NR 293 PHARMACOLOGY FINAL EXAM TEST BANK | ALL QUESTIONS AND CORRECT ANSWERS | GRADED A+, Exams of Pharmacology

Download NR 293 PHARMACOLOGY FINAL EXAM TEST BANK | ALL QUESTIONS AND CORRECT ANSWERS | GRADED A+ and more Exams Pharmacology in PDF only on Docsity! NR 293 PHARMACOLOGY FINAL EXAM TEST BANK | ALL QUESTIONS AND CORRECT ANSWERS | ALREADY GRADED A+ | VERIFIED ANSWERS A nurse is caring for a client who is receiving a continuous IV infusion of erythromycin lactobionate to treat a Bordetella pertussis infection. Which of the following actions should the nurse perform to minimize the risk of thrombophlebitis? a. make sure the medication infuses slowly b. stop the infusion after the client has received half the dosage. c. make sure the solution is not dilute d. request a prescription for intermittent dosing ---------CORRECT ANSWER-----------------a. make sure the medication infuses slowly A nurse is reinforcing teaching with a client who has a urinary tract infection and new prescriptions for phenazopyridine and ciprofloxacin. Which of the following statements by the client indicates the need for further teaching? a. if phenazopyridine upsets my stomach, I can take it with meals. b. Phenazopyridine will relieve my discomfort, but ciprofloxacin will get ride of the infection. c. I need to drink 2 liters of fluid per day while I am taking ciprofloxacin. d. I should notify my provider immediately if my urine turns orange. --------- CORRECT ANSWER-----------------d. I should notify my provider immediately if my urine turns orange. a nurse in a provider's office is collecting data from a client who has been taking amoxicillin for 10 days and reports diarrhea and cramping. the nurse should recognize that these manifestations occur secondary to which of the following adverse effects? a. development of gastric ulcers b. development of milk intolerance c. allergic reactions to the medication d. alterations in gastrointestinal flora ---------CORRECT ANSWER------------- ----d. alterations in gastrointestinal flora A nurse is collecting data from a client who has tuberculosis and a prescription for ethambutol. The nurse should inform the client he is likely to develop which of the following alterations as an adverse effect of this medication? a. mottling of the extremities. b. orange-red urine and bodily secretions. c. yellowing of the sclera d. loss of red/green color discrimination ---------CORRECT ANSWER--------- --------d. loss of red/green color discrimination A nurse is caring for a client taking streptomycin. Which of the following medications should the nurse identify as increasing the risk of developing ototoxicity when taken with streptomycin? a. cefoxitin b. furosemide c. naproxen d. amphotericin b ---------CORRECT ANSWER-----------------b. furosemide A nurse is preparing to administer an otic medication to an adult client. Which of the following actions should the nurse take? a. place the client leaning forward in a chair. b. hold the medication dropper 1 in from the client's ear canal. c. pull the pinna of the client's ear upward and outward. d. have the client remain still for 30 seconds after the medication is administered. ---------CORRECT ANSWER-----------------c. pull the pinna of the client's ear upward and outward. nurse should expect the provider to prescribe which of the following medications? a. vancomycin b. metronidazole c. clindamycin d. ciprofloxacin ---------CORRECT ANSWER-----------------b. metronidazole A nurse is planning care for a client who is receiving gentamicin IM and has a new prescription to obtain gentamicin peak and trough levels. At which of the following times should the nurse plan to obtain a blood sample to evaluate the gentamicin peak? a. 1 hour after administering the IM injection b. Just before administering the IM injection c. 12 hours after the last IM injection d. 30 minutes after administering the IM injection ---------CORRECT ANSWER-----------------a. 1 hour after administering the IM injection A nurse is administering a medication to a client. The nurse should identify that which of the following medication distribution factors facilitates the effective passage of the medication across the client's cell membranes? a. protein-binding ability b. lipid solubility c. hepatic metabolism d. slow dissolution ---------CORRECT ANSWER-----------------b. lipid solubility A nurse is administering an enteric-coated tablet to a client and explaining the pharmaceutical preparation. Which is correct? a. the coated tablet dissolves better in your stomach and intestines. b. you are less likely to have an upset stomach with this pill because of the coating on the tablet. c. the coating on the tablet improves the absorption of the medication d. the coating on the tablet allows a gradual release of the medication ------- --CORRECT ANSWER-----------------b. you are less likely to have an upset stomach with this pill because of the coating on the tablet. A nurse is collecting data from a client who has a C-diff infection and is receiving vancomycin via intermittent IV bolus over 60 minutes. The nurse should document the absence of which of the following conditions as a positive response to this slowed administration rate? a. red man syndrome b. thrombophlebitis c. renal failure d. ototoxicity ---------CORRECT ANSWER-----------------a. red man syndrome A nurse is caring for a client who has TB and is taking rifampin. Which of the following client statements should indicate to the nurse that the client is experiencing an adverse effect of the medication? a. I have noticed my urine is orange in color. b. I sleep more than I used to. c. My tongue and mouth are sore. d. My voice seems hoarse. ---------CORRECT ANSWER-----------------a. I have noticed my urine is orange in color. Which type of laxative can cause malabsorption of fat-soluble vitamins (A, D, E, and K)? a. Stimulants b. Bulk laxatives c. Lubricants d. Osmotic laxatives e. Stool softeners ---------CORRECT ANSWER-----------------Lubricants- mineral oils Which type of laxative contains polysaccharides and cellulose derivatives that combine with intestinal fluids to form gels that increase peristalsis? a. Stimulants b. Bulk laxatives c. Lubricants