Science Test 2

1. A patient has received an antibiotic to take for a week before planned oral surgery. The nurse knows that this is an example of which type of therapy?

Empirical

Prophylactic

Definitive

Resistance

Prophylactic antibiotic therapy is used to prevent infection. Empiric therapy involves selecting the antibiotic that can best kill the microorganisms known to be the most common causes of an infection. Definitive therapy occurs once the culture and sensitivity results are known. Resistance is not a type of antibiotic therapy.

Explanation

Prophylactic antibiotic therapy is used to prevent infection. Empiric therapy involves selecting the antibiotic that can best kill the microorganisms known to be the most common causes of an infection. Definitive therapy occurs once the culture and sensitivity results are known. Resistance is not a type of antibiotic therapy.

2. When teaching a patient who will be taking tetracycline, which of the following instructions should the nurse share?

“Avoid direct sunlight and tanning beds while on this medication.”

“Milk and cheese products result in increased levels of tetracycline.”

“Antacids taken with the medication help to reduce gastrointestinal distress.”

“Take the medication until you are feeling better.”

Drug-related photosensitivity occurs when patients take tetracyclines, and it may continue for several days after therapy. Milk and cheese products result in decreased levels of tetracycline when the two are taken together. Antacids also interfere with absorption and should not be taken with tetracycline.

Explanation

Drug-related photosensitivity occurs when patients take tetracyclines, and it may continue for several days after therapy. Milk and cheese products result in decreased levels of tetracycline when the two are taken together. Antacids also interfere with absorption and should not be taken with tetracycline.

3. A patient is receiving aminoglycoside therapy and will be receiving a beta-lactam antibiotic as well. The patient asks why two antibiotics have been ordered. What is the nurse's best response?

“The combined effect of both antibiotics is greater than each of them alone.”

“The first antibiotic was not strong enough to work.”

“We have not yet isolated the bacteria, so the two antibiotics are given to cover a wide range of microorganisms.”

“We can give a reduced amount of each one if we give them together.”

Aminoglycosides are often used in combination with other antibiotics, such as beta-lactams or vancomycin, in the treatment of various infections because the combined effect of the two antibiotics is greater than that of either drug alone.

Explanation

Aminoglycosides are often used in combination with other antibiotics, such as beta-lactams or vancomycin, in the treatment of various infections because the combined effect of the two antibiotics is greater than that of either drug alone.

4. The nurse is reviewing the medication history of a patient who will be taking an antibiotic. During antibiotic therapy, a significant drug interaction may occur with which drug group?

Opioids

Oral contraceptives

Antihypertensives

Antihistamines

The effectiveness of oral contraceptives may be decreased with certain antibiotics.

Explanation

The effectiveness of oral contraceptives may be decreased with certain antibiotics.

5. During drug therapy for pneumonia, a female patient develops a superinfection. The nurse explains that this infection is caused by

Large doses of antibiotics that kill normal flora.

The infection spreading from her lungs to the new site of infection.

Resistance of the pneumonia-causing bacteria to the drugs.

An allergic reaction to the antibiotics.

Normally occurring bacteria are killed during antibiotic therapy, allowing other flora to take over and resulting in superinfections.

Explanation

Normally occurring bacteria are killed during antibiotic therapy, allowing other flora to take over and resulting in superinfections.

6. When a patient is on aminoglycoside therapy, the nurse will monitor the patient for which indicators of potential toxicity?

Fever

White blood cell count of 7000 mm3

Tinnitus and hearing loss

Decreased creatinine levels

Tinnitus and hearing loss could indicate ototoxicity, a potentially serious toxicity in a patient. Nephrotoxicity is indicated by rising blood urea nitrogen and creatinine levels. Fever may be indicative of the patient’s infection; a white blood count of 7000 mm3 is within the normal range of 5000 to 10,000.

Explanation

Tinnitus and hearing loss could indicate ototoxicity, a potentially serious toxicity in a patient. Nephrotoxicity is indicated by rising blood urea nitrogen and creatinine levels. Fever may be indicative of the patient’s infection; a white blood count of 7000 mm3 is within the normal range of 5000 to 10,000.

7. Which of the following nursing diagnoses is appropriate for a patient who has started aminoglycoside therapy?

Constipation

Risk for injury (hearing loss)

Disturbed body image related to gynecomastia

Imbalanced nutrition, less than body requirements, related to nausea

Patients on aminoglycoside therapy have an increased risk for injury caused by ototoxicity. The other options are incorrect.

Explanation

Patients on aminoglycoside therapy have an increased risk for injury caused by ototoxicity. The other options are incorrect.

8. The nurse is administering intravenous acyclovir (Zovirax) to a patient with a viral infection. Which administration technique is correct?

Intravenous infusions should be administered slowly, over at least 1 hour.

Intravenous infusions should be administered by rapid bolus.

Intravenous acyclovir should be refrigerated.

Oral fluids should be restricted while a patient is taking intravenous acyclovir.

Intravenous acyclovir is stable for 12 hours at room temperature and often precipitates when refrigerated. Intravenous infusions should be diluted as recommended (e.g., with 5% dextrose in water or normal saline) and infused with caution. Infusion over longer than 1 hour is suggested to avoid the renal tubular damage seen with more rapid infusions. Adequate hydration should be encouraged (unless contraindicated) during the infusion and for several hours afterward to prevent drug-related crystalluria.

Explanation

Intravenous acyclovir is stable for 12 hours at room temperature and often precipitates when refrigerated. Intravenous infusions should be diluted as recommended (e.g., with 5% dextrose in water or normal saline) and infused with caution. Infusion over longer than 1 hour is suggested to avoid the renal tubular damage seen with more rapid infusions. Adequate hydration should be encouraged (unless contraindicated) during the infusion and for several hours afterward to prevent drug-related crystalluria.

9. During an intravenous (IV) infusion of amphotericin B, a patient develops tingling and numbness in his toes and fingers. What will the nurse do?

Discontinue the infusion immediately.

Reduce the infusion rate gradually until the adverse effects subside.

Administer the medication by rapid IV infusion to reduce the potential adverse effects.

Nothing; these are expected side effects of this medication.

Once the intravenous infusion of amphotericin B has begun, vital signs should be monitored frequently to assess for adverse reactions such as cardiac dysrhythmias, visual disturbances, paresthesias (numbness or tingling of the hands or feet), respiratory difficulty, pain, fever, chills, and nausea. Should these adverse effects or a severe reaction occur, the infusion should be discontinued (while the patient is closely monitored) and the prescriber contacted. The other options are not correct.

Explanation

Once the intravenous infusion of amphotericin B has begun, vital signs should be monitored frequently to assess for adverse reactions such as cardiac dysrhythmias, visual disturbances, paresthesias (numbness or tingling of the hands or feet), respiratory difficulty, pain, fever, chills, and nausea. Should these adverse effects or a severe reaction occur, the infusion should be discontinued (while the patient is closely monitored) and the prescriber contacted. The other options are not correct.

10. During drug therapy with a tetracycline antibiotic, a patient complains of some nausea and anorexia. The nurse's best advice to the patient would be which of the following?

“Take it with cheese and crackers or yogurt.”

“Take each dose with a glass of milk.”

“Take an antacid with each dose as needed.”

“Drink a full glass of water with each dose.”

Oral doses should be given with at least 8 ounces of fluids and food to minimize gastrointestinal upset; however, antacids and dairy products will bind with the tetracycline and make it inactive.

Explanation

Oral doses should be given with at least 8 ounces of fluids and food to minimize gastrointestinal upset; however, antacids and dairy products will bind with the tetracycline and make it inactive.

