotherapy. Gowns, gloves, masks, and headgear are not necessary for chemotherapy drugs. A mask is not necessary when the pharmacist prepared the drug. Nurses can administer chemotherapy without the observation of the physician.
A client is receiving IV cyclophosphamide (Cytoxan). What nursing intervention is a priority for this client?
A)
The client should be well hydrated while taking this drug to prevent hemorrhagic cystitis (bleeding as a result of severe bladder inflammation).
The nurse is completing an admission assessment for a client admitted for chemotherapy. The health care provider has ordered doxorubicin (Adriamycin). The nurse plans to contact the health care provider if the client is taking which supplement?
B)
Green tea (Camellia sinensis) may enhance antitumor effects of doxorubicin (Adriamycin). Use of green tea should be reported to the health care provider.
A client asks "Why am I getting three drugs for my cancer if they all do the same thing?" What is the nurse's best response?
B)
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.
The nurse is caring for a client receiving cyclophosphamide (Cytoxan). What is a priority intervention for this client?
C)
Clients receiving cyclophosphamide (Cytoxan) should drink at least 2 to 3 L of fluid before, during, and after administration to prevent hemorrhagic cystitis.
The nurse is caring for a client receiving high-dose methotrexate (MTX) (Rheumatrex, Trexall) therapy. What intervention is a priority for this client?
A)
Leucovorin calcium (Citrovorum factor, folinic acid) is given within the first 24 to 42 hours 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 fluid to this degree is not necessary with MTX.
A client is nauseated and vomiting after receiving chemotherapy. How will the nurse best intervene?
D)
It is very important for clients undergoing chemotherapy to maintain adequate nutrition and hydration. Several antiemetic drugs are available that are very successful in controlling this side effect. The client will most likely remain nauseated even without food intake.
When teaching a client receiving paclitaxel (Taxol), the nurse plans to instruct the client to monitor for which side effect?
C)
Myalgias (muscle pain) and arthralgias (joint pain) are a common side effect of paclitaxel that the client should be prepared to expect.
The nurse is assessing a client receiving cisplatin (Platinol). What finding requires immediate action by the nurse?
B)
Cisplatin (Platinol) is known to be ototoxic, nephrotoxic, neurotoxic, and emetogenic. Increased blood urea nitrogen and creatinine could indicate nephrotoxicity.
The nurse is monitoring a client receiving doxorubicin (Adriamycin). What intervention is a priority for this client?
B)
Clients receiving doxorubicin need to be monitored for cardiac toxicity. Dexrazoxane (Zinecard) is a cytoprotective (chemoprotective) agent that may be given to help prevent cardiac toxicities associated with doxorubicin administration.
The nurse is caring for a client with a hemoglobin of 15 g/dL; platelet count of 450,000/mm3, and thrombocyte count of 8000/mm3 who is to receive cyclophosphamide (Cytoxan) therapy. What is the nurse's priority intervention?
A) Hold the Cytoxan therapy.
B) Isolate the client.
C) Start platelet transfusion.
D) Teach client effects of chemotherapy.
A
Cyclophosphamide (Cytoxan) 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.
red blood cells
F 4.2-5.4M/mm3M 4.7-6.1M/mm3
white blood cells
5,000-10,000/mm3
platelets
150,000-400,000/mm3
The nurse is caring for several clients receiving chemotherapy. What client will the nurse assess first?
D)
Mechlorethamine (nitrogen mustard, [Mustargen]) 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 client is not the priority.
The nurse administers pilocarpine (Pilocar) to a client with glaucoma. Which assessment finding would indicate a therapeutic effect of the medication?
B)
Pilocarpine is a direct-acting parasympathomimetic agent that is used as a miotic in the treatment of open-angle glaucoma. Miosis causes pupillary constriction, increasing the outflow of aqueous humor. This medication will not decrease drainage, cause excessive drying, or dilate the pupils.
Which statement, made by a client, indicates to the nurse a need for further client teaching regarding proper administration of eye drops?
C)
It is important to maintain sterility of the eye drop container, and therefore it should not be rinsed; the cap should be put immediately back on the container.
The nurse is planning to administer eardrops. Which intervention is essential to include in the plan of care?
