Medication Administration in Pediatric Nursing, Exams of Nursing

Download Medication Administration in Pediatric Nursing and more Exams Nursing in PDF only on Docsity! NURS 6521 Advanced Pharmacology Final Questions and Answers A nurse is caring for an infant after a surgical procedure. After ensuring that the ordered dose is appropriate for the infant's age and weight, the nurse administers a narcotic analgesic intravenously. When assessing the infant 15 minutes later, the nurse notes respirations of 22 breaths/minute and a heart rate of 110 beats/minute. The infant is asleep in the parent's arms and does not awaken when vital signs are assessed. The nurse understands that these findings are the result of: - ANS-immaturity of the blood- brain barrier in the infant. A child will receive 750 mg of an antibiotic for 10 days. The child attends day care. The drug may be dosed in several ways and is available in two concentrations. Which dosing regimen will the nurse discuss with the child's provider? - ANS-500 mg/5 mL to 375 mg PO twice daily Parents ask the nurse why an over-the-counter cough suppressant with sedative side effects is not recommended for infants. Which response by the nurse is correct? - ANS-"Infants are more susceptible to central nervous system effects than are adults." A nurse caring for a 5-year-old child notes that the child has discoloration of several teeth. When taking a medication history, the nurse will ask about which group of medications? - ANS-Tetracyclines An infant has allergies and often develops a pruritic rash when exposed to allergens. The infant's parents ask the nurse about using a topical antihistamine. What should the nurse tell them? - ANS-Applying an antihistamine to the skin can cause toxicity in this age group. An infant is receiving a medication that has a narrow therapeutic range. The nurse reviews the medication information and learns that the drug is excreted by the kidneys. When giving the medication, the nurse will assess the infant for: - ANS-signs of drug toxicity. A pediatric nurse is teaching nursing students to calculate medication doses for children using a formula based on body surface area. Which statement by a nursing student indicates understanding of the teaching? - ANS-"This formula helps approximate the first dose; other doses should be based on clinical observations." A pediatric nurse is teaching nursing students about medication administration in children. Which statement by a student indicates an understanding of the teaching? - ANS-"Drugs effective in adults may not work in children, even if the dose is proportional for weight and size." A nurse is teaching nursing students about pediatric medication administration. What will the nurse include when discussing pediatric drug research? - ANS-Studies showed a significant percentage of unanticipated and potentially lethal side effects in children. A prescriber has ordered medication for a newborn. The medication is eliminated primarily by hepatic metabolism. The nurse expects the prescriber to: - ANS-order a dose that is lower than an adult dose. The parents of a child with asthma ask the nurse why their child can not use oral corticosteroids more often, because they are so effective. The nurse will offer which information that is true for children? - ANS-Chronic steroid use can inhibit growth. A patient with schizophrenia receives a dose of risperidone [Risperdal Consta] IM. The nurse teaching this patient about this medication will make which statement? - ANS-"You will need to take an oral antipsychotic drug for 3 weeks." A patient with schizophrenia shows suicidal behaviors, and the provider orders clozapine [Clozaril]. The nurse teaches the family about the medication and its side effects. Which statement by a family member indicates a need for further teaching about this drug? - ANS-"If the ANC is less than 3000, the drug will be discontinued permanently." A patient in whom drug therapy has failed several times in the past is readmitted to a hospital to begin therapy for schizophrenia. What will the nurse do to help improve adherence? - ANS-Teach the patient about drug side effects and how to manage them. A nurse provides teaching for a patient about to begin taking an FGA drug for schizophrenia. Which statement by the patient indicates a need for further teaching about side effects of these drugs? - ANS-"Dry mouth and constipation are uncommon with this medication." A patient taking an FGA medication develops severe parkinsonism and is treated with amantadine [Symmetrel]. The amantadine is withdrawn 2 months later, and the parkinsonism returns. The nurse will expect the provider to: - ANS-try a second- generation antipsychotic (SGA). What are negative symptoms of schizophrenia? Select all that apply. - ANS-Poor judgment Poor self-care Poverty of speech A patient is taking an FGA for schizophrenia. The nurse notes that the patient has trouble speaking and chewing and observes slow, wormlike-movements of the patient's tongue. The nurse recognizes which adverse effect in this patient? - ANS-Tardive dyskinesia pounds. The patient reports feeling tired and confused all the time but does not have suicidal thoughts. What does the nurse suspect? - ANS-Major depression A patient taking an MAOI is seen in the clinic with a blood pressure of 170/96 mm Hg. What will the nurse ask this patient? - ANS-To list all foods eaten that day A patient taking fluoxetine [Prozac] complains of decreased sexual interest. A prescriber orders a "drug holiday." What teaching by the nurse would best describe a drug holiday? - ANS-"Don't take the medication on Friday and Saturday." A patient with bipolar disorder who wants to minimize the need for drug therapy asks the nurse what else can be done to treat the disorder. The nurse will recommend which measures? Select all that apply. - ANS-Psychotherapy Regular sleep and exercise Using a chart to monitor mood changes A patient with bipolar disorder who is taking divalproex sodium [Valproate] has just been admitted to the hospital. During the admission assessment, the patient tells the nurse about recent suicidal ideation. The nurse observes several areas of bruising over soft tissue areas and notes a weight gain of 10 pounds since the last admission 1 year ago. What will the nurse do? - ANS-Contact the provider to report these findings. A patient with bipolar disorder takes lamotrigine [Lamictal]. Which statement by the patient would prompt the nurse to hold the drug and notify the prescriber for further assessment? - ANS-"I've broken out in a rash on my chest and back." A patient who has recently begun taking carbamazepine [Equetro] for bipolar disorder reports having vertigo and headaches. Which action by the nurse is appropriate? - ANS- Reassure the patient that these effects occur early in treatment and will resolve over time. A patient is admitted to a hospital for treatment for first-time symptoms of mania and is exhibiting euphoric mania. Which medication will the provider order? - ANS-Lithium [Lithobid] A patient with bipolar disorder has been taking lithium [Lithobid] for several years. The patient has developed a goiter, and serum tests reveal hypothyroidism. What will the nurse expect the provider to order for this patient? - ANS-Administration of levothyroxine A nurse is preparing to administer medications to a hospitalized patient who has been taking lithium [Lithobid] for 3 days. The patient is complaining of mild nausea and abdominal bloating. The patient's lithium level is 0.8 mEq/L. What will the nurse do? - ANS-Administer the dose and tell the patient that the side effects are temporary. A patient recently was diagnosed with bipolar disorder. The patient, who has a history of seasonal allergies, is an athlete who participates in track. The nurse is teaching the patient about lithium [Lithobid], which the prescriber has just ordered. Which statement by the patient indicates the need for further teaching? - ANS-"I can continue to use ibuprofen as needed for muscle pain." A patient with bipolar disorder is admitted to the hospital. The patient has been taking lithium [Lithobid] for several years and has not been evaluated by a provider for over a year. Besides obtaining a lithium level, the nurse caring for this patient will anticipate orders for which laboratory tests? Select all that apply. - ANS-Calcium level Renal function tests Thyroid function tests The spouse of a patient with bipolar disorder (BPD) tells the nurse that the patient will not stay on the lithium ordered by the provider longer than 1 or 2 months at a time. The nurse understands that adherence to medication regimens in patients with BPD is problematic and will tell the spouse: - ANS-"During manic episodes, many patients don't see the benefit of prophylactic medications." A patient with bipolar disorder has frequent manic episodes alternating with depressive episodes. The prescriber orders risperidone [Risperdal] in addition to the lithium [Lithobid] that the patient is already taking. The patient asks the nurse why another drug is needed. The nurse will tell the patient that the risperidone is used to: - ANS-help control symptoms during manic episodes. A patient with a new-onset seizure disorder receives a prescription for phenobarbital. The patient reports being concerned about the sedative side effects of this drug. Which response by the nurse is correct? - ANS-"Phenobarbital doses for seizures are nonsedating." A patient who travels frequently for business reports occasional instances of being unable to fall asleep. The patient tells the nurse that job demands require staying up late and then getting up early for meetings. The nurse expects that the provider will prescribe which medication for this patient? - ANS-Zaleplon [Sonata] A patient who is experiencing alcohol withdrawal is given a benzodiazepine. The nurse understands that this drug is effective because: - ANS-the patient has a cross- dependence to the benzodiazepine. A patient in the emergency department is given intravenous diazepam [Valium] for seizures. When the seizures stop, the nurse notes that the patient is lethargic and confused and has a respiratory rate of 10 breaths/minute. The nurse will expect to administer which of the following? - ANS-Respiratory support A patient who has been using secobarbital for several months to treat insomnia tells the nurse that the prescriber has said the prescription will be changed to temazepam [Restoril] because it is safer. The patient asks why this agent is safer. The nurse is correct in telling the patient that temazepam: - ANS-potentiates endogenous gamma- aminobutyric acid (GABA) producing a finite CNS depression. A hospitalized patient who is given one dose of flurazepam continues to show drowsiness the next day. A nursing student asks the nurse the reason for this, because the drug's