d. Osmotic laxatives e. Stool softeners ---------CORRECT ANSWER-----------------Bulk laxatives Bulk laxatives are preferred and safest What organism is responsible for thrush? ---------CORRECT ANSWER------- ----------Candida albicans Sodium metabisulfite, sodium bisulfite, and acetone sodium bisulfite are what type of additional ingredients in LA? a. Sodium hydroxide b. Sodium chloride c. Antioxidants d. Propylparabens ---------CORRECT ANSWER-----------------Antioxidants Reduces oxidation of epi to prolong shelf life methohexital (Brevital), thiopental (Pentothal), and thiamylal (Surital) are classified as what type of general anesthetics? a. Benzodiazepines b. Opioids c. Ultra-short-acting barbiturates d. Halogenated ethers ---------CORRECT ANSWER-----------------Ultra-short- acting barbiturates Anxioselective (because of its anxiolytic action without hypnotic, anticonvulsant, or muscle relaxant properties; less CNS depression) Zolpidem (Ambien), Zaleplon (Sonata), and Eszopiclone (Lunesta) are: a. Non-benzodiazepine, benzodiazepine receptor agonists b. Non-benzodiazepine, non-barbiturate sedative hypnotic --------- CORRECT ANSWER-----------------a. Non-benzodiazepine, benzodiazepine receptor agonists Not benzodiazepines Agonist effects on GABA receptor Indicated for management of insomnia What is the most common indication for the non-benzodiazepine, benzodiazepine receptor agonists? ---------CORRECT ANSWER--------------- --Insomnia Compare and contrast how the short- and long-acting barbiturates are metabolized and excreted ---------CORRECT ANSWER----------------- Short/intermediate-acting agents: metabolized by liver Long-acting agents: excreted by kidneys A nurse is caring for a client who has multiple medication allergies. During which of the following steps of the nursing process should the nurse identify the client's allergies? A. Planning B. Evaluation C. Data Collection D. Implementation ---------CORRECT ANSWER-----------------C. Data Collection A nurse is caring for a client and realizes after administering the 0900 medications that she gave digoxin 0.25 mg PO to the client instead of the prescribed dose of digoxin 0.125 mg PO. Which of the following actions should the nurse take first? A. notify the provider B. contact the nursing supervisor C. check the client's apical pulse D. complete an incident report ---------CORRECT ANSWER-----------------C. check the client's apical pulse A nurse is preparing to administer medication to a client. Which of the following abbreviations indicates the greatest frequency of medication administration? A. BID B. TID C. QID D. Q8h ---------CORRECT ANSWER-----------------C. QID A nurse is reviewing the medication administration record of a client who has impaired swallowing. The nurse should crush the medication when administering which of the following prescriptions? A. Aspirin EC 80 mg PO daily B. Levothyroxine 75 mcg PO q AM before breakfast C. Metformin XR 500 mg PO daily D. Nitroglycerin 0.3 mg SL PRN chest pain, can repeat q 5 min for 2 additional doses. ---------CORRECT ANSWER-----------------B. Levothyroxine 75 mcg PO q AM before breakfast EC = enteric coated, XR = extended release, SL = sublingually A nurse is caring for a client who is receiving cefotetan 1 g via intermittent IV bolus every 12 hours to treat a postoperative infection. Which of the following manifestations should the nurse monitor for as an adverse effect of the medication? A. disorientation B. epistaxis C. constipation D. jaundice ---------CORRECT ANSWER-----------------B. Epistaxis Cefotetan is an antibiotic that affects vitamin K levels, which can result in bleeding and epistaxis. It is a second generation cephalosporin. A nurse is assisting with the care of a client who is postoperative. The client reports a pain level of 8 on a scale of 0 to 10 and has a prescription for meperidine. Which of the following routes of administration will deliver the medication with the shortest time of onset? A. oral B. Intravenous C. intramuscular d. subcutaneous ---------CORRECT ANSWER-----------------B. Intravenous nurse is monitoring a client with pneumonia who has received penicillin G intramuscularly. Which of the following findings should the nurse plan to evaluate first? A. pain at the injection site B. prolonged motor dysfunction C. laryngeal edema D. temperature of 99.7 F ---------CORRECT ANSWER-----------------C. laryngeal edema this can indicate an allergic reaction, possibly anaphylaxis A nurse is reviewing the laboratory results of a client who is taking a medication and notes that the client's blood tests show an elevated level of the enzymes aspartate aminotransferase (AST) and alanine aminotransferase (ALT). The nurse should recognize that these findings are potential indications of which of the following conditions? a. renal dysfunction A nurse is caring for a client who takes gentamicin IM and has a prescription to obtain a blood sample to measure a trough level. At which of the following times should the nurse draw the blood sample? A. within 15 minutes prior to the next medication dose B. 3 hours prior to administering a dose. C. Within 15 minutes following the next medication dose D. 2 hours after administering a dose. ---------CORRECT ANSWER----------- ------A. within 15 minutes prior to the next medication dose A nurse is reinforcing teaching with a client who has a new prescription for sertraline. The client asks the nurse if he should containue to take St. John's wort for depression. Which of the following instructions should the nurse give the client? A. take the medication and herbal supplement together. B. stop taking the herbal supplement while taking the medication. C. take the herbal supplement and the medication at least 2 hours apart. D. take an antacid with both the herbal supplement and the medication. ---- -----CORRECT ANSWER-----------------B. stop taking the herbal supplement while taking the medication. Taking the antidepressant sertraline and St. John's wort together puts the client at risk for serotonin syndrome. A nurse is preparing to administer meperidine 100 mg IM to a client who has a BMI of 23. Which of the following needle lengths should the nurse use to administer the