D)
Eardrops that are administered too cold may cause vomiting and dizziness by stimulating a vestibular-type reaction. Cool eardrops should not be administered. The pinna should be held up and out in an adult. Eardrops should not be warmed in the microwave because too high a temperature can destroy the effectiveness of the medication.
A client is complaining of excessive earwax that diminishes hearing ability. What medication will the nurse use to assist the client?
C)
Carbamide peroxide (Debrox) works to soften earwax for easy removal while providing a weak antibacterial action to prevent infection.
The nurse evaluates the client using eyedrops. The client puts two drops into his eye. What is the nurse's best action?
B)
One drop of eye medication is the preferred amount with prescriptions as the second drop may cause overflow. The client does not need to irrigate his eye. Excess medication will run out. The client should not rub his eye.
A client is receiving amoxicillin (Amoxil). The nurseknows that the action of this drug is by which process?
A. Inhibition of bacterial cell-wall synthesis
Amoxicillin (Amoxil) is prescribed for a client who has a respiratory infection. The nurse is teaching the client about this medication and realizes that more teaching is needed when the client makes which statement?
B. "I should not take my medication with food."
A client is prescribed dicloxacillin (Dynapen). The nurse plans to monitor the client for which side effect/adverse reaction?
C. Hemolytic anemia
A client is taking cefoperazone (Cefobid). The nurse antic-ipates which appropriate nursing intervention(s) for thismedication? (Select all that apply.)
a. Monitoring renal function studies
b. Monitoring liver function studies
c. Infusing IV medication over 30 minutes
d. Monitoring client for mouth ulcers
e. Advising client to take medication with food
A, B, C, D
A client has been prescribed cefaclor (Ceclor). The nurse knows what fact about this medication?
D. It is used to treat respiratory infections.
Penicillin G (Pentids) has been prescribed for a client. Which nursing intervention(s) should the nurse include for this client? (Select all that apply.)
a. Collect C & S prior to first dose.
b. Monitor client for mouth ulcers.
c. Instruct client to limit fluid intake to 1000 mL/day.
d. Have epinephrine on hand for a potential severe allergic reaction.
A, B, D
A client is prescribed cephradine (Vcloscf). The nurse should follow which nursing implication(s)? (Select allthat apply.)
a. Report seizures to the health care provider.
b. Advise client to eat yogurt to prevent a superinfection.
c. Monitor client for an allergic reaction especially after first and second dose
d. Advise client to take medication on an empty stomach even if GI distress occurs. e. Culture infected area prior to first dose of medication.
A, B, C, E
A client is taking azithromycin (Zithromax). The nurse should apply which interventions? (Select all that apply.)
a. Monitor periodic liver function tests.
b. Dilute with 50 mL for IV administration.
c. Tell the client to report any hearing loss. d. Instruct the client to report evidence of superinfection.
e. Teach the client to take oral drug 1 hour a.c. or 2 hours p.c.
f. Avoid antacids from 2 hours prior to 2 hours after azithromycin administration.
A, C, D, E, F
The nurse closely monitors the client taking lincosamides for which serious adverse effect?
D. Pseudomembranous colitis
The nurse enters a client's room to find that his heart rate is 120, his BP is 70/50, and he is flushed. Vancomycin(Vancocin) is running IVPB. The nurse interprets this as a severe adverse effect of "red man syndrome." What should the nurse do?
a. Stop the infusion and call the laboratory. b. Reduce the infusion to 10 mg/min.
c. Encourage the client to drink more oral fluids up to 2L/day.
d. Report to health care provider the onset of Stevens-Johnson syndrome.
b. Reduce the infusion to 10 mg/min.
The nurse is administering tetracycline (Vibramycin) to a client. Which would be appropriate teaching?
D. Take sunscreen precautions when at the beach.
A client is taking levofloxacin (Levaquin). The nurse knows that which is true regarding this drug?
A. Adverse reaction includes dysrhythmias
What should the nurse include when teaching a client about gentamicin (Garamycin)? (Select all that apply.)
a. Client should report any hearing loss.
b. Client must use sunscreen.
c. IV gentamicin will be given over 20 minutes.
d. Client will be monitored for mouth ulcers and vaginitis.
e. Peak levels will be drawn 30 minutes prior to IV dose.
f. Client should increase fluid intake.