11. When reviewing the medication orders for a patient who is taking penicillin, the nurse notes that the patient is also taking the oral anticoagulant warfarin (Coumadin). What possible effect may occur as the result of an interaction between these drugs?

The penicillin will cause an enhanced anticoagulant effect of the warfarin.

The penicillin will cause the anticoagulant effect of the warfarin to decrease.

The warfarin will reduce the antiinfective action of the penicillin.

The warfarin will increase the effectiveness of the penicillin.

Administering penicillin reduces the vitamin K in the gut (intestines); therefore, enhanced anticoagulant effect of warfarin may occur.

Explanation

Administering penicillin reduces the vitamin K in the gut (intestines); therefore, enhanced anticoagulant effect of warfarin may occur.

12. The nurse is administering a vancomycin (Vancocin) infusion. Which measure is appropriate for the nurse to implement in order to reduce complications that may occur with this drug's administration?

Monitoring blood pressure for hypertension during the infusions

Infusing the drug rapidly

Restricting fluids during vancomycin therapy

Infusing the drug over at least 1 hour

Adequate hydration (at least 2 liters of fluid in 24 hours) during vancomycin therapy is important for the prevention of nephrotoxicity. The medication should be infused during at least 60 minutes to reduce red man syndrome. Hypotension may occur during the infusion, especially if it is given too rapidly.

Explanation

Adequate hydration (at least 2 liters of fluid in 24 hours) during vancomycin therapy is important for the prevention of nephrotoxicity. The medication should be infused during at least 60 minutes to reduce red man syndrome. Hypotension may occur during the infusion, especially if it is given too rapidly.

13. When reviewing the history of a patient who will be taking an antifungal drug, the nurse knows that which of the following conditions is a contraindication to these drugs?

Diabetes mellitus

Renal failure

Hyperthyroidism

Meningitis

Liver failure, kidney failure, and porphyria (for griseofulvin) are the most common contraindications for antifungal drugs. The other options are not contraindications.

Explanation

Liver failure, kidney failure, and porphyria (for griseofulvin) are the most common contraindications for antifungal drugs. The other options are not contraindications.

14. A patient who has been hospitalized for 2 weeks has developed a pressure ulcer that contains multidrug-resistant Staphylococcus aureus (MRSA). Which drug would the nurse expect to be chosen for his therapy?

Metronidazole (Flagyl)

Tobramycin (Nebcin)

Vancomycin (Vancocin)

Ciprofloxacin (Cipro)

Vancomycin is the drug of choice for the treatment of MRSA. The other drugs and drug classes are not used for MRSA.

Explanation

Vancomycin is the drug of choice for the treatment of MRSA. The other drugs and drug classes are not used for MRSA.

15. The nurse is reviewing instructions for vaginal antifungal drugs with a patient. Which is an appropriate instruction regarding these drugs?

“The medication can be stopped when your symptoms are relieved.”

“Discontinue this medication if menstruation begins.”

“Daily douching is part of the treatment for vaginal fungal infections.”

“Abstain from sexual intercourse until the treatment has been completed and the infection has resolved.”

Female patients taking antifungal medications for the treatment of vaginal infections should abstain from sexual intercourse until the treatment has been completed and the infection has resolved. The medication should be taken for as long as prescribed. Patients should be told to continue to take the medication even if they are actively menstruating. Douching is not an appropriate intervention.

Explanation

Female patients taking antifungal medications for the treatment of vaginal infections should abstain from sexual intercourse until the treatment has been completed and the infection has resolved. The medication should be taken for as long as prescribed. Patients should be told to continue to take the medication even if they are actively menstruating. Douching is not an appropriate intervention.

16. When reviewing the allergy history of a patient, the nurse notes that the patient is allergic to penicillin. Based on this finding, the nurse would question an order for which class of antibiotics?

Tetracyclines

Sulfonamides

Cephalosporins

Imipenem-cilastatin

Allergy to penicillin may also result in hypersensitivity to cephalosporins. The other options are not correct.

Explanation

Allergy to penicillin may also result in hypersensitivity to cephalosporins. The other options are not correct.

17. The nurse is counseling a woman who will be starting rifampin. The patient is on oral contraceptives. Which statement is true regarding rifampin therapy for this patient?

Women have a high risk for thrombophlebitis while on this drug.

A higher dose of rifampin will be necessary because of the contraceptive.

Oral contraceptives are less effective while the patient is taking rifampin.

The incidence of adverse effects is greater if the two drugs are taken together.

Women taking oral contraceptives and rifampin should be counseled about other forms of birth control because of the impaired effectiveness of the oral contraceptives during concurrent use of rifampin.

Explanation

Women taking oral contraceptives and rifampin should be counseled about other forms of birth control because of the impaired effectiveness of the oral contraceptives during concurrent use of rifampin.

18. A patient is taking nystatin (Mycostatin) lozenges because of an oral candidiasis infection resulting from inhaled corticosteroid therapy for asthma. Which instruction by the nurse is appropriate?

“Chew the lozenges until they are completely dissolved.”

“Let the lozenge dissolve slowly and completely in your mouth without chewing it.”

“Rinse your mouth with water before taking the inhaler.”

“Rinse your mouth with mouthwash after taking the inhaler.”

Nystatin may be given orally in the form of lozenges, or troches, which should be slowly and completely dissolved in the mouth for optimal effects; they should not be chewed or swallowed whole. The other options are not correct. Patients taking an inhaled corticosteroid should rinse their mouths with water thoroughly after taking the inhaler.

Explanation

Nystatin may be given orally in the form of lozenges, or troches, which should be slowly and completely dissolved in the mouth for optimal effects; they should not be chewed or swallowed whole. The other options are not correct. Patients taking an inhaled corticosteroid should rinse their mouths with water thoroughly after taking the inhaler.

19. The nurse is monitoring for therapeutic results of antibiotic therapy in a patient with an infection. Which laboratory value would indicate therapeutic effectiveness of this therapy?

Increased red blood cell count

Increased white blood cell count

Decreased white blood cell count

Decreased platelet count

Decreased white blood cell counts are an indication of reduction of infection and are a therapeutic effect of antibiotic therapy. The other options are incorrect.

Explanation

Decreased white blood cell counts are an indication of reduction of infection and are a therapeutic effect of antibiotic therapy. The other options are incorrect.

20. A patient has a urinary tract infection. The nurse knows that which class of drugs is especially useful for such infections?

Sulfonamides

Carbapenems

Macrolides

Tetracyclines

These antibiotics achieve very high concentrations in the kidneys, through which they are eliminated. Therefore, sulfonamides are often used in the treatment of urinary tract infections.

Explanation

These antibiotics achieve very high concentrations in the kidneys, through which they are eliminated. Therefore, sulfonamides are often used in the treatment of urinary tract infections.

21. The nurse is about to give a dose of vancomycin (Vancocin), but before doing so checks the patient's lab work and finds that the trough vancomycin level is 24 mcg/mL. What will the nurse do next?

Administer the vancomycin as ordered and draw a peak level.

Hold the drug and administer 4 hours later.

Hold the drug and notify the physician.

Repeat the test to verify results.

Optimal blood levels of vancomycin are a trough level of 10 to 20 mcg/mL. Measurement of peak levels is no longer routinely recommended, and only trough levels are commonly monitored. Blood samples for measurement of trough levels should be drawn immediately before administration of the next dose. Because of the increase in resistant organisms, many clinicians use a trough level of 15 to 20 mcg/mL as their goal. These trough levels mean that even just before the next dose is due, when drug levels should be low, the drug levels are actually too high.