medication? A. 1/2 inch B. 1 1/2 inch C. 2 1/2 inch D. 3 inch ---------CORRECT ANSWER-----------------B. 1 1/2 inch A nurse in a long-term care facility is administering medications to a group of older clients. Which of the following factors of pharmacokinetics should the nurse consider when caring for this age group? A. the excretion of the medication is reduced B. the percentage of medication absorbed is increased C. the liver metabolizes the medication more quickly. D. the rate at which the liver metabolizes medication declines with age. ----- ----CORRECT ANSWER-----------------A. the excretion of the medication is reduced A nurse in a provider's office is assessing a client who has been taking amoxicillin for 10 days and reports diarrhea and cramping. The nurse should recognize that these manifestations occur secondary to which of the following adverse effects? A. development of gastric ulcers B. development of milk intolerance C. allergic reactions to the medication D. alterations in the gastrointestinal flora ---------CORRECT ANSWER-------- ---------D. alterations in the gastrointestinal flora A nurse is preparing to administer desmopressin 0.1 mcg/kg in 0.9% sodium chloride 50 mL IV over 30 min to a client who weights 154 lb. How many mcg of medication should the client receive? ---------CORRECT ANSWER-----------------21 A nurse is preparing to administer 150 units/hr of regular insulin to a client. Regular insulin is available at 1,500 units in 0.9% sodium chloride 500 mL. The nurse should set the IV pump to deliver how many mL/hr? --------- CORRECT ANSWER-----------------50 A nurse is preparing to administer medication to a preschooler. The nurse should use which of the following measurements to calculate the medication dosage for this client? A. body mass index B. height c. weight d. rule of 9s ---------CORRECT ANSWER-----------------c. weight A nurse is caring for a client who takes Ginkgo biloba daily at home. Which of the following effects should the nurse expect from the use of this herbal supplement? A. decreased platelet aggregation b. prevention of migraine headaches c. increase risk of DVT d. lowered cholesterol and triglyceride levels ---------CORRECT ANSWER-- ---------------A. decreased platelet aggregation A nurse administered an antibiotic 10 min ago to a client who is now reporting wheezing and swelling of the eyelids. Which of the following actions should the nurse perform first? A. give oral corticosteroids B. administer dopamine c. give diphenhydramine IV d. administer epinephrine subcutaneously ---------CORRECT ANSWER------ -----------d. administer epinephrine subcutaneously A nurse is providing teaching to a client with tuberculosis who has prescriptions for rifampin and ethambutol. Which of the following findings is an adverse effect of these medications that the client should report to the provider? A. red-orange discoloration of urine B. unexpected weight gain C. ringing in the ears C. check your hands and feet for sensory dysfunction D. this medication can increase the risk of ototoxicity. ---------CORRECT ANSWER-----------------A. seizures can occur with this medication. A nurse is teaching a client about a new prescription for extended-release oxycodone for pain management. Which of the following statements should the nurse include in the teaching? A. swallow this medication whole B. take this medication before meals and at bedtime C. constipation decreases with continued use. D. avoid taking other supplemental analgesics with this medication. --------- CORRECT ANSWER-----------------A. swallow this medication whole A nurse is caring for a client who has osteoporosis and has been taking a vitamin D supplement. The nurse notes that the client reports also taking a multivitamin daily. Which of the following findings should indicate to the nurse that the client might be experiencing vitamin D toxicity? A. hyperkalemia B. hypermagnesemia C. hypercalcemia D. hypernatremia ---------CORRECT ANSWER-----------------C. hypercalcemia A nurse is educating a client with urethritis who has a new prescription for oral erythromycin. Which of the following statements should the nurse include in the teaching? A. report persistent diarrhea to the provider B. take this medication with a full glass of milk C. some people who take erythromycin experience vision loss D. Antacids will reduce the extent of absorption of this medication. --------- CORRECT ANSWER-----------------A. report persistent diarrhea to the provider can cause superinfection of the bowel because it destroys some sensitive flora in the GI system A nurse is reviewing the laboratory results of a client who is taking tobramycin and notes that the medication's peak level is 7 mcg/mL. Which of the following actions should the nurse take? A. administer half of the prescribed dosage at the client's next scheduled dose. B. tell the client that the medication seems to be effective. C. advise the client to drink more water throughout the day. D. Continue to administer the medication as prescribed. ---------CORRECT ANSWER-----------------D. Continue to administer the medication as prescribed. This peak level is within the expected reference range of 5 to 10 mcg/mL. A nurse is reviewing the laboratory report for a client who is taking tobramycin and notes that the peak blood level is 9.3 mcg/mL. Which of the following actions should the nurse take? A. administer half of the prescribed dosage at the client's next scheduled dose. B. tell the client that the medication seems to be appropriate. C. advise the client to drink more water throughout the day. D. Ask if the client has been experiencing any peripheral neuropathy. ------- --CORRECT ANSWER-----------------B. tell the client that the medication seems to be appropriate. This peak level is within the expected reference range of 5 to 10 mcg/mL. A nurse is preparing to administer heparin 8,000 units subcutaneously every 8 hours. Heparin 10,000 units/1 mL is available. How many mL should the nurse administer per dose? ---------CORRECT ANSWER---------- -------0.8 mL A nurse is preparing to administer amoxicillin liquid suspension 250 mg PO every 8 hours to an older client. The amount available is amoxicillin 