half-life is only 2 to 3 hours. Which response by the nurse is correct? - ANS-"When this drug is metabolized, the resulting compound has longer-lasting effects." A patient takes temazepam [Restoril] for insomnia. The patient tells the nurse that a recent telephone bill lists several calls to friends that the patient does not remember making. What will the nurse do? - ANS-Ask the patient about any alcohol consumption in conjunction with the benzodiazepine. A nurse is discussing the use of benzodiazepines as sedative-hypnotic agents with a group of nursing students. A student asks about the actions of these drugs in the central nervous system. The nurse makes which correct statement? - ANS-"Benzodiazepines affect the hippocampus and the cerebral cortex to cause anterograde amnesia." A patient who has been taking alprazolam [Xanax] to treat generalized anxiety disorder (GAD) reports recently stopping the medication after symptoms have improved but reports having feelings of panic and paranoia. Which initial action by the nurse is correct? - ANS-Ask the patient if the medication was stopped abruptly. A patient is diagnosed with anxiety after describing symptoms of tension, poor concentration, and difficulty sleeping that have persisted for over 6 months. Which medication will the nurse expect the provider to order for this patient? - ANS-Buspirone [Buspar] A nurse is preparing a patient who will stop taking lorazepam [Ativan] for anxiety and begin taking buspirone [Buspar]. Which statement by the patient indicates a need for further teaching? - ANS-"I should stop taking the Ativan when I start taking the Buspar." A patient reports having occasional periods of tremors, palpitations, nausea, and a sense of fear, which usually dissipate within 30 minutes. To treat this condition, the nurse anticipates the provider will prescribe a drug in which drug class? - ANS-Selective serotonin reuptake inhibitors Selective serotonin reuptake inhibitors are known to be effective for which disorders? Select all that apply. - ANS-Generalized anxiety disorder (GAD) Obsessive-compulsive disorder Panic disorder Social anxiety disorder A nursing student who is preparing to care for a postoperative patient with deep vein thrombosis asks the nurse why the patient must take heparin rather than warfarin. Which response by the nurse is correct? - ANS-"The onset of warfarin is delayed." A postoperative patient reports pain in the left lower extremity. The nurse notes swelling in the lower leg, which feels warm to the touch. The nurse will anticipate giving which medication? - ANS-Enoxaparin [Lovenox] A patient who is taking warfarin [Coumadin] has just vomited blood. The nurse notifies the provider, who orders laboratory work revealing a PT of 42 seconds and an INR of 3.5. The nurse will expect to administer: - ANS-phytonadione (vitamin K1) 1 mg IV over 1 hour. A patient is admitted to the emergency department with chest pain. An electrocardiogram shows changes consistent with an evolving myocardial infarction. The patient's cardiac enzymes are pending. The nurse caring for this patient will expect to: - ANS-give alteplase [Activase] within 2 hours. A patient who takes warfarin for atrial fibrillation undergoes hip replacement surgery. On the second postoperative day, the nurse assesses the patient and notes an oxygen saturation of 83%, pleuritic chest pain, shortness of breath, and hemoptysis. The nurse will contact the provider to report possible and request an order for - ANS-pulmonary embolism; heparin A patient with atrial fibrillation is receiving warfarin [Coumadin]. The nurse notes that the patient's INR is 2.7. Before giving the next dose of warfarin, the nurse will notify the provider and: - ANS-administer the dose as ordered. A postoperative patient will begin anticoagulant therapy with rivaroxaban [Xarelto] after knee replacement surgery. The nurse performs a history and learns that the patient is taking erythromycin. The patient's creatinine clearance is 50 mL/minute. The nurse will: - ANS-notify the provider to discuss changing the patient's antibiotic. A patient who is taking clopidogrel [Plavix] calls the nurse to report black, tarry stools and coffee-ground emesis. The nurse will tell the patient to: - ANS-continue taking the clopidogrel until talking to the provider. A patient has been taking warfarin [Coumadin] for atrial fibrillation. The provider has ordered dabigatran etexilate [Pradaxa] to replace the warfarin. The nurse teaches the patient about the change in drug regimen. Which statement by the patient indicates understanding of the teaching? - ANS-"I will stop taking the warfarin and will start taking the dabigatran when my INR is less than 2." A 50-year-old female patient asks a nurse about taking aspirin to prevent heart disease. The patient does not have a history of myocardial infarction. Her cholesterol and blood pressure are normal, and she does not smoke. What will the nurse tell the patient? - ANS-There is most likely no protective benefit for patients her age. A patient who takes warfarin [Coumadin] is brought to the emergency department after accidentally taking too much warfarin. The patient's heart rate is 78 beats/minute and the blood pressure is 120/80 mm Hg. A dipstick urinalysis is normal. The patient does not have any obvious hematoma or petechiae and does not complain of pain. The nurse will anticipate an order for: - ANS-a PT and an INR. A nurse caring