Explanation

Optimal blood levels of vancomycin are a trough level of 10 to 20 mcg/mL. Measurement of peak levels is no longer routinely recommended, and only trough levels are commonly monitored. Blood samples for measurement of trough levels should be drawn immediately before administration of the next dose. Because of the increase in resistant organisms, many clinicians use a trough level of 15 to 20 mcg/mL as their goal. These trough levels mean that even just before the next dose is due, when drug levels should be low, the drug levels are actually too high.

22. A patient who has started drug therapy for tuberculosis wants to know how long he will be on the medications. What is the nurse's best response?

“Drug therapy will last until the symptoms have stopped.”

“Drug therapy will continue until the tuberculosis develops resistance.”

“You should expect to take these drugs for as long as 24 months.”

“You will be on antituberculosis drug therapy for the rest of your life.”

Drug therapy commonly lasts for 24 months if consistent drug therapy has been maintained.

Explanation

Drug therapy commonly lasts for 24 months if consistent drug therapy has been maintained.

23. The nurse is reviewing the sputum culture results of a patient with pneumonia and notes that the patient has a gram-positive infection. Which type of cephalosporin is most appropriate for this infection?

First generation

Second generation

Third generation

Fourth generation

First-generation cephalosporins provide excellent coverage against gram-positive bacteria but limited coverage against gram-negative bacteria.

Explanation

First-generation cephalosporins provide excellent coverage against gram-positive bacteria but limited coverage against gram-negative bacteria.

24. A patient with a long-term intravenous catheter is going home. The nurse knows that if he is allergic to seafood, which antiseptic agent is contraindicated?

Chlorhexidine gluconate (Hibiclens)

Hydrogen peroxide

Povidone-iodine (Betadine)

Isopropyl alcohol

Iodine compounds are contraindicated in patients with allergies to seafood. The other options are not correct.

Explanation

Iodine compounds are contraindicated in patients with allergies to seafood. The other options are not correct.

25. A patient is receiving his third intravenous dose of a penicillin drug. He calls the nurse to report that he is feeling "anxious" and is having trouble breathing. What will the nurse do first?

Notify the physician.

Take the patient’s vital signs.

Stop the antibiotic infusion.

Check for allergies.

Hypersensitivity reactions are characterized by wheezing; shortness of breath; swelling of the face, tongue, or hands; itching; or rash. The nurse should immediately stop the antibiotic infusion, have someone notify the physician, and stay with the patient to monitor the patient’s vital signs and condition. Checking for allergies should have been done before the infusion.

Explanation

Hypersensitivity reactions are characterized by wheezing; shortness of breath; swelling of the face, tongue, or hands; itching; or rash. The nurse should immediately stop the antibiotic infusion, have someone notify the physician, and stay with the patient to monitor the patient’s vital signs and condition. Checking for allergies should have been done before the infusion.

26. A young adult calls the clinic to ask for a prescription for "that new flu drug." He says he has had the flu for almost 4 days and just heard about a drug that can reduce the symptoms. Based on knowledge of antiviral therapy for influenza, what is the nurse's best response to his request?

“Now that you’ve had the flu, you will need a booster vaccination, not the antiviral drug.”

“We need to do a blood test to verify that you actually have the flu.”

“Ideally, drug therapy should be started within 2 days of symptom onset, not 4 days

These drugs should be started within 2 days of influenza symptom onset; they can be used for prophylaxis and treatment of influenza. The other options are not correct.

Explanation

These drugs should be started within 2 days of influenza symptom onset; they can be used for prophylaxis and treatment of influenza. The other options are not correct.

27. A patient is admitted with a fever of 102.8° F (39.3 ° C), origin unknown. Assessment reveals cloudy, foul-smelling urine that is dark amber in color. Orders have just been written to obtain urine and blood cultures and to administer an antibiotic intravenously stat (now). The nurse will complete these orders in which sequence?

Blood culture, ampicillin dose, urine culture

Urine culture, ampicillin dose, blood culture

Ampicillin dose, blood and urine cultures

Blood and urine cultures, ampicillin dose

Culture specimens should be obtained before initiating drug therapy; otherwise, the presence of antibiotics in the tissues may result in misleading culture and sensitivity results.

Explanation

Culture specimens should be obtained before initiating drug therapy; otherwise, the presence of antibiotics in the tissues may result in misleading culture and sensitivity results.

28. A 79-year-old patient is receiving a quinolone as treatment for a complicated incision infection. The nurse will monitor for which adverse effect that is associated with these drugs?

Neuralgia

Double vision

Hypotension

Tendinitis and tendon rupture

See Table 39-4 for common adverse effects of quinolones. A black-box warning is required by the U.S. Food and Drug Administration for all quinolones because of the increased risk for tendinitis and tendon rupture with use of the drugs. This effect is more common in elderly patients, patients with renal failure, and those receiving concurrent glucocorticoid therapy (e.g., prednisone). The other options are not common adverse effects.

Explanation

See Table 39-4 for common adverse effects of quinolones. A black-box warning is required by the U.S. Food and Drug Administration for all quinolones because of the increased risk for tendinitis and tendon rupture with use of the drugs. This effect is more common in elderly patients, patients with renal failure, and those receiving concurrent glucocorticoid therapy (e.g., prednisone). The other options are not common adverse effects.

29. When assessing patients who are to receive antitubercular therapy, the nurse should assess for which potential contraindication?

Glaucoma

Anemia

Heart failure

Hepatic impairment

Results of liver function studies (e.g., bilirubin level, liver enzyme levels) need to be assessed because isoniazid and rifampin may cause hepatic impairment; severe liver dysfunction is a contraindication to these drugs. In addition, the patient’s history of alcohol use should be assessed.

Explanation

Results of liver function studies (e.g., bilirubin level, liver enzyme levels) need to be assessed because isoniazid and rifampin may cause hepatic impairment; severe liver dysfunction is a contraindication to these drugs. In addition, the patient’s history of alcohol use should be assessed.

30. The nurse is preparing to administer morning medications to a patient who has been newly diagnosed with tuberculosis. The patient asks, "Why do I have to take so many different drugs?" Which answer by the nurse is correct?

“It is hoped that at least one of these drugs will work to fight the tuberculosis.”

“Taking multiple drugs reduces the chance that the tuberculosis will become drug resistant.”

“Using several drugs has a faster effect than single-drug therapy.”

“Using multiple drugs enhances the effect of each drug.”

The use of multiple medications reduces the possibility that the organism will become drug resistant. The other options are not correct.

Explanation

The use of multiple medications reduces the possibility that the organism will become drug resistant. The other options are not correct.

31. A woman is traveling to a country where she will be at high risk for malarial infection. What will the nurse teach her regarding prophylactic therapy?

The medication is better absorbed and has fewer adverse effects if taken on an empty stomach.

This drug should be started 3 weeks before exposure but can be discontinued once she leaves the area.

This drug is taken only when she observes mosquito bites, because it can have toxic effects if taken unnecessarily.

Prophylaxis of malaria is usually started 1 to 2 weeks before exposure and continued for 4 weeks after the person has left the area. The medication should be taken with food to decrease gastrointestinal upset.

Explanation

Prophylaxis of malaria is usually started 1 to 2 weeks before exposure and continued for 4 weeks after the person has left the area. The medication should be taken with food to decrease gastrointestinal upset.

32. A patient has received a prescription for a 2-week course of antifungal suppositories for a vaginal yeast infection. She asks the nurse if there is an alternative to this medication, saying, "I don't want to do this for 2 weeks!" The nurse recognizes that a possible alternative prescription in this situation would be

A single dose of a vaginal antifungal cream.

A one-time infusion of amphotericin B.