50 mg/mL. How many mL should the nurse administer per dose? --------- CORRECT ANSWER-----------------5 A nurse is caring for a client who has a positive tuberculin skin test and a new prescription for isoniazid. Which for of the following lab values should the nurse monitor? A. thyroid stimulating hormone b. aspartate aminotransferase (AST) c. potassium d. sodium ---------CORRECT ANSWER-----------------b. aspartate aminotransferase (AST) A nurse is preparing to administer dextrose 5% in water 1,000 mL infused over 12 hours. The drop factor of the manual IV tubing is 10 gtt/mL. The nurse should set the manual IV infusion to delivery how many gtt/min? ------ ---CORRECT ANSWER-----------------14 A nurse is preparing to administer lactated Ringer's 700 mL IV infused over 24 hours to a pediatric client. The drop factor of the manual IV tubing is 60 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min? ---------CORRECT ANSWER-----------------29 A nurse is reinforcing teaching about immunosuppressive medications to a client who had kidney transplant surgery. Which of the following adverse effects of these medications should the nurse include in the teaching? A. increased urinary output B. increased susceptibility to infection c. increased hair loss d. increased risk for autoimmune disorders ---------CORRECT ANSWER---- -------------B. increased susceptibility to infection A nurse is reinforcing teaching with a client who has tuberculosis and a prescription for isoniazid. Which of the following instructions should the nurse include? A. You'll need to take this medication for the rest of your life to prevent recurrence. B. Your provider will monitor your liver function while you are taking this medication. C. Limit your alcohol intake to 2 drinks per day. D. You should take this medication with a meal to increase absorption. ------ ---CORRECT ANSWER-----------------B. Your provider will monitor your liver function while you are taking this medication. A nurse is collecting data from a client who has heart failure and is receiving digoxin. Which of the following findings should indicate to the nurse the client is experiencing digoxin toxicity? A. Suppression of dysrhythmias B. Increase in AV conduction C. Visual disturbances D. weight gain ---------CORRECT ANSWER-----------------C. Visual disturbances Common signs of digoxin toxicity include nausea, vomiting, abdominal discomfort, fatigue, and visual disturbances A nurse is collecting data preoperatively from a client who is about to undergo an aneurysm clipping. The nurse should identify a risk for increased bleeding when the client reports taking which of the following dietary supplements? A. Soy B. Garlic C. Black cohosh D. Green tea ---------CORRECT ANSWER-----------------B. Garlic A nurse in a community health clinic is collecting data from a new client who has prescriptions for isoniazid and rifampin. Which of the following disorders should the nurse expect the client to have? A. tuberculosis B. hypertension C. diabetes D. cirrhosis ---------CORRECT ANSWER-----------------A. tuberculosis A nurse is preparing an in-service session for medical-surgical staff on infections and antibiotic use. Which of the following antibiotics should the nurse identify as having the highest rate of severe allergic reactions? A. trimethoprim B. erythromycin C. sulfonamides D. penicillins ---------CORRECT ANSWER-----------------D. penicillins A nurse is preparing to administer medications to a client who is NPO and is receiving enteral feedings through an NG tube. Which of the following prescriptions should the nurse clarify with the provider? A. Aspirin EC 325 mg per NG tube daily B. Atorvastatin 40 mg per NG tube daily C. Propranolol 20 mg per NG tube daily D. Sulcralfate 2 g oral suspension per NG tube BID ---------CORRECT ANSWER-----------------A. Aspirin EC 325 mg per NG tube daily A nurse is performing a reconciliation of a client's medications. Which of the following actions should the nurse take first? A. review the medications the client is taking at home and compare the list with the medications the client is taking in the facility. B. compare any new medication prescriptions with the client's current list of medications C. obtain a list of the client's current medications, including those that are over-the-counter. D. provide the current and accurate medication list to all of the client's health care providers. ---------CORRECT ANSWER-----------------C. obtain a list of the client's current medications, including those that are over-the- counter. A nurse is reviewing lab results fora client who has C-diff infection and is receiving vancomycin. Which of the following results should the nurse report to he provider before administering the next dose? A. hematocrit 46% B. serum glucose 110 mg/dL c. serum creatinine 2.5 mg/dL d. serum potassium 4.8 mEq/L ---------CORRECT ANSWER-----------------c. serum creatinine 2.5 mg/dL Vancomycin is nephrotoxic and can result in renal failure, which is indicated by elevated levels of creatinie above the expected reference range of 0.5 to 1.3 mg/dL. . A nurse is reinforcing teaching with a client who has tuberculosis and a prescription for rifampin. The nurse should identify which of the following findings as a harmless and expected adverse effect of rifampin? A. red-orange discoloration of urine B. increased ecchymosis C. yellow appearance of the sclerae D. lack of energy ---------CORRECT ANSWER-----------------A. red-orange discoloration of urine A nurse is checking a client who is receiving an IV infusion of telavancin for streptococcus pyogenes. Which of the following actions should the nurse perform? A. check to see if the client's urine is blue. B. check the client for pruritis C. check for hypertension D. check for numbness in the limbs ---------CORRECT ANSWER-------------- ---B. check the client for pruritis Rashes, flushing, tachycardia, and hypotension If occurs, slow administration of medication associated w/ vancomycin ---------CORRECT ANSWER-----------------Red man syndrome Treats anthrax Black box warning for tendon rupture Older adults risk for renal failure, increased risk of tendonitis/rupture with concurrent glucocorticoid therapy -- -------CORRECT ANSWER-----------------Quinolones/Ciprofloxacin Risk of tooth discoloration Not recommended for under 8 years old used for topical application of acne associated with calcium loss ---------CORRECT ANSWER----------------- Tetracycline treatment before specific culture info has been obtained. ---------CORRECT ANSWER-----------------Empiric therapy antibiotic therapy tailored to treat organism identified with cultures --------- CORRECT ANSWER-----------------Definitive therapy treatment with antibiotics to prevent an infection, as in intraabdominal surgery or after trauma ---------CORRECT ANSWER----------------- Prophylactic therapy C-diff or yeast infections result of taking antibiotic ---------CORRECT ANSWER----------------- Superinfection anti-fungal. HIGHLY TOXIC - infusin rxns (fever and chills) - nephrotoxicity - hypokalemia - hepatoxicity - gynecomasita - C/I with aminoglycosides (just like PCN) Expected reactions: often pre-medicated serious interaction w/ alcohol i.e. fluconozale, nystatin ---------CORRECT ANSWER----------------- Amphotericin B hard on bone marrow susceptible to opportunistic infections may cause aplastic anemia ---------CORRECT ANSWER----------------- Zidovudine/Retrovir used in treatment of TB Body secretions become orange/brown ---------CORRECT ANSWER--------- --------Rifampin Stop the flow of medication but leave the catheter in. When chemo drug leaks outside of vessel into surrounding tissue. --------- CORRECT ANSWER-----------------Extravasation Easily diagnose and monitor Wide therapeutic index Lower chance of toxicity ---------CORRECT ANSWER-----------------OTC Medication Criteria -Fever and/or chills with temp >100.5F -New sores or white patches in the mouth or throat -Swollen tongue/bleeding gums -Dry, burning, "scratchy", or swollen throat -Changes in bladder function or patterns -New and persistent cough -Blood in the urine -Nausea, vomiting, constipation, diarrhea >2-3 days -Blood in the stool ---------CORRECT ANSWER-----------------Oncologic Emergency -fever of 100.5+ -chills or sweating -sore throat -abdominal pain -pain near anus -pain/burning w/ urination -diarrhea/anal sores -cough -SOB -redness and swelling or pain around wound -unusual vaginal discharge or itching ---------CORRECT ANSWER------------ -----Neutropenia w/ Oncology patient drugs used to treat cancer by breaking DNA strands in the cancerous cell -- -------CORRECT ANSWER-----------------alkylating drugs The nurse is discussing with the patient management of symptoms of an upper respiratory tract infection. What classes of medications are often used in treating the symptoms of upper respiratory tract infections? --------- CORRECT ANSWER-----------------Antihistamines Expectorant Nasal decongestants Antitussive The nurse is discussing use of antihistamines for allergic rhinitis. What medications would be included in the list of H1 antagonists used in the treatment of allergic rhinitis? ---------CORRECT ANSWER----------------- Cetirizine Fexofenadine Loratadine The nurse is providing discharge teaching to a patient receiving a beta- agonist bronchodilator. What side effect would the nurse emphasize the patient needs to report? ---------CORRECT ANSWER----------------- Tachycardia Which herbal product, when taken with theophylline, can decrease theophylline's serum drug levels? ---------CORRECT ANSWER----------------- St. John's wort Which statement by a patient best indicates an understanding of the teaching on flunisolide? ---------CORRECT ANSWER-----------------"I will rinse my mouth with water after each use." Which laboratory value would the nurse assess before administering zafirlukast to a patient? ---------CORRECT ANSWER-----------------Liver enzymes The nurse receives laboratory values for a patient with a theophylline level of 14 mcg/mL. How does the nurse interpret this theophylline level? --------- CORRECT ANSWER-----------------Therapeutic The nurse is providing care to a patient prescribed a nonselective adrenergic agonist bronchodilator. Which condition documented in the patient's medical history would alert the nurse to question this medication order? ---------CORRECT ANSWER-----------------Coronary Artery Disease A nurse is providing education to a patient taking two different bronchodilator medications. The nurse identifies which characteristic as the advantage of salmeterol over other beta2 agonists such as albuterol? ------- --CORRECT ANSWER-----------------Longer duration of action The nurse is teaching a patient about the use of leukotriene receptor antagonists (LTRAs) drugs such as zafirlukast. Which statement would be appropriate by the nurse? ---------CORRECT ANSWER-----------------"This medication works by preventing the inflammation that causes your asthma attack." What is the role of corticosteroids in the treatment of acute respiratory disorders? ---------CORRECT ANSWER-----------------They decrease inflammation Which statement by the nurse would be included when teaching a patient about the proper use of metered-dose inhalers? ---------CORRECT ANSWER-----------------"Wait 1 to 2 minutes before you take a second puff of the same drug." The nurse performs discharge teaching with a patient who is prescribed the anticholinergic inhaler ipratropium bromide. Which statement by the patient indicates to the nurse that teaching has been successful? --------- CORRECT ANSWER-----------------"This inhaler is not to be used alone to treat an acute asthma attack." Before administering an LTRA medication, the nurse would assess the patient for allergies to which substance? ---------CORRECT ANSWER-------- ---------Povidone Lactose Cellulose The nurse is assessing the patient's knowledge regarding drug therapy prescribed for the treatment of hypertension. Which statement by the patient indicates the need for further teaching by the nurse? --------- CORRECT ANSWER-----------------"When my blood pressure is over 140/90, I will take my medication." Which medication would the nurse question if prescribed together with ACE inhibitors? ---------CORRECT ANSWER-----------------Potassium chloride The nurse would question a prescription for a calcium channel blocker in a patient with which condition? ---------CORRECT