for a patient receiving heparin therapy notes that the patient has a heart rate of 98 beats/minute and a blood pressure of 110/72 mm Hg. The patient's fingertips are purplish in color. A stat CBC shows a platelet count of less than 100,000 mm3. The nurse will: - ANS-discontinue the heparin and notify the provider. A patient will begin taking dabigatran etexilate [Pradaxa] to prevent stroke. The nurse will include which statement when teaching this patient? - ANS-It is important not to crush, chew, or open capsules of dabigatran. A patient is admitted to the hospital with unstable angina and will undergo a percutaneous coronary intervention. Which drug regimen will the nurse expect to administer to prevent thrombosis in this patient? - ANS-Aspirin, heparin, abciximab [ReoPro] A patient who has taken warfarin [Coumadin] for a year begins taking carbamazepine. The nurse will anticipate an order to: - ANS-increase the dose of warfarin. A nurse has just received an order for tenecteplase [TNKase] for a patient experiencing an acute myocardial infarction. The nurse should administer this drug: - ANS-by bolus injection A nurse is taking a medication history on a newly admitted patient. The patient reports taking folic acid and vitamin B12. The nurse notifies the provider because of the concern that folic acid can: - ANS-mask the signs of vitamin B12 deficiency. A nurse is caring for a patient after hip replacement surgery. The patient has been receiving iron replacement therapy for 2 days. The nurse notes that the patient's stools appear black. The patient is pale and complains of feeling tired. The patient's heart rate is 98 beats/minute, respirations are 20 breaths/minute, and the blood pressure is 100/50 mm Hg. The nurse will contact the provider to: - ANS-request a hemoglobin and hematocrit (H&H). A 12-year-old female patient is admitted to the hospital before sinus surgery. The nurse preparing to care for this patient notes that the admission hemoglobin is 10.2 gm/dL, and the hematocrit is 32%. The nurse will ask the child's parents which question about their daughter? - ANS-"Has she begun menstruating?" A patient with renal failure is undergoing chronic hemodialysis. The patient's hemoglobin is 10.6 gm/dL. The provider orders sodium-ferric gluconate complex (SFGC [Ferrlecit]). What will the nurse expect to do? - ANS-Administer the drug intravenously with erythropoietin. A patient tells a nurse that she is thinking about getting pregnant and asks about nutritional supplements. What will the nurse recommend? - ANS-400 to 800 mg of folic acid per day A patient who has recently immigrated to the United States from an impoverished country appears malnourished. The patient's folic acid levels are low, and the vitamin B12 levels are normal. The nurse expects this patient's treatment to include: - ANS-a diet high in folic acid. A patient is admitted to the hospital. The patient's initial laboratory results reveal megaloblastic anemia. The patient complains of tingling of the hands and appears confused. The nurse suspects what in this patient? - ANS-Vitamin B12 deficiency A nurse is reviewing a patient's most recent blood count and notes that the patient has a hemoglobin of 9.6 gm/dL and a hematocrit of 33%. The nurse will notify the provider and will expect initial treatment to include: - ANS-determining the cause of the anemia. What are the indications for administration of a parenteral iron preparation? Select all that apply. Blood loss of 750 mL/week - ANS-Blood loss of 750 mL/week Celiac disease with anemia Intestinal disease impairing absorption A patient was given a 30-day supply of Feosol and has been taking the drug for 4 weeks for iron deficiency anemia. The patient's initial hemoglobin was 8.9 gm/dL. The nurse notes that the hemoglobin has risen to 9.7 gm/dL. What will the nurse ask the patient about? - ANS-Whether the prescription needs to be refilled The patient with which of the following is most at risk for folic acid deficiency? - ANS- Alcoholism A patient is receiving oral iron for iron deficiency anemia. Which antibiotic drug, taken concurrently with iron, would most concern the nurse? - ANS-Tetracycline A patient with vitamin B12 deficiency is admitted with symptoms of hypoxia, anemia, numbness of hands and feet, and oral stomatitis. The nurse expects the prescriber to order which of the following therapies? - ANS-IM cyanocobalamin and folic acid A patient who has been prescribed oral ferrous sulfate reports taking extra doses for the past few months. The patient's serum iron level is 560 mcg/dL. What will the nurse A patient is taking a combination oral contraceptive (OC) and reports breast tenderness, edema, and occasional nausea. What will the nurse recommend? - ANS-The patient should request an OC containing less estrogen A patient calls the nurse to report that she forgot to take a combination OC pill during the third week of her cycle. She tells the nurse that she missed another pill earlier that week. The nurse will tell her to: - ANS-take a pill now, continue the pack, skip the placebo pills, and start a new pack on week 4. A patient has just purchased a 1-year supply of 28-day-cycle oral contraceptives. She tells the nurse she wishes she had planned things better, because she has calculated that her period will begin during her upcoming honeymoon. What will the nurse suggest? - ANS-She should discard the inert pills and start a new pack during