A single dose of a fluconazole (Diflucan) oral tablet.

Less effective than the suppositories.

A single oral dose of fluconazole may be used to treat vaginal candidiasis. The other options are incorrect.

Explanation

A single oral dose of fluconazole may be used to treat vaginal candidiasis. The other options are incorrect.

33. A patient with an intestinal infection that is positive for the Giardia lamblia organism will be taking an antiprotozoal drug. Which of the following should the nurse include in the teaching plan for this patient?

The urine may become dilute and pale during therapy.

Taking the medications with food reduces gastrointestinal upset.

The medications should be taken on an empty stomach.

The drugs may be discontinued once the diarrhea subsides.

Antiprotozoal drugs should be administered for the prescribed length of time to ensure complete eradication of the infection. These drugs may cause the urine to turn dark, and taking them with food reduces gastrointestinal upset.

Explanation

Antiprotozoal drugs should be administered for the prescribed length of time to ensure complete eradication of the infection. These drugs may cause the urine to turn dark, and taking them with food reduces gastrointestinal upset.

34. When reviewing the medication orders for a patient who will be receiving linezolid (Zyvox) therapy, the nurse is aware that this drug may interact with which medications?

Calcium channel blockers

Selective serotonin-reuptake inhibitor antidepressants

Phenytoin

Phenobarbital

This drug may cause serotonin syndrome when used concurrently with serotonergic drugs such as the selective serotonin-reuptake inhibitor antidepressants.

Explanation

This drug may cause serotonin syndrome when used concurrently with serotonergic drugs such as the selective serotonin-reuptake inhibitor antidepressants.

35. A patient diagnosed with shingles is taking topical acyclovir and the nurse is providing instructions about adverse effects. Which are adverse effects of topical acyclovir that should be discussed with the patient?

Insomnia and nervousness

Temporary swelling and rash

Transient burning when applied

This medication has no adverse effects.

Transient burning may occur with the topical application of acyclovir. The other options are not correct.

Explanation

Transient burning may occur with the topical application of acyclovir. The other options are not correct.

36. A patient has been taking antitubercular therapy for 3 months. The nurse notes a therapeutic response to these drugs with which assessment findings?

The chronic cough is gone.

There are two consecutive negative purified protein derivative (PPD) results over 2 months.

There is increased tolerance to the medication therapy and there are fewer reports of adverse effects.

There is a decrease in symptoms of tuberculosis along with improved chest x-rays and sputum cultures.

A therapeutic response to antitubercular therapy is manifested by a decrease in the symptoms of tuberculosis, such as cough and fever, and by weight gain. The results of laboratory studies (culture and sensitivity tests) and the chest radiographic findings should confirm the clinical findings of resolution of the infection.

Explanation

A therapeutic response to antitubercular therapy is manifested by a decrease in the symptoms of tuberculosis, such as cough and fever, and by weight gain. The results of laboratory studies (culture and sensitivity tests) and the chest radiographic findings should confirm the clinical findings of resolution of the infection.

37. If a patient is taking an antifungal drug with an oral anticoagulant, the nurse should monitor for which possible interaction?

Reduced action of oral anticoagulants, resulting in decreased prothrombin time-international normalized ratio (PT-INR)

Increased action of oral anticoagulants, resulting in increased PT-INR

Increased change in renal impairment caused by the antifungal drug

Decreased effectiveness of the antifungal drug

Some antifungal drugs increase the effects of oral anticoagulants, which manifest as increases in PT-INR. As a result, increased bleeding may occur. The other options are not correct.

Explanation

Some antifungal drugs increase the effects of oral anticoagulants, which manifest as increases in PT-INR. As a result, increased bleeding may occur. The other options are not correct.

38. The nurse is reviewing anthelmintic drug therapy with a patient and instructs the patient to look for and report which potential adverse reactions?

Drowsiness

Insomnia

Visual disturbances

Constipation

The patient should be encouraged to notify the prescriber immediately if experiencing visual disturbances, gastrointestinal distress, blurred vision, altered hearing, or fatigue. Drowsiness may occur with some medications; most anthelmintic drugs cause diarrhea.

Explanation

The patient should be encouraged to notify the prescriber immediately if experiencing visual disturbances, gastrointestinal distress, blurred vision, altered hearing, or fatigue. Drowsiness may occur with some medications; most anthelmintic drugs cause diarrhea.

39. The nurse is administering one of the lipid formulations of amphotericin B. When giving this drug, it is important to remember that

The lipid formulations may be given in an oral form.

The doses are much lower than the doses of the older drugs.

The lipid formulations are associated with fewer adverse effects than the older drugs.

There is no difference in cost between the new and older forms.

Newer lipid formulations of amphotericin B have been developed in an attempt to decrease the incidence of its adverse effects and increase its efficacy. However, the lipid formulations are more costly.

Explanation

Newer lipid formulations of amphotericin B have been developed in an attempt to decrease the incidence of its adverse effects and increase its efficacy. However, the lipid formulations are more costly.

40. A patient is taking a combination of antiviral drugs as treatment for early stages of HIV infection. While discussing the drug therapy, he asks the nurse if the drugs will kill the virus. When answering him, the nurse keeps in mind the fact that antiviral drugs

Are given for palliative reasons only.

Will be effective as long as he is not exposed to the virus again.

Can be given in large enough doses to eradicate the virus without harming the body’s healthy cells.

May also kill healthy cells while killing viruses.

Because viruses reproduce in human cells, selective killing is difficult; consequently, many healthy human cells, in addition to virally infected cells, may be killed in the process, and this results in the serious toxicities that are involved with these drugs.

Explanation

Because viruses reproduce in human cells, selective killing is difficult; consequently, many healthy human cells, in addition to virally infected cells, may be killed in the process, and this results in the serious toxicities that are involved with these drugs.

41. During therapy with amphotericin B, the nurse would monitor for known adverse effects that would be reflected by which lab result?

Serum potassium level of 2.9 mEq/L

Serum potassium level of 5.6 mEq/L

White blood count of 6500 mm3

Platelet count of 300,000 per microliter

The nurse should monitor for hypokalemia, a possible adverse effect of amphotericin B.

Explanation

The nurse should monitor for hypokalemia, a possible adverse effect of amphotericin B.

42. The nurse is discussing adverse effects of antitubercular drugs. Which potential adverse effect should the patient report to his or her prescriber?

Gastrointestinal upset

Headache and nervousness

Reddish-orange urine and stool

Numbness and tingling of extremities

Patients on antitubercular therapy should report experiencing numbness and tingling of extremities, which may indicate peripheral neuropathy. Some drugs may color the urine, stool, and other body secretions reddish-orange, but this is not an effect that needs to be reported. Patients should be informed of this expected effect.

Explanation

Patients on antitubercular therapy should report experiencing numbness and tingling of extremities, which may indicate peripheral neuropathy. Some drugs may color the urine, stool, and other body secretions reddish-orange, but this is not an effect that needs to be reported. Patients should be informed of this expected effect.

43. A patient with a severe fungal infection has orders for voriconazole (Vfend). The nurse is reviewing the patient's medical record and would be concerned with what assessment finding?

Decreased breath sounds in the lower lobes

History of cardiac dysrhythmias

History of diabetes type II

Potassium level of 3.8 mEq/L

Voriconazole is contraindicated when coadministered with certain other drugs metabolized by the cytochrome P-450 enzyme CYP3A4 (e.g., quinidine) because of the risk for inducing serious cardiac dysrhythmias.

Explanation

Voriconazole is contraindicated when coadministered with certain other drugs metabolized by the cytochrome P-450 enzyme CYP3A4 (e.g., quinidine) because of the risk for inducing serious cardiac dysrhythmias.