A, B, D, F
The nurse acknowledges which nursing intervention(s) for the client taking ciprofloxacin (Cipro)? (Select all thatapply.)
a. Obtain culture prior to drug administration.
b. Tell the client to avoid taking Cipro with antacids.
c. Monitor the client for hearing loss.
d. Encourage fluids to prevent crystalluria.
e. Infuse IV Cipro over 60 minutes.
f. Monitor blood glucose, as Cipro can decrease effects of oral hypoglycemic.
A, B, C, D, E
Sulfasalazine (Azulfidine) has been ordered for a client.The nurse knows that this drug is most effective against which organisms?
a. Escherichia coli and Clostridium
b. Neisseria gonorrhoeae and H. Influenzae c Pseudomonas aeruginosa and Helicobacter pylori
d. Enterococcus faecium and Staphylococcus aureus
a. Escherichia coli and Clostridium
A client is taking sulfasalazine (Azulfidine). What should the nurse teach the client to do?
D. Drink at least 10 glasses of fluid per day.
The nurse is teaching a client about sulfadiazine (Micro-sulfon). Which directive should the nurse include in the teaching?
B. Avoid sulfonamides during the third trimester of pregnancy.
A client is ordered to take trimethoprim-sulfamethoxazole (Bactrim). The nurse knows to expect which common adverse reaction?
D. Stevens-Johnson syndrome
A client is taking a sulfonamide for an acute urinary tract infection. Which medication does the nurse realize is a short-acting sulfonamide?
D. sulfadiazine (Microsulfon)
The nurse is teaching the client about trimethoprim-sulfamethoxazole (Bactrim). Which directives should be included in the teaching? (Select all that apply.)
a. Report any bruising or bleeding immediately.
b. Report any diarrhea or bloody stools promptly
c. Report any fever, rash, or sore throat promptly.
d. Avoid unprotected exposure to sunlight.
e. Report thirst and polyuria immediately.
A, B, C, D
A client is beginning isoniazid and rifampin treatment for tuberculosis. The nurse gives the client which instruction?
C. Do not skip doses.
A client taking isoniazid is worried about the side effects/adverse reactions. The nurse realizes that which is a common adverse reaction of isoniazid?
C. Hepatotoxicity
The nurse teaches the client taking amphotericin B to report which signs and symptoms to the health care pro-vider?
C. Blindness
A client with a diagnosis of intestinal amebiasis developssevere nausea, vomiting, fever, facial flushing, slurred speech, tachycardia, hypotension, and palpitations. A beginning assessment reveals that the client has just had several alcoholic beverages. The nurse should obtain a drug history for which drug?
C. metronidazole (Flagyl)
A client has developed vaginal candidiasis. The nurse knows that which medication is appropriate treatment for this condition?
D. terconazole (Terazol-3)
A client has been diagnosed with tuberculosis and is to begin the antitubercular medications isoniazid, rifampin, and ethambutol. What should the nurse do? (Select all thatapply.)
a. Encourage periodic eye examinations.
b. Instruct client to take medications with meals.
c. Suggest that client take antacids with medications to prevent GI distress.
d. Advise client to report numbness and tingling of hands or feet.
e. Alert client that body fluids may develop a red-orange color.
f. Teach client to avoid direct sunlight and to use sunblock.
A, D, E, F
A client is diagnosed with HSV-3. The nurse understands that this illness is better known by which name?
C. Shingles in an adult
Zanamivir (Relenza) is ordered for a client. The nurse knows that this drug is intended for which purpose?
B. Administration within 48 hours of onset of symptoms to be effective
A client who is taking acyclovir asks the nurse about the drug. Which instruction should the nurse include in client teaching?
D. Importance of frequent CBC, BUN, and creatinine tests.
A client with a history of malaria, presently being treated with chloroquine, is admitted to the hospital. What should the nurse advise the client to do?
A. Get frequent hearing checks.
A client is taking thiabendazole. What does the nurse realize about this drug?