ANSWER----------------- Hypotension Before administering isosorbide mononitrate sustained-release tablet to a patient, what is the priority nursing intervention? ---------CORRECT ANSWER-----------------Obtain a blood pressure reading. The nurse is teaching treatment of acute chest pain for a patient prescribed nitroglycerin sublingual tablets. Which instructions would the nurse include? ---------CORRECT ANSWER-----------------Sit or lie down before taking medication. A patient who is taking nitroglycerin sublingual tablets is complaining of flushing and headaches. What is the nurse's best response? --------- CORRECT ANSWER-----------------"These are the most common adverse effects of nitroglycerin. They should subside with continued use of nitroglycerin." When applying nitroglycerin ointment, the nurse would perform which action? ---------CORRECT ANSWER-----------------Apply the ointment to a nonhairy part of the upper torso. A patient receiving IV nitroglycerin at 20 mcg/min and now complains of dizziness. Nursing assessment reveals a blood pressure of 85/40 mm Hg, heart rate of 110 beats/min, and respiratory rate of 16 breaths/min. What is the priority nursing action? ---------CORRECT ANSWER----------------- Decrease the IV nitroglycerin by 10 mcg/min. It is most important for the nurse to instruct a patient prescribed nitroglycerin to avoid which substance? ---------CORRECT ANSWER--------- --------Erectile dysfunction drugs The nurse understands that a patient receiving nitroglycerin would be monitored for which common adverse effects associated with this medication? (Select all that apply.) ---------CORRECT ANSWER--------------- --Flushing Dizziness Headache Hypotension For a patient receiving IV nitroglycerin, what are the priority nursing interventions? ---------CORRECT ANSWER-----------------Monitor blood pressure Assess for worsening chest pain. Check heart rate The nurse is preparing to administer digoxin 0.25 mg intravenous push to a patient. Which is an expected patient outcome related to the administration of digoxin? ---------CORRECT ANSWER-----------------Decrease in the heart rate The patient's serum digoxin level is 0.4 ng/mL. How does the nurse interpret this laboratory value result for digoxin? ---------CORRECT ANSWER-----------------Below the therapeutic level A patient prescribed digoxin 0.25 mg and furosemide 40 mg for the treatment of systolic heart failure states, "I am starting to see yellow halos around lights." What is the appropriate nursing intervention? --------- CORRECT ANSWER-----------------Assess for other symptoms of digoxin toxicity. Which are therapeutic effects of digoxin? ---------CORRECT ANSWER------- ----------Positive inotropic, negative chronotropic, and negative dromotropic When teaching a patient regarding the administration of digoxin, the nurse instructs the patient not to take this medication with which food? --------- CORRECT ANSWER-----------------Wheat brain A patient weighing 44 lb is prescribed a digoxin loading dose of 0.03 mg/kg to be administered in three divided doses. How much will the nurse administer in each dose? ---------CORRECT ANSWER-----------------0.2 mg Phosphodiesterase inhibitors (PDIs) have an added advantage in treating heart failure. These drugs cause a positive inotropic effect and what other effect? ---------CORRECT ANSWER-----------------Vasodilation The nurse reviews an adult patient's laboratory values and notes a digoxin level of 11 ng/mL and a serum potassium level of 6.2 mEq/L. The nurse would notify the health care provider and anticipate which medication will be prescribed to administer? ---------CORRECT ANSWER----------------- Digoxin immune Fab The nurse would question the use of milrinone in a patient with which condition? ---------CORRECT ANSWER-----------------Aortic regurgitation The nurse is giving discharge instructions to a patient prescribed warfarin for atrial fibrillation. Which statement by the patient indicates a need for further instruction from the nurse? ---------CORRECT ANSWER---------------- -"I will increase the dark green leafy vegetables in my diet." A patient is prescribed oral anticoagulant therapy while still receiving IV heparin infusion. The patient is concerned about risk for bleeding. What is the nurse's best response? ---------CORRECT ANSWER-----------------It usually takes 4 to 5 days to achieve a full therapeutic effect for warfarin, so the heparin infusion is continued to help prevent blood clots until the warfarin reaches its therapeutic effect." The nurse determines the patient has a good understanding of the discharge instructions regarding warfarin with which patient statement? ----- ----CORRECT ANSWER-----------------"I should use a soft toothbrush for dental hygiene." The nurse would assess which laboratory value to determine the effectiveness of intravenous heparin? ---------CORRECT ANSWER----------- ------Activated partial thromboplastin time (aPTT) The nurse is caring for a patient admitted with gastrointestinal bleeding who is anticoagulated with warfarin. Which medication should the nurse anticipate administering? ---------CORRECT ANSWER-----------------Vitamin k The nurse notes a patient's international normalized ratio (INR) value of 2.5. What is the meaning of this reported value? ---------CORRECT ANSWER-----------------The patient's warfarin dose is within the therapeutic range. Which medication is an antiplatelet drug? ---------CORRECT ANSWER------ -----------Clopidogrel The nurse is preparing a patient with acute chest pain for an emergency angioplasty. The nurse would anticipate administering which medication to prevent platelet aggregation? ---------CORRECT ANSWER----------------- Tirofiban Enoxaparin sodium is an anticoagulant used to prevent and treat deep vein thrombosis and pulmonary embolism. This medication is in which drug class? ---------CORRECT ANSWER-----------------Low-molecular-weight heparin The patient asks the nurse, "What is the difference between dalteparin and heparin?" What is the nurse's best response? ---------CORRECT ANSWER- ----------------"Dalteparin is a low-molecular-weight heparin that has a more predictable anticoagulant effect." Before emergency surgery, the