44. A patient who has undergone bone marrow transplantation has contracted cytomegalovirus (CMV) retinitis. The nurse expects which drug to be ordered for this patient?

Acyclovir (Zovirax)

Ganciclovir (Cytovene)

Zanamivir (Relenza)

Amantadine (Symmetrel)

Ganciclovir is indicated for the treatment of cytomegalovirus retinitis. Acyclovir is used for herpes simplex types 1 and 2, herpes zoster, and chickenpox; amantadine is used for influenza A; and zanamivir is used for influenza types A and B.

Explanation

Ganciclovir is indicated for the treatment of cytomegalovirus retinitis. Acyclovir is used for herpes simplex types 1 and 2, herpes zoster, and chickenpox; amantadine is used for influenza A; and zanamivir is used for influenza types A and B.

45. A patient with AIDS has been taking zidovudine (Retrovir) therapy for almost 1 year. At this time, the physician decides to switch her medication to didanosine. The patient is very concerned about this change. What will the nurse explain to her?

The didanosine is less expensive.

Didanosine has been shown to improve survival rates.

The zidovudine therapy is effective for only a year.

The zidovudine therapy may have caused severe bone marrow suppression.

Bone marrow suppression is often the reason that a patient with HIV infection has to be switched to another anti-HIV drug such as didanosine. The two drugs can be taken together, cutting back on the dosages of both and thus decreasing the likelihood of toxicity.

Explanation

Bone marrow suppression is often the reason that a patient with HIV infection has to be switched to another anti-HIV drug such as didanosine. The two drugs can be taken together, cutting back on the dosages of both and thus decreasing the likelihood of toxicity.

46. A patient who has been taking isoniazid (INH) has a new prescription for pyridoxine. She is wondering why she needs this medication. The nurse explains that pyridoxine is given concurrently with the isoniazid to prevent

Hair loss.

Renal failure.

Peripheral neuropathy.

Heart failure.

Pyridoxine (vitamin B6) may be beneficial for isoniazid-induced peripheral neuropathy. The other options are not correct.

Explanation

Pyridoxine (vitamin B6) may be beneficial for isoniazid-induced peripheral neuropathy. The other options are not correct.

47. An infant has been hospitalized with a severe lung infection caused by the respiratory syncytial virus (RSV). The nurse expects which drug to be administered via the inhalation route?

Acyclovir (Zovirax)

Ganciclovir (Cytovene)

Amantadine (Symmetrel)

Ribavirin (Virazole)

The inhalational form (Virazole) is used primarily in the treatment of hospitalized infants with severe lower respiratory tract infections caused by RSV. The other drugs listed are not used for the treatment of RSV.

Explanation

The inhalational form (Virazole) is used primarily in the treatment of hospitalized infants with severe lower respiratory tract infections caused by RSV. The other drugs listed are not used for the treatment of RSV.

48. A patient has a roundworm infestation and will be taking mebendazole. What adverse effects should the nurse include in a teaching plan for this patient?

Vertigo

Seizures

Diarrhea

Insomnia

Diarrhea and abdominal pain are possible gastrointestinal effects of mebendazole. The other options are not correct.

Explanation

Diarrhea and abdominal pain are possible gastrointestinal effects of mebendazole. The other options are not correct.

49. The nurse is preparing to use an antiseptic. Which statement is correct regarding how antiseptics differ from disinfectants?

Antiseptics are used to sterilize surgical equipment.

Disinfectants are used as preoperative skin preparation.

Antiseptics are used on living tissue to kill microorganisms.

Disinfectants are used only on nonliving objects to destroy organisms.

Antiseptics primarily inhibit microorganisms but do not necessarily kill them. They are applied exclusively to living tissue. Disinfectants are able to kill organisms and are used only on nonliving objects.

Explanation

Antiseptics primarily inhibit microorganisms but do not necessarily kill them. They are applied exclusively to living tissue. Disinfectants are able to kill organisms and are used only on nonliving objects.

50. The nurse is preparing an infusion of amphotericin B for a patient who has a severe fungal infection. Which intervention is appropriate regarding the potential adverse effects of amphotericin B?

Discontinuing the infusion immediately if fever, chills, or nausea occur

Gradually increasing the infusion rate until adverse effects occur

If fever, chills, or nausea occur during the infusion, administering medications to treat the symptoms

Before beginning the infusion, administering an antipyretic and an antiemetic drug

Almost all patients given the drug intravenously experience fever, chills, hypotension, tachycardia, malaise, muscle and joint pain, anorexia, nausea and vomiting, and headache. For this reason, as noted earlier, pretreatment with an antipyretic (acetaminophen), antihistamines, and antiemetics may be conducted to decrease the severity of the infusion-related reaction. The other options are not correct.

Explanation

Almost all patients given the drug intravenously experience fever, chills, hypotension, tachycardia, malaise, muscle and joint pain, anorexia, nausea and vomiting, and headache. For this reason, as noted earlier, pretreatment with an antipyretic (acetaminophen), antihistamines, and antiemetics may be conducted to decrease the severity of the infusion-related reaction. The other options are not correct.

51. A patient who is being treated for malaria has started therapy with quinine and tetracycline. He asks the nurse why he is on an antibiotic when malaria is caused by a parasite. What should the nurse tell the patient?

“The tetracycline prevents reinfection by the malarial parasite.”

“The antibiotic is combined with quinine to reduce the adverse effects of the quinine.”

“An antibacterial drug prevents the occurrence of superinfection during antimalarial therapy.”

“The two drugs are more effective against malaria when given together.”

The combination of quinine and tetracycline takes advantage of their synergistic protozoacidal effects.

Explanation

The combination of quinine and tetracycline takes advantage of their synergistic protozoacidal effects.

52. A patient is receiving hydroxychloroquine therapy but tells the nurse that she has never traveled out of her state. The nurse knows that a possible reason for this drug therapy is which condition?

Lyme disease

Toxoplasmosis

Rheumatoid arthritis

Intestinal tapeworms

Hydroxychloroquine, which is used for malaria, also possesses antiinflammatory actions and has been used to treat rheumatoid arthritis and systemic lupus erythematosus since the 1950s. The other options are not correct.

Explanation

Hydroxychloroquine, which is used for malaria, also possesses antiinflammatory actions and has been used to treat rheumatoid arthritis and systemic lupus erythematosus since the 1950s. The other options are not correct.

53. During antibiotic therapy, the nurse should monitor closely for signs and symptoms of a hypersensitivity reaction. Which of the following may be an indication of a hypersensitivity reaction? Select all that apply.

Wheezing

Diarrhea

Shortness of breath

Swelling of the tongue

Itching

Black, hairy tongue

Submit

54. A patient is being evaluated for a possible helmintic infection. The nurse knows that which of the following statements about anthelmintic therapy is true?

They may cause severe drowsiness.

Anthelmintics are very specific in their actions.

Anthelmintics are effective against broad classes of infestations.

They are used to treat protozoal infections such as intestinal amebiasis.

Anthelmintics are very specific in their actions, and it is important to identify the cause of the infestation before beginning treatment.

Explanation

Anthelmintics are very specific in their actions, and it is important to identify the cause of the infestation before beginning treatment.

55. When monitoring patients on antitubercular drug therapy, the nurse knows that which drug may cause a decrease in visual acuity?

Rifampin

Isoniazid

Ethambutol

Streptomycin

Ethambutol may cause a decrease in visual acuity or even blindness resulting from retrobulbar neuritis.

Explanation

Ethambutol may cause a decrease in visual acuity or even blindness resulting from retrobulbar neuritis.