the honeymoon. A nurse working in a family planning clinic is preparing to administer a first dose of intramuscular DMPA [Depo-Provera] to a young adult patient. The woman tells the nurse she has just finished her period. What will the nurse do? - ANS-Schedule an appointment for her to receive the injection in 3 weeks. A patient who is taking a combination oral contraceptive begins taking carbamazepine. After severalweeks, the patient tells the nurse she has begun experiencing spotting during hercycle. What will the nurse tell her to do? - ANS-Discuss an oral contraceptive with increased estrogen. A woman has been taking a progestin-only oral contraceptive and will begin using a vaginal ring. The nurse will teach the patient to insert the ring: - ANS-the day the last pill is taken and use backup contraception for 7 days A nurse is teaching an adolescent female patient about 28-day monophasic combination oral contraceptives. The provider has instructed the patient to begin taking the pills on the first Sunday after the onset of her next period. What will the nurse tell the patient? - ANS-"Use another form of contraception for the next month." A nurse is teaching a male adult patient about the use of testosterone gel. Which statement by the patient indicates an understanding of the teaching? - ANS-"I should not let my child touch the gel to prevent behavioral problems." A 12-year-old male patient diagnosed with hypogonadism will begin testosterone injections. What will the nurse include when teaching the family about this therapy? - ANS-Injections are given every 2 to 4 weeks for 3 to 4 years. An adolescent male patient is beginning androgen therapy for delayed puberty. His parents ask the nurse when this treatment may be stopped. The nurse will offer which response? - ANS-When testicular enlargement occurs A 14-year-old male patient has not begun puberty. His parents tell the nurse that their son does not want to go to school, because he gets teased. The nurse learns that the boy's father did not begin puberty until age 16 years. Laboratory tests on this child do not reveal true hypogonadism. What will the nurse tell these parents when they ask what can be done for their son? - ANS-"A limited course of androgen therapy may be prescribed, but it is not necessary." A nurse is providing education to a patient who is beginning therapy with AndroGel testosterone gel. Which statement made by the patient demonstrates a need for further teaching? - ANS-"I should apply the medication to my genitals for best results." A clinic nurse is assessing an adolescent male patient who has been receiving androgen therapy for hypogonadism via a transdermal patch. The patient's last clinic visit was 4 weeks earlier. Which part of the interval history is of most concern to the nurse? - ANS-Five-pound weight gain A nurse provides teaching for a female patient with anemia who has had cancer chemotherapy and who will begin treatment with testosterone. Which statement by the patient indicates understanding of the teaching? - ANS-"Testosterone treats anemia by stimulating the synthesis of a renal hormone." A nurse is obtaining a history and reviewing the chart of an adult male patient who has been taking oral androgens. Which assessment would warrant notifying the provider? - ANS-Nausea, anorexia, and fatigue An adult male patient will begin androgen therapy for testicular failure. Which statement by the patient indicates understanding of the treatment regimen? - ANS-"My libido may improve while I am taking this medication." A 14-year-old male patient who plays football is admitted to the hospital. The nurse notes that the patient has short stature for his age according to a standard growth chart. The patient is muscular, has a deep voice, and needs to shave. The nurse notifies the provider of these findings. Which test will the nurse expect the provider to order? - ANS- Liver function tests and serum cholesterol A patient receiving transurethral alprostadil asks about intracavernous administration. Which information would be included in the explanation? - ANS-Transurethral administration has fewer side effects. A patient with erectile dysfunction is prescribed sildenafil (Viagra) 50 mg PRN. Which assessment finding would be most concerning? - ANS-Snoring now wakens the patient's wife A patient with erectile dysfunction is prescribed tadalafil (Cialis) 2.5 mg daily. Which medication history finding would indicate the need to discontinue this prescription? - ANS-Nitro-tab 0.4 mg sublingual PRN A patient prescribed dutasteride 2 weeks ago presents with continued complaints of urinary hesitancy. Which action is most appropriate? - ANS-Document these findings. Which finding would indicate that terazosin has been effective for a patient with BPH? - ANS-Improved urinary hesitation A patient receiving doxazosin presents for a routine evaluation. Which assessment finding would be most concerning? - ANS-Blood pressure 96/58 After educating a patient about administration of papaverine plus phentolamine for erectile dysfunction, which statement made by the patient indicates a need for further teaching? - ANS-"I will take the pill 30 minutes before sex." A patient has a viral sinus infection, and the provider tells the patient that antibiotics will not be prescribed. The patient wants to take an antibiotic and asks the nurse what possible harm could occur by taking an antibiotic. Which response by the