A. Proper hygiene must be taught to avoid the spread of disease.
Acyclovir (Zovirax) has been ordered for a client with genital herpes. Which nursing interventions are appropriate for this client? (Select all that apply.)
a. Monitor BUN and creatinine.
b. Monitor client's BP for hypertension.
c. Administer IV acyclovir over 30 minutes.
d. Advise client to maintain adequate fluid intake.
e. Teach client to perform oral hygiene several times aday.
f. Monitor client's CBC, especially WBC, platelets, hemo-globin, and hematocrit.
A, D. E, F
For the client who is crushing nitrofurantoin (Macrodan-tin) tablets, what should the nurse teach the client to do?
C. Rinse the mouth after oral nitrofurantoin to avoid teeth staining.
The client complains about a burning sensation and pain when urinating. The nurse knows that which is an appropriate urinary analgesic?
D. phenazopyridine (Pyridium)
A client is taking the urinary antiseptic methenaminemandelate (Mandelamine) for a UTI. The nurse realizes that this drug should not be given concurrently with which other drug to avoid potential crystalluria?
D. trimethoprim-sulfamethoxazole (Bactrim)
A client is receiving solifenacin succinate (VESIcare). The nurse knows that this drug is used to treat which condition?
C. Overactive bladder
The client is taking tolterodine tartrate (Detrol). The nurse should teach the client to report which condition?
B. Urinary retention
The nurse is caring for a client taking nitrofurantoin(Macrodantin). Which are appropriate nursing interventions for this client? (Select all that apply.)
a. Monitor urinary output and urine specific gravity.
b. Monitor the client for peripheral neuropathy.
c. Advise the client to wear protective clothing to prevent photosensitivity.
d. Warn the client to avoid excess exposure to sunlight.
e. Inform the client that urine may turn a harmless brown color.
A, B, E
A client has been prescribed HAART therapy following a laboratory test that indicated an increasing viral load. The client reports that he's glad to have a choice of medications from which to choose so he will have an easier time with daily medications. What should the nurse's response include?
D. Education about the importance of using multiple medications concurrently
A client who has been taking antiretroviral treatment for 6 months indicates increasing difficulty managing the daily dosing and remembering to take the medications at frequent but inconvenient times throughout the day. In discussing the plan of treatment with the health care team, what should the nurse recommend?
B. Using a single daily dose of coformulated medication
During routine prenatal testing, a client was newly diagnosed with HIV infection. To help prevent perinatal transmission of HIV to the fetus, what should the nurse do?
A. Provide written and oral education about the antiretroviral therapy during pregnancy.
During a routine visit, a client asks how she is supposed to follow all the blood values in her laboratory results. She wonders if she will ever understand how to tell that her condition is improving as a result of her prescribed antiretroviral medications. The nurse explains that which is the best lab value to track to see results of antiretroviraltreatment?
B. CD4 T-cell level
When a client does not appear for her routine clinic visit, the nurse calls to ask about the missed visit. The client says, I really don't need to come any longer. I'm so thankfull I no longer have HIV." The nurse finds that the laboratory results indicated an "undetectable" HIV viral load and that the client stopped her medication several weeks earlier. What is the nurse's best response?
B. Educate the client about the continued need for her medications and ongoing laboratory monitoring.
A client is to receive an alkylating agent, an antimetabolite, and an antitumor antibiotic as his chemotherapy protocol. He asks the nurse why he needs so much che-motherapy. What is the nurse's best response?
B. Combination chemotherapy increases the extent of tumor cell kill.
A client is scheduled to receive chemotherapy drugs that will cause myelosuppression. Which action by the nurse would be the most important?
C. Monitor for a change in temperature.
A client has low platelet counts secondary to administration of chemotherapy. Which nursing action would be most appropriate?
D. Assess for occult bleeding; apply pressure to injection sites.
A client is to receive fluorouracil (5-FU, Adrucil) as part of his treatment protocol for colorectal cancer. Which symptom would be most important for the nurse to report to the physician?
A. Stomatitis
Stomatitis
an inflammation of the mucous lining of any of the structures in the mouth
A client in the outpatient oncology clinic complains of fatigue after her chemotherapy. Which nursing intervention would be most appropriate?