56. The nurse is reviewing the medication record of a patient who is taking isoniazid (INH). Which drug or drug class has a significant drug interaction with isoniazid?

Pyridoxine

Penicillin

Antacids

Benzodiazepines

Antacids reduce absorption of isoniazid and thus reduce serum levels. Pyridoxine is often given with isoniazid to prevent peripheral neuropathy. The other options are not correct.

Explanation

Antacids reduce absorption of isoniazid and thus reduce serum levels. Pyridoxine is often given with isoniazid to prevent peripheral neuropathy. The other options are not correct.

57. A patient is receiving cidofovir as part of the treatment for a viral infection, and the nurse is preparing to administer probenecid, which is also ordered. The nurse understands that the probenecid is given for which reason?

It has a synergistic effect when given with cidofovir, thus making the antiviral medication more effective.

The probenecid also prevents the replication of the virus.

Concurrent drug therapy with probenecid reduces the nephrotoxicity of the cidofovir.

The probenecid reduces the adverse gastrointestinal effects of the cidofovir.

Probenecid is recommended as concurrent drug therapy with cidofovir to help alleviate the nephrotoxic effects of probenecid. The other options are not correct.

Explanation

Probenecid is recommended as concurrent drug therapy with cidofovir to help alleviate the nephrotoxic effects of probenecid. The other options are not correct.

58. A patient has an infestation with flukes. The nurse anticipates the use of which drug to treat this infestation?

Praziquantel (Biltricide)

Pyrantel (Antiminth)

Mebendazole (Vermox)

Ivermectin (Stromectol)

Praziquantel is an anthelmintic that can kill flukes, as is albendazole. The other drugs listed are used for other infestations.

Explanation

Praziquantel is an anthelmintic that can kill flukes, as is albendazole. The other drugs listed are used for other infestations.

59. A patient with late-stage HIV infection also has Pneumocystis jirovecii pneumonia. The nurse anticipates treatment with which medication for this pneumonia?

Iodoquinol (Yodoxin)

Atovaquone (Mepron)

Praziquantel (Biltricide)

Metronidazole (Flagyl)

Pentamidine and atovaquone are used for the treatment of pneumonia caused by P. jirovecii. The other options are not used for this pneumonia.

Explanation

Pentamidine and atovaquone are used for the treatment of pneumonia caused by P. jirovecii. The other options are not used for this pneumonia.

60. A patient has been diagnosed with Klebsiella pneumoniae carbapenemases. The nurse expects to see orders for which drug?

Dapsone

Ciprofloxacin (Cipro)

Linezolid (Zyvox)

Colistimethate sodium or colistin (Coly-Mycin)

Colistimethate (Coly-Mycin), commonly referred to as colistin, is now being used again, often as one of the only drugs available to treat this infection. The other options are incorrect.

Explanation

Colistimethate (Coly-Mycin), commonly referred to as colistin, is now being used again, often as one of the only drugs available to treat this infection. The other options are incorrect.

61. A patient is infected by invasive aspergillosis, and his medical record reveals that he has not been able to tolerate several antifungal drugs. The nurse anticipates an order for which medication to treat this infection?

Fluconazole (Diflucan)

Micafungin (Mycamine)

Caspofungin (Cancidas)

Nystatin (Mycostatin)

Caspofungin is used for treating severe infection by Aspergillus species (invasive aspergillosis) in patients who are intolerant of or refractory to other drugs.

Explanation

Caspofungin is used for treating severe infection by Aspergillus species (invasive aspergillosis) in patients who are intolerant of or refractory to other drugs.

62. The nurse is administering intravenous vancomycin (Vancocin) to a patient who has had gastrointestinal surgery. Which nursing measures are appropriate? Select all that apply.

Monitoring serum creatinine levels

Restricting fluids while the patient is on this medication

Warning the patient that he might feel flushed or have facial itching

Instructing the patient to report dizziness or a feeling of fullness in the ears

Reporting a trough drug level of 12 mcg/mL and holding the drug

Reporting a trough drug level of 24 mcg/mL and holding the drug

Constant monitoring for drug-related neurotoxicity, nephrotoxicity, ototoxicity, and superinfection remain critical to patient safety. Monitor for nephrotoxicity by monitoring serum creatinine levels. Ototoxicity may be indicated if a patient experiences dizziness or a feeling of fullness in the ears, and these symptoms should be reported immediately. Vancomycin infusions may cause red man syndrome, which is characterized by flushing of the neck and face and a decrease in blood pressure. In addition, adequate hydration (at least 2 liters of fluids every 24 hours unless contraindicated) is most important to prevent nephrotoxicity. Optimal trough blood levels of vancomycin are 10 to 20 mcg/mL; therefore, the drug should not be administered when there is a trough level of 24 mcg/mL.

Explanation

Constant monitoring for drug-related neurotoxicity, nephrotoxicity, ototoxicity, and superinfection remain critical to patient safety. Monitor for nephrotoxicity by monitoring serum creatinine levels. Ototoxicity may be indicated if a patient experiences dizziness or a feeling of fullness in the ears, and these symptoms should be reported immediately. Vancomycin infusions may cause red man syndrome, which is characterized by flushing of the neck and face and a decrease in blood pressure. In addition, adequate hydration (at least 2 liters of fluids every 24 hours unless contraindicated) is most important to prevent nephrotoxicity. Optimal trough blood levels of vancomycin are 10 to 20 mcg/mL; therefore, the drug should not be administered when there is a trough level of 24 mcg/mL.

Submit

63. A patient diagnosed with genital herpes is taking topical acyclovir. What teaching is important for this patient? Select all that apply.

“Be sure to wash your hands thoroughly before and after applying this medicine.”

“Apply this ointment until the lesion stops hurting.”

“Sterile gloves are required when applying this ointment.”

“Use a clean glove when applying this ointment.”

“If your partner develops these lesions, then he can also use the medication.”

“You need to avoid touching the area around your eyes.”

“You will have to practice abstinence when these lesions are active.”

This medication should be applied as long as prescribed, and sterile gloves are not needed. Prescriptions should not be shared; if the partner develops these lesions, the partner will have to be evaluated before medication is prescribed, if needed.

Explanation

This medication should be applied as long as prescribed, and sterile gloves are not needed. Prescriptions should not be shared; if the partner develops these lesions, the partner will have to be evaluated before medication is prescribed, if needed.

Submit

64. A patient is experiencing the exoerythrocytic phase of malaria. The nurse expects which drug to be used for this patient?

Quinine

Chloroquine (Aralen)

Mefloquine (Lariam)

Primaquine

Primaquine is one of the few antimalarial drugs that can destroy the malarial parasites while they are in their exoerythrocytic phase. The other drugs are effective during the erythrocytic, or blood, phase.

Explanation

Primaquine is one of the few antimalarial drugs that can destroy the malarial parasites while they are in their exoerythrocytic phase. The other drugs are effective during the erythrocytic, or blood, phase.

65. The nurse who is administering aminoglycoside therapy must monitor the patient closely for signs of toxicity as manifested by which of the following? Select all that apply.

Electrocardiogram changes

Hearing loss

Dizziness

Blood dyscrasias

Decreasing serum creatinine level

Rising serum creatinine level

Patients on aminoglycoside therapy must be monitored for signs of nephrotoxicity (rising serum creatinine level) and ototoxicity (hearing loss, dizziness). The other options are not signs of toxicity.

Explanation

Patients on aminoglycoside therapy must be monitored for signs of nephrotoxicity (rising serum creatinine level) and ototoxicity (hearing loss, dizziness). The other options are not signs of toxicity.