nurse would anticipate administering which medication to a patient receiving heparin? ---------CORRECT ANSWER------ -----------Protamine A patient who is prescribed an anticoagulant requests an aspirin (acetylsalicylic acid) for headache relief. What is the nurse's best action? --- ------CORRECT ANSWER-----------------Inform the patient of potential drug interactions with anticoagulants. While observing a patient self-administer enoxaparin, the nurse identifies the need for further teaching when the patient performs which self-injection action? ---------CORRECT ANSWER-----------------Massages the site after administration of the medication The nurse recognizes that the patient understands the teaching about warfarin when the patient verbalizes an increased risk of bleeding with concurrent use of which herbal product/products? ---------CORRECT ANSWER-----------------Dong quai Ginko Garlic St. John's wort For a patient receiving an IV infusion of alteplase which nursing actions should be taken? ---------CORRECT ANSWER-----------------Record vital signs and report changes. Assess for cardiac dysrhythmias. Observe for signs and symptoms of bleeding. To assess for a potentially serious adverse effect to HMG-CoA reductase inhibitors, the nurse should monitor which laboratory results? --------- CORRECT ANSWER-----------------Liver function studies The nurse is providing discharge teaching for a patient about potential serious adverse effects to simvastatin. Which symptom may indicate the The nurse is educating a patient on increasing dietary sources of folic acid. The nurse would teach the patient that what food source has the highest amount of folic acid? ---------CORRECT ANSWER-----------------dried beans The formation of erythrocytes and maturation of the red blood cell (RBC) is driven by what hormone? ---------CORRECT ANSWER----------------- Erythropoietin A pediatric patient is prescribed ferrous fumarate for iron-deficiency anemia. The dose prescribed is 3 mg/kg/day. The patient's weight is 7.5 kg. What amount will the nurse administer per day? __ ---------CORRECT ANSWER-----------------22.5 mg When administering ferrous sulfate to a patient, the nurse plans to give this medication with what fluid to increase absorption of the iron? --------- CORRECT ANSWER-----------------orange juice The nurse will plan to inject iron dextran by what technique? --------- CORRECT ANSWER-----------------Intramuscular (IM) injection using the Z- track method The nurse knows iron supplementation has what common adverse effect? - --------CORRECT ANSWER-----------------Constipation The nurse is caring for a patient who is prescribed epoetin alfa (Epogen). What does the nurse expect as the reason for use of this medication in this patient? ---------CORRECT ANSWER-----------------Treatment of anemia due to renal failure A patient states to the nurse, "I must take my iron supplement with a meal to avoid stomach upset." To increase uptake of oral iron, what food group would the nurse instruct the patient to avoid? ---------CORRECT ANSWER-- ---------------dairy The nurse would question the prescription for epoetin alfa in a patient with what condition? ---------CORRECT ANSWER-----------------Uncontrolled hypertension When developing a nursing care plan for a patient receiving epoetin alfa, the nurse will include monitoring for what adverse effect? ---------CORRECT ANSWER-----------------Change in level of consciousness What are known contraindications for use of erythropoiesis-stimulating agents (ESAs) in patients? ---------CORRECT ANSWER----------------- Cancer of the neck History of thrombosis Uncontrolled hypertension Hemoglobin level of 15 g/dL What groups of individuals are at highest risk for development of iron deficiency anemia? ---------CORRECT ANSWER-----------------Children Pregnant women Women ages 12 to 40 years The nurse is educating a client about prescribed antiepileptic medication. What response shows education is effective? ---------CORRECT ANSWER- ----------------I will most likely take this medication my entire life. A nurse is teaching a client who has a urinary tract infection (UTI) and is taking ciprofloxacin. Which of the following instructions should the nurse give to the client? ---------CORRECT ANSWER-----------------"You should report any tendon discomfort you experience while taking this medication." The nurse is educating clients with a new prescription for allopurinol. Which statements indicate understanding? ---------CORRECT ANSWER-------------- ---May take a few weeks to work, I will take this medication daily. Diagnosed with influenza A receives a new prescription for oseltamivir. The nurse should plan to instruct the client that this drug is most effective when taken within many hours of the onset of symptoms? ---------CORRECT ANSWER-----------------48 Hours A 32-year-old client presents to the ED with abdominal pain and no bowel movements for 3 days their abdomen is tender and slightly distended. Which should the nurse anticipate implementing? ---------CORRECT ANSWER-----------------No laxative should be given at this time. A client with renal disease has been diagnosed with gastritis and is requesting an antacid. Which antacid is appropriate for this client? --------- CORRECT ANSWER-----------------Aluminum salts A nurse is planning to administer digoxin to a client with heart failure. Which lab results should the nurse review prior to administering? --------- CORRECT ANSWER-----------------Potassium level decrease viral load A client prescribed warfarin therapy reports a headache to the nurse The nurse should anticipate the healthcare provider will commend which medication? ---------CORRECT ANSWER-----------------Acetaminophen A nurse is caring for a post-operative client who is receiving morphine every two hours. Which intervention should be included in the plan of care? ---------CORRECT ANSWER-----------------Encourage fiber and fluids. A nurse is educating a client who has a seizure disorder and will be taking phenytoin. The nurse should instruct the client that the healthcare provider will taper the dose when discontinuing the medication to prevent which disorder? ---------CORRECT ANSWER-----------------Severe