D. Assess for other factors contributing to her fatigue (e.g., trouble sleeping).
A nurse is teaching a client about alopecia, which is one of the side effects of the chemotherapy drugs she is to receive. Which statement, made by the client, indicates that she needs additional teaching about alopecia?
C. "My hair won't grow back after chemotherapy is completed."
A client in the outpatient oncology clinic has developed mucositis after receiving fluorouracil (Adrucil, 5-FU). Which statement made by the client indicates the need for additional teaching about mucositis?
a. "I will frequently rinse out my mouth with normal saline."
b. "I will use ice pops or ice chips to help relieve my mouth pain."
c "I will use a mouthwash with alcohol to get my mouth cleaner."
d. "I will use a soft toothbrush to clean my teeth and freshen my breath."
c "I will use a mouthwash with alcohol to get my mouth cleaner."
A client is scheduled to receive high-dose cyclophosphamide (Cytoxan) via IV infusion as treatment for cancer. Which would be most important for the nurse to include when teaching the client about cyclophosphamide (Cytoxan)?
D. Drink 2 to 3 L of fluid per day.
A client is scheduled to receive MVP: mitomycin C (Mutamycin), vincristine (Oncovin), and cisplatin (Platinol) as treatment for her lung cancer. She asks the nurse what side effects she can expect. Which is an appropriate nursing diagnosis for this client?
D. Knowledge deficit related to side effects of chemotherapy
A nurse is administering doxorubicin (Adriamycin) to a client in the outpatient oncology clinic. Which information would be most important for the nurse to include in client teaching?
a. Blood counts will most likely remain normal.
b. Complete alopecia rarely occurs with this drug.
c Report any shortness of breath, palpitations, or edema your doctor.
d. Tissue necrosis usually occurs 2 to 3 days after administration.
c Report any shortness of breath, palpitations, or edema your doctor.
A client is scheduled to receive vincristine (Oncovin) as part of his chemotherapy protocol. Which nursing action would have the highest priority when providing care for this patient?
C. Assess for peripheral neuropathy.
Which have been identified as causes of multidrug resistance to chemotherapy? (Select all that apply.)
a. Cancer cells that are not killed may mutate and become resistant to chemotherapy.
b. Some cancer cells may be naturally resistant to chemotherapy.
c. Cell cycle-nonspecific chemotherapy drugs
d. Gene amplification can cause overproduction of proteins that make chemotherapy less effective.
e. Cancer cells develop the ability to repair damagecaused by chemotherapy.
A, B, D, E
A client is experiencing mucositis (stomatitis) secondary to receiving chemotherapy. Which symptomatic treatments would be appropriate? (Select all that apply.)
a. Frequent mouth rinses
b. Provide antiemetics
c .Topical anesthetics
d. Encourage stress reduction
e. Antibiotics
A, C, E
The nurse reviews the client's list of medications, which includes mannitol. The nurse must be aware that which condition is a contraindication for use of this drug?
B. Dehydration
The client is being prepared for an eye examination. When the nurse takes the health history, the client says that she is sensitive to atropine sulfate. What drug might be used instead for the examination?
C. Cyclopentolate
An 85-year-old client is taking acetazolamide, a carbonic anhydrase inhibitor. A nursing intervention associated with clients receiving this drug is to monitor what?
A. Electrolytes
The nurse reviews the African-American client's list of medications. It is important for the nurse to be aware that the prostaglandin analogue more effective in African Americans than in non-African Americans is what?
B. travoprost
The school nurse is preparing a presentation for the parent-teacher association meeting on medications commonly used in school-aged children. It is important to note what primary disadvantage of the use of combination products such as Cortisporin Otic?
C. School-aged children may need only one drug, not combination.
The camp nurse reviews the "shopping list" of supplies needed for the upcoming camping season. What product is recommended to prevent and treat chronic impaction of cerumen?
D. Hydrogen peroxide
The nurse prepares a health teaching plan for the client with glaucoma. Which important nursing interventions are included for this client? (Select all that apply.)
a. Instruct the client to report changes in vision and breathing.
b. Maintain sterile technique and prevent dropper contamination during administration of eyedrops.
c Include return demonstration only with geriatric clients
d. Wait 10 minutes to instill the second eye medication to be given at the same time.