Submit

66. Important points the nurse should emphasize when teaching a patient who will be taking antitubercular therapy include which of the following? Select all that apply.

“Take medications until the symptoms disappear.”

“Take medications at the same time every day.”

“You will be considered contagious during most of the illness and must take precautions to avoid spreading the disease.”

“Stop taking the medications if you have severe adverse effects.”

“Alcoholic beverages should be avoided while on this therapy.”

“If you notice reddish-brown or reddish-orange urine, stop taking the drug and contact your doctor right away.”

“If you experience a burning or tingling in your fingers or toes, report it to your physician immediately.”

Medications for tuberculosis must be taken on a consistent schedule to maintain blood levels. Medication therapy for tuberculosis may last up to 24 months, long after symptoms disappear, and patients are infectious during the early part of the treatment. Compliance with antitubercular drug therapy is key, so if symptoms become severe, the prescriber should be contacted for an adjustment of the drug therapy. The medication should not be stopped. Because of potential liver toxicity, patients on this drug therapy should not drink alcohol. Discoloration of the urine is an expected adverse effect, and patients should be warned about it beforehand. A second form of birth control should be used because antitubercular drug therapy makes oral contraceptives ineffective.

Explanation

Medications for tuberculosis must be taken on a consistent schedule to maintain blood levels. Medication therapy for tuberculosis may last up to 24 months, long after symptoms disappear, and patients are infectious during the early part of the treatment. Compliance with antitubercular drug therapy is key, so if symptoms become severe, the prescriber should be contacted for an adjustment of the drug therapy. The medication should not be stopped. Because of potential liver toxicity, patients on this drug therapy should not drink alcohol. Discoloration of the urine is an expected adverse effect, and patients should be warned about it beforehand. A second form of birth control should be used because antitubercular drug therapy makes oral contraceptives ineffective.

Submit

67. A patient is in the HIV clinic for a follow-up appointment. He has been on antiretroviral therapy for HIV for more than 3 years. The nurse will assess for which potential adverse effects of long-term antiretroviral therapy? Select all that apply.

Lipodystrophy

Liver damage

Kaposi’s sarcoma

Osteoporosis

Type 2 diabetes

Anti-HIV drugs produce strain on the liver and may result in liver disease. A major adverse effect of protease inhibitors is lipid abnormalities, including lipodystrophy, or redistribution of fat stores under the skin. In addition, dyslipidemias such as hypertriglyceridemia can occur, and insulin resistance and type 2 diabetes symptoms can result. The increase in long-term antiretroviral drug therapy due to prolonged disease survival has led to the emergence of another long-term adverse effect associated with these medications—bone demineralization and possible osteoporosis. Kaposi’s sarcoma is an opportunistic disease associated with HIV, not a result of long-term drug therapy.

Explanation

Anti-HIV drugs produce strain on the liver and may result in liver disease. A major adverse effect of protease inhibitors is lipid abnormalities, including lipodystrophy, or redistribution of fat stores under the skin. In addition, dyslipidemias such as hypertriglyceridemia can occur, and insulin resistance and type 2 diabetes symptoms can result. The increase in long-term antiretroviral drug therapy due to prolonged disease survival has led to the emergence of another long-term adverse effect associated with these medications—bone demineralization and possible osteoporosis. Kaposi’s sarcoma is an opportunistic disease associated with HIV, not a result of long-term drug therapy.

Submit

68. When administering amphotericin B, which of the following actions by the nurse are appropriate? Select all that apply.

Administering the medication by rapid IV infusion

Discontinuing the drug immediately if the patient develops tingling and numbness in the extremities

If adverse effects occur, reducing the IV rate gradually until they subside

Using an infusion pump for IV therapy

Monitoring the IV site for signs of phlebitis and infiltration

Ordering premedication for fever and nausea

Knowing that the intravenous solution for amphotericin B will be cloudy

Knowing that muscle twitching may indicate hypokalemia

If the patient develops tingling and numbness in the extremities (paresthesias), the drug should be discontinued immediately. An infusion pump is necessary for the infusion, and the nurse should monitor the IV site for signs of phlebitis and infiltration. Premedication to reduce the adverse effects of fever, malaise, and nausea may be ordered. The IV solution should be clear and without precipitates; and muscle weakness, not twitching, may indicate hypokalemia. The medication should be administered at the rate recommended and stopped, not slowed, if adverse reactions occur.

Explanation

If the patient develops tingling and numbness in the extremities (paresthesias), the drug should be discontinued immediately. An infusion pump is necessary for the infusion, and the nurse should monitor the IV site for signs of phlebitis and infiltration. Premedication to reduce the adverse effects of fever, malaise, and nausea may be ordered. The IV solution should be clear and without precipitates; and muscle weakness, not twitching, may indicate hypokalemia. The medication should be administered at the rate recommended and stopped, not slowed, if adverse reactions occur.

Submit

69. Hydroxychloroquine is prescribed as part of malaria prophylaxis for a patient who will be traveling. The nurse will discuss which potential adverse effects with the patient? Select all that apply.

Diarrhea

Constipation

Drowsiness

Dizziness

Anxiety

Anorexia

Diarrhea, anorexia, nausea, vomiting, dizziness, anxiety, and headache are potential adverse effects of hydroxychloroquine. The other options are not adverse effects of this drug.

Explanation

Diarrhea, anorexia, nausea, vomiting, dizziness, anxiety, and headache are potential adverse effects of hydroxychloroquine. The other options are not adverse effects of this drug.

Submit

Science Test 2

1. A patient has received an antibiotic to take for a week before planned oral surgery. The nurse knows that this is an example of which type of therapy?

2.

What first name or nickname would you like us to use?

2. When teaching a patient who will be taking tetracycline, which of the following instructions should the nurse share?

3. A patient is receiving aminoglycoside therapy and will be receiving a beta-lactam antibiotic as well. The patient asks why two antibiotics have been ordered. What is the nurse's best response?

4. The nurse is reviewing the medication history of a patient who will be taking an antibiotic. During antibiotic therapy, a significant drug interaction may occur with which drug group?

5. During drug therapy for pneumonia, a female patient develops a superinfection. The nurse explains that this infection is caused by

6. When a patient is on aminoglycoside therapy, the nurse will monitor the patient for which indicators of potential toxicity?

7. Which of the following nursing diagnoses is appropriate for a patient who has started aminoglycoside therapy?

8. The nurse is administering intravenous acyclovir (Zovirax) to a patient with a viral infection. Which administration technique is correct?

9. During an intravenous (IV) infusion of amphotericin B, a patient develops tingling and numbness in his toes and fingers. What will the nurse do?

10. During drug therapy with a tetracycline antibiotic, a patient complains of some nausea and anorexia. The nurse's best advice to the patient would be which of the following?

11. When reviewing the medication orders for a patient who is taking penicillin, the nurse notes that the patient is also taking the oral anticoagulant warfarin (Coumadin). What possible effect may occur as the result of an interaction between these drugs?

12. The nurse is administering a vancomycin (Vancocin) infusion. Which measure is appropriate for the nurse to implement in order to reduce complications that may occur with this drug's administration?

13. When reviewing the history of a patient who will be taking an antifungal drug, the nurse knows that which of the following conditions is a contraindication to these drugs?

14. A patient who has been hospitalized for 2 weeks has developed a pressure ulcer that contains multidrug-resistant Staphylococcus aureus (MRSA). Which drug would the nurse expect to be chosen for his therapy?

15. The nurse is reviewing instructions for vaginal antifungal drugs with a patient. Which is an appropriate instruction regarding these drugs?