nurse is correct? - ANS-"Even normal flora can develop resistance and transfer this to pathogens." An older adult patient with chronic obstructive pulmonary disease (COPD) develops bronchitis. The patient has a temperature of 39.5° C. The nurse will expect the provider to: - ANS-order empiric antibiotics while waiting for sputum culture results. The nurse is caring for a patient on a medical-surgical unit who has a fever of unknown origin. The prescriber has ordered a broad-spectrum antibiotic. Which intervention is the priority? - ANS-Obtaining all cultures before the antibiotic is administered The nurse has been caring for a patient who has been taking antibiotics for 3 weeks. Upon assessing the patient, the nurse notices the individual has developed oral thrush. What describes the etiology of the thrush? - ANS-Superinfection A child has received amoxicillin [Amoxil] for three previous ear infections, but a current otitis media episode is not responding to treatment. The nurse caring for this child suspects that resistance to the bacterial agent has occurred by which microbial mechanism? - ANS-Drug inactivation A recent campaign, initiated by the Centers for Disease Control (CDC), to delay the emergence of antibiotic resistance in hospitals, has what as one of its objectives? - ANS-Increased adherence to prescribed antibiotics A nursing student asks a nurse to clarify the differences between the mechanisms of spontaneous mutation and conjugation in acquired resistance of microbes. What will the nurse say? - ANS-Spontaneous mutation leads to resistance to only one antimicrobial agent. A pregnant patient is treated with trimethoprim/sulfamethoxazole (TMP/SMZ) [Bactrim] for a urinary tract infection at 32 weeks' gestation. A week later, the woman delivers her infant prematurely. The nurse will expect to monitor the infant for: - ANS-kernicterus. A nurse is caring for a patient who takes an ACE inhibitor and an ARB medication who will begin taking TMP/SMZ to treat a urinary tract infection. Which serum electrolyte will the nurse expect to monitor closely? - ANS-Potassium A nurse is obtaining a drug history from a patient about to receive sulfadiazine. The nurse learns that the patient takes warfarin, glipizide, and a thiazide diuretic. Based on this assessment, the nurse will expect the provider to: - ANS-monitor the patient's coagulation levels. A patient with bronchitis is taking TMP/SMZ, 160/800 mg orally, twice daily. Before administering the third dose, the nurse notes that the patient has a widespread rash, a temperature of 103° F, and a heart rate of 100 beats/minute. The patient looks ill and reports not feeling well. What will the nurse do? - ANS-Withhold the dose and notify the provider of the symptoms. A patient with type 2 diabetes mellitus takes glipizide. The patient develops a urinary tract infection, and the prescriber orders TMP/SMZ. What will the nurse tell the patient? - ANS-The patient should check the blood glucose level more often while taking TMP/SMZ. A patient who is taking immunosuppressant medications develops a urinary tract infection. The causative organism is sensitive to sulfonamides and to another, more expensive antibiotic. The prescriber orders the more expensive antibiotic. The nursing student assigned to this patient asks the nurse why the more expensive antibiotic is being used. Which response by the nurse is correct? - ANS-"Sulfonamides are bacteriostatic and depend on host immunity to work." A nurse is discussing microbial resistance among sulfonamides and trimethoprim with a nursing student. Which statement by the student indicates a need for further teaching? - ANS-"Resistance to sulfonamides is less common than resistance totrimethoprim" A patient with a urinary tract infection is given a prescription for TMP/SMZ. When reviewing the drug with the patient, the nurse learns that the patient has type 1 diabetes mellitus and consumes alcohol heavily. What will the nurse do? - ANS-Contact the provider to request a different antibiotic for this patient. A patient with a history of renal calculi has fever, flank pain, and bacteriuria. The nurse caring for this patient understands that it is important for the provider to: - ANS-begin antibiotic therapy after urine culture and sensitivity results are available. A 30-year-old male patient reports having two to four urinary tract infections a year. What will the nurse expect to teach this patient? - ANS-"You will need to take a low dose of medication for 6 months to prevent infections." A patient has a positive urine culture 1 week after completion of a 3-day course of antibiotics. The nurse anticipates that the prescriber will: - ANS-begin a 2-week course of antibiotics. A young, nonpregnant female patient with a history of a previous urinary tract infection is experiencing dysuria, urinary urgency and frequency, and suprapubic pain of 3 days' duration. She is afebrile. A urine culture is positive for more than 100,000/mL of urine. The nurse caring for this patient knows that which treatment is most effective? - ANS-A 3-day course of trimethoprim/sulfamethoxazole [Bactrim] A patient who is taking nitrofurantoin calls the nurse to report several side effects. Which side effect of this drug causes the most concern and would require discontinuation of the medication? - ANS-Tingling of the fingers Before giving methenamine [Hiprex] to a patient, it is important for the nurse to review the patient's history for evidence of which problem? - ANS-Elevated blood urea nitrogen and creatinine A pregnant female patient with bacteriuria, suprapubic pain, urinary urgency and frequency, and a low-grade fever is allergic to sulfa, ciprofloxacin, and amoxicillin. The nurse knows that the best alternative for treating this urinary tract infection is with: - ANS-methenamine [Hiprex]. The parent of a 5-year-old child who has had four urinary tract infections in the past year asks the nurse why the provider doesn't just order an antibiotic for the child's current symptoms of low-grade fever, flank pain, and dysuria since these are similar symptoms as before. Which is the most important reason given by the nurse? - ANS-"Your child may need tests to assess for urinary tract abnormalities." Which patient with a urinary tract infection will require hospitalization and intravenous antibiotics? - ANS-An older adult man with a low-grade fever, flank pain, and an indwelling catheter A 20-year-old female patient has suprapubic discomfort, pyuria, dysuria, and bacteriuria greater than 100,000/mL of urine. Which are the most likely diagnosis and treatment? - ANS-Uncomplicated lower urinary tract infection treatable with short-course therapy An older male patient comes to the clinic with complaints of chills, malaise, myalgia, localized pain, dysuria, nocturia, and urinary retention. The nurse would most likely suspect that the patient has: - ANS-prostatitis. A patient presents to the emergency department with complaints of chills, severe flank pain, dysuria, and urinary frequency. The patient has a temperature of 102.9° F, a pulse of 92 beats/minute, respirations of 24 breaths/minute, and a blood pressure of 119/58 mm Hg. The nurse would be correct to suspect that the patient shows signs and symptoms of: - ANS-pyelonephritis. A pregnant patient with fever, flank pain, and chills has a history of two previous bladder infections before getting pregnant. She is allergic to several antibiotics. She reports having taken methenamine successfully in the past. What will the nurse tell her? - ANS-"This agent is not effective against infections of the upper urinary tract." A nurse is preparing to administer an antibiotic to a patient with methicillin-resistant Staphylococcus aureus (MRSA). The nurse would expect the health care provider to order which antibiotic? - ANS-Daptomycin [Cubicin] A patient who is taking calcium supplements receives a prescription for ciprofloxacin [Cipro] for a urinary tract infection. The nurse will teach this patient to: - ANS-take the calcium either 6 hours before or 2 hours after taking the ciprofloxacin A nurse is preparing to administer oral ofloxacin to a patient. While taking the patient's medication history, the nurse learns that the patient takes warfarin and theophylline. The correct action by the nurse is to request an order to: - ANS-monitor coagulation levels A 65-year-old patient who receives glucocorticoids for arthritis is admitted to the hospital for treatment of a urinary tract infection. The prescriber has ordered intravenous ciprofloxacin [Cipro]. Before administering the third dose of this drug, the nurse reviews the bacterial culture report and notes that the causative organism is Escherichia coli. The bacterial sensitivity report is pending. The patient complains of right ankle pain. What will the nurse do? - ANS-Withhold the dose of ciprofloxacin and notify the provider of the patient'ssymptoms. A provider orders intravenous moxifloxacin [Avelox] for a patient who has sinusitis. Before administering the drug, the nurse will review this patient's chart for: - ANS-recent serum electrolyte levels. A patient will receive oral ciprofloxacin [Cipro] to treat a urinary tract infection. The nurse provides teaching for this patient. Which statement by the patient indicates a need for further teaching? - ANS-"I should take this medication with food or milk to improve absorption." A patient who is receiving intravenous ciprofloxacin for pneumonia develops diarrhea. A stool culture is positive for Clostridium difficile. The nurse will expect the provider to: - ANS-add metronidazole [Flagyl]. A nursing student asks a nurse to explain the differences between amphotericin B [Abelcet] and the azoles group of antifungal agents. Which statement by the nurse is correct? - ANS-"Azoles have lower toxicity than amphotericin B." A patient with HIV and mucocutaneous HSV is being treated with foscarnet after failing treatment with acyclovir. After 2 weeks, the patient's dose is increased to 90 mg/kg over 2 hours from 40 mg/kg over 1 hour. The patient reports numbness in the extremities and perioral tingling. What will the nurse do? - ANS-Notify the provider and request an order for a serum calcium level A nurse is teaching a group of nursing students about influenza prevention. Which statement by a student indicates understanding of the teaching? - ANS-"I should receive the vaccine every year in October or November." A patient has a positive test for hepatitis C and is admitted to the hospital. The admission laboratory tests reveal a normal ALT, and a liver biopsy is negative for hepatic fibrosis and inflammation. The nurse will prepare this patient for: - ANS-no medication therapy at this time. A patient with HIV contracts herpes simplex virus (HSV), and the prescriber orders acyclovir [Zovirax] 400 mg PO twice daily for 10 days. After 7 days of therapy, the