16. When reviewing the allergy history of a patient, the nurse notes that the patient is allergic to penicillin. Based on this finding, the nurse would question an order for which class of antibiotics?

17. The nurse is counseling a woman who will be starting rifampin. The patient is on oral contraceptives. Which statement is true regarding rifampin therapy for this patient?

18. A patient is taking nystatin (Mycostatin) lozenges because of an oral candidiasis infection resulting from inhaled corticosteroid therapy for asthma. Which instruction by the nurse is appropriate?

19. The nurse is monitoring for therapeutic results of antibiotic therapy in a patient with an infection. Which laboratory value would indicate therapeutic effectiveness of this therapy?

20. A patient has a urinary tract infection. The nurse knows that which class of drugs is especially useful for such infections?

21. The nurse is about to give a dose of vancomycin (Vancocin), but before doing so checks the patient's lab work and finds that the trough vancomycin level is 24 mcg/mL. What will the nurse do next?

22. A patient who has started drug therapy for tuberculosis wants to know how long he will be on the medications. What is the nurse's best response?

23. The nurse is reviewing the sputum culture results of a patient with pneumonia and notes that the patient has a gram-positive infection. Which type of cephalosporin is most appropriate for this infection?

24. A patient with a long-term intravenous catheter is going home. The nurse knows that if he is allergic to seafood, which antiseptic agent is contraindicated?

25. A patient is receiving his third intravenous dose of a penicillin drug. He calls the nurse to report that he is feeling "anxious" and is having trouble breathing. What will the nurse do first?

26. A young adult calls the clinic to ask for a prescription for "that new flu drug." He says he has had the flu for almost 4 days and just heard about a drug that can reduce the symptoms. Based on knowledge of antiviral therapy for influenza, what is the nurse's best response to his request?

28. A 79-year-old patient is receiving a quinolone as treatment for a complicated incision infection. The nurse will monitor for which adverse effect that is associated with these drugs?

29. When assessing patients who are to receive antitubercular therapy, the nurse should assess for which potential contraindication?

30. The nurse is preparing to administer morning medications to a patient who has been newly diagnosed with tuberculosis. The patient asks, "Why do I have to take so many different drugs?" Which answer by the nurse is correct?

31. A woman is traveling to a country where she will be at high risk for malarial infection. What will the nurse teach her regarding prophylactic therapy?

33. A patient with an intestinal infection that is positive for the Giardia lamblia organism will be taking an antiprotozoal drug. Which of the following should the nurse include in the teaching plan for this patient?

34. When reviewing the medication orders for a patient who will be receiving linezolid (Zyvox) therapy, the nurse is aware that this drug may interact with which medications?

35. A patient diagnosed with shingles is taking topical acyclovir and the nurse is providing instructions about adverse effects. Which are adverse effects of topical acyclovir that should be discussed with the patient?

36. A patient has been taking antitubercular therapy for 3 months. The nurse notes a therapeutic response to these drugs with which assessment findings?

37. If a patient is taking an antifungal drug with an oral anticoagulant, the nurse should monitor for which possible interaction?

38. The nurse is reviewing anthelmintic drug therapy with a patient and instructs the patient to look for and report which potential adverse reactions?

39. The nurse is administering one of the lipid formulations of amphotericin B. When giving this drug, it is important to remember that

40. A patient is taking a combination of antiviral drugs as treatment for early stages of HIV infection. While discussing the drug therapy, he asks the nurse if the drugs will kill the virus. When answering him, the nurse keeps in mind the fact that antiviral drugs

41. During therapy with amphotericin B, the nurse would monitor for known adverse effects that would be reflected by which lab result?

42. The nurse is discussing adverse effects of antitubercular drugs. Which potential adverse effect should the patient report to his or her prescriber?

43. A patient with a severe fungal infection has orders for voriconazole (Vfend). The nurse is reviewing the patient's medical record and would be concerned with what assessment finding?

44. A patient who has undergone bone marrow transplantation has contracted cytomegalovirus (CMV) retinitis. The nurse expects which drug to be ordered for this patient?

45. A patient with AIDS has been taking zidovudine (Retrovir) therapy for almost 1 year. At this time, the physician decides to switch her medication to didanosine. The patient is very concerned about this change. What will the nurse explain to her?

46. A patient who has been taking isoniazid (INH) has a new prescription for pyridoxine. She is wondering why she needs this medication. The nurse explains that pyridoxine is given concurrently with the isoniazid to prevent

47. An infant has been hospitalized with a severe lung infection caused by the respiratory syncytial virus (RSV). The nurse expects which drug to be administered via the inhalation route?

48. A patient has a roundworm infestation and will be taking mebendazole. What adverse effects should the nurse include in a teaching plan for this patient?

49. The nurse is preparing to use an antiseptic. Which statement is correct regarding how antiseptics differ from disinfectants?

50. The nurse is preparing an infusion of amphotericin B for a patient who has a severe fungal infection. Which intervention is appropriate regarding the potential adverse effects of amphotericin B?

51. A patient who is being treated for malaria has started therapy with quinine and tetracycline. He asks the nurse why he is on an antibiotic when malaria is caused by a parasite. What should the nurse tell the patient?

52. A patient is receiving hydroxychloroquine therapy but tells the nurse that she has never traveled out of her state. The nurse knows that a possible reason for this drug therapy is which condition?

53. During antibiotic therapy, the nurse should monitor closely for signs and symptoms of a hypersensitivity reaction. Which of the following may be an indication of a hypersensitivity reaction? Select all that apply.

54. A patient is being evaluated for a possible helmintic infection. The nurse knows that which of the following statements about anthelmintic therapy is true?

55. When monitoring patients on antitubercular drug therapy, the nurse knows that which drug may cause a decrease in visual acuity?

56. The nurse is reviewing the medication record of a patient who is taking isoniazid (INH). Which drug or drug class has a significant drug interaction with isoniazid?

57. A patient is receiving cidofovir as part of the treatment for a viral infection, and the nurse is preparing to administer probenecid, which is also ordered. The nurse understands that the probenecid is given for which reason?

58. A patient has an infestation with flukes. The nurse anticipates the use of which drug to treat this infestation?

59. A patient with late-stage HIV infection also has Pneumocystis jirovecii pneumonia. The nurse anticipates treatment with which medication for this pneumonia?

60. A patient has been diagnosed with Klebsiella pneumoniae carbapenemases. The nurse expects to see orders for which drug?

61. A patient is infected by invasive aspergillosis, and his medical record reveals that he has not been able to tolerate several antifungal drugs. The nurse anticipates an order for which medication to treat this infection?

62. The nurse is administering intravenous vancomycin (Vancocin) to a patient who has had gastrointestinal surgery. Which nursing measures are appropriate? Select all that apply.

63. A patient diagnosed with genital herpes is taking topical acyclovir. What teaching is important for this patient? Select all that apply.

64. A patient is experiencing the exoerythrocytic phase of malaria. The nurse expects which drug to be used for this patient?

65. The nurse who is administering aminoglycoside therapy must monitor the patient closely for signs of toxicity as manifested by which of the following? Select all that apply.

66. Important points the nurse should emphasize when teaching a patient who will be taking antitubercular therapy include which of the following? Select all that apply.

67. A patient is in the HIV clinic for a follow-up appointment. He has been on antiretroviral therapy for HIV for more than 3 years. The nurse will assess for which potential adverse effects of long-term antiretroviral therapy? Select all that apply.

68. When administering amphotericin B, which of the following actions by the nurse are appropriate? Select all that apply.

69. Hydroxychloroquine is prescribed as part of malaria prophylaxis for a patient who will be traveling. The nurse will discuss which potential adverse effects with the patient? Select all that apply.