patient reports having an increased number of lesions. The nurse will expect the provider to: - ANS-give intravenous foscarnet every 8 hours for 2 to 3weeks. A nursing student asks a nurse why pegylated interferon alpha is used instead of regular interferon for a patient with hepatitis C. The nurse will tell the student that pegylated interferon: - ANS-is administered less frequently than interferon. A patient has a positive test for influenza type A and tells the nurse that symptoms began 5 days before being tested. The prescriber has ordered oseltamivir [Tamiflu]. The nurse will tell the patient that oseltamivir: - ANS-may not be effective because of the delay in starting treatment A patient who is pregnant has a history of recurrent genital herpesvirus (HSV). The patient asks the nurse what will be done to suppress an outbreak when she is near term. The nurse will tell the patient that: - ANS-oral acyclovir [Zovirax] may be used during pregnancy. A nurse provides teaching for a patient with cytomegalovirus (CMV) retinitis who will receive the ganciclovir ocular implant [Vitrasert]. Which statement by the patient indicates a need for further teaching? - ANS-"The implant will remain in place permanently." A patient has lamivudine-resistant hepatitis B and has been taking entecavir [Baraclude] for 2 years. The patient asks the nurse why the provider has recommended taking the drug for another year. What will the nurse tell the patient? - ANS-"Entecavir can reverse fibrosis and cirrhosis of the liver when taken long term." The nurse is caring for a patient receiving intravenous acyclovir [Zovirax]. To prevent nephrotoxicity associated with intravenous acyclovir, the nurse will: - ANS-hydrate the patient during the infusion and for 2 hours after the infusion. A patient comes to the clinic and receives valacyclovir [Valtrex] for a herpes-zoster virus. The nurse instructs the patient to take the medication: - ANS-without regard to meals. An immunocompromised child is exposed to chickenpox and the provider orders valacyclovir [Valtrex] to be given orallythree times daily. The nurse will contact the provider to change this order for which reason? - ANS-The drug may cause serious adverse effects in immunocompromised patients. A male patient with hepatitis C will begin triple drug therapy with pegylated interferon alpha 2a [Pegasys], ribavirin [Ribasphere], and boceprevir [Victrelis]. The patient tells the nurse that his wife is pregnant. What will the nurse tell him? - ANS-Boceprevir is contraindicated in males whose partners are pregnant. A female patient who has hepatitis C is being treated with pegylated interferon alpha and ribavirin [Ribasphere]. It will be important for the nurse to teach this patient that: - ANS-she will need a monthly pregnancy test during her treatment. A patient with hepatitis B begins treatment with adefovir [Hepsera] and asks the nurse how long the drug therapy will last. The nurse will tell the patient that the medication will need to be taken for: - ANS-an indefinite, prolonged period of time. A female patient has come to the STD clinic and has been diagnosed with a Trichomonas vaginalis infection. What education should be provided to this patient? - ANS-Male partners should always be treated, even if they are asymptomatic An adolescent patient comes to the clinic complaining of a burning sensation upon urination and a pus-like discharge fromthe penis. The nurse is correct to suspect that the patient has which disorder? - ANS-Gonorrhea A newborn infant has been given erythromycin ophthalmic ointment as a routine postpartum medication. The infant's mother learns that she has a C. trachomatis infection and asks the nurse if her baby will need to be treated. Which response by the nurse is correct? - ANS-"Your baby will need to be treated with oral erythromycin." A patient complains of painful urination. A physical examination reveals vesicles on her labia, vagina, and the foreskin of her clitoris. The nurse will expect to teach this patient about which medication? - ANS-Acyclovir [Zovirax] A nurse is teaching a group of adolescent students about sexually transmitted diseases. Which statement by a student indicates understanding of infections caused by C. trachomatis? - ANS-"Women with asymptomatic C. trachomatis infections can become sterile." A patient is admitted to the hospital with fever, headache, malaise, joint pain, and enlarged lymph nodes. Blood cultures are positive for Treponema pallidum. The nurse recognizes this as which type of syphilis? - ANS-Secondary A patient is diagnosed with pelvic inflammatory disease (PID). Which treatment regimen is most appropriate for reducing the risk of sterility in this patient? - ANS-Doxycycline [Vibramycin], 100 mg IV twice daily, and cefoxitin, 2 g IV every 6 hours in the hospital An adolescent patient with mild cervicitis is diagnosed with gonorrhea. The nurse will expect the provider to order which drug(s)? - ANS-Ceftriaxone [Rocephin], 250 mg IM once, and azithromycin [Zithromax], 1 g PO once A patient admitted to the hospital is using metronidazole [Flagyl] 0.75% gel. The nurse understands that this agent is used to treat which condition? - ANS-Gardnerella vaginalis During a routine screening, an asymptomatic, pregnant patient at 37 weeks' gestation learns that she has an infection caused by Chlamydia trachomatis. The nurse will expect the provider to order which drug? - ANS-Azithromycin