nausea A nurse is providing discharge education for a client diagnosed with pneumonia. Discharge education for antibiotic therapy should include instructions to report 1)_____ to their healthcare provider and to 2)_____. Clients should call their healthcare provider if 3)_____. ---------CORRECT ANSWER-----------------1) diarrhea 2) complete full dose of antibiotic 3) client becomes nauseated A nurse is reviewing the laboratory results of a client who has liver failure with ascites and is receiving spironolactone. Which of the following findings should the nurse expect? ---------CORRECT ANSWER----------------- Decreased sodium level A nurse is instructing a client with bipolar disorder about lithium. Which statement should the nurse include in the instruction? ---------CORRECT ANSWER-----------------"Notify your healthcare provider if you are experiencing vomiting or diarrhea" A nurse is caring for a client who ordered simvastatin. The nurse suspects that the client may be experiencing _____. The nurse will administer simvastatin _____ and instruct the client to report any _____. --------- CORRECT ANSWER-----------------hypercholesterolemia at bedtime muscle weakness A nurse is caring for a client who is prescribed a loop diuretic. The nurse should monitor the client for which adverse effects)? Select all that apply. -- -------CORRECT ANSWER-----------------Hypotension Hypokalemia A nurse is reviewing the medical record of a client who is to receive the first dose of cefoxitin via intermittent intravenous (V) bolus. Which of the following findings should the nurse report to the primary health care provider (PCP) as a contraindication to cefoxitin? ---------CORRECT ANSWER-----------------Severe allergy to amoxicillin A nurse is caring for a client who will be starting ibuprofen for hip pain Which information should the nurse plan to provide? ---------CORRECT ANSWER-----------------Take medication with food A nurse is caring for a client who is receiving amphotericin B via intermittent intravenous bolus. The nurse understands the importance of monitoring for adverse effects including _____ and _____. --------- CORRECT ANSWER-----------------Cardiac dysrhytmias Pulmonary infiltrates A nurse is caring for a child with influenza. The nurse should identify which statement by the parent indicates that the child has an increased risk for Reyes syndrome. ---------CORRECT ANSWER-----------------I give my child aspirin to reduce fevers The nurse is providing discharge instructions to the client with a new prescription for phenytoin. What instruction should the nurse include in the discharge teaching? ---------CORRECT ANSWER-----------------Perform mouth care at least twice a day. A nurse is providing instruction to a client with a new diagnosis of asthma. What medication should the nurse instruct the client to use to treat an acute asthma attack? ---------CORRECT ANSWER-----------------Albuterol A client with respiratory syncytial virus (RSV is prescribed ribavirin aerosol treatment. When caring for this client, which precautions should a pregnant healthcare worker take? ---------CORRECT ANSWER-----------------Stay out of the room during aerosol treatment. A nurse is instructing the parents of a child with attention deficit hyperactivity disorder (ADHD) about methylphenidate. Which statements) should the nurse include in the instructions? Select all that apply. --------- CORRECT ANSWER-----------------Administer the medication in morning, Restrict child's intake of caffeine A nurse is caring for a client who presents with gout. The nurse recognizes that gout is caused by _____, and can be treated with _____ and _____. --- ------CORRECT ANSWER-----------------Hyperuricemia Colchicine Allopurinol A nurse is providing follow-up care to a client who is taking lisinopril Which manifestation should the nurse instruct the client to report as an adverse effect of lisinopril? ---------CORRECT ANSWER-----------------Persistent cough A client presents to their healthcare provider's office to check the drug level of their antiepileptic medication. Which drug is associated with autoinduction? ---------CORRECT ANSWER-----------------carbamazepine A nurse is caring for a client who is prescribed a selective serotonin reuptake inhibitor (SSRI). Which statement by the client should indicate to the nurse that the client is experiencing a common side effect? --------- CORRECT ANSWER-----------------I have zero interest in sex now Which assessment finding should indicate to the nurse that the therapeutic effect of mannitol has been achieved? ---------CORRECT ANSWER----------- ------Increased level of consciousness A nurse provides teaching to a client diagnosed with diabetes mellitus. The client receives 20 units of insulin isophane suspension (NPH) at 0700 if the client's blood glucose level is above 180 mg/dL. Which information should the nurse include in the teaching plan? ---------CORRECT ANSWER---------- -------Plan to eat a snack mid-afternoon. A nurse is caring for a client who has a gastrostomy tube and is reporting nausea. Which antiemetic category would be appropriate for this client? ---- -----CORRECT ANSWER-----------------Prokinetics A nurse is educating a client about their new prescription for zolpidem. The nurse should advise the client about which adverse effect. --------- CORRECT ANSWER-----------------Daytime sleepiness A nurse is caring for a client who is prescribed oral corticosteroids. The nurse should assess the client for potential adverse effects including _____ and _____. ---------CORRECT ANSWER-----------------hypertension and weight gain A client on antibiotic therapy for two weeks has developed persistent diarrhea. The nurse expects which medication to be ordered to treat this diarrhea? ---------CORRECT ANSWER-----------------Lactobacillus acidophilus A nurse provides teaching to a client diagnosed with Parkinson's disease who has been prescribed carbidopa-levodopa. Which information should the nurse include in the client teaching. ---------CORRECT ANSWER--------- --------Change position slowly to prevent orthostatic hypotension. A nurse has administered ondansteron to a client with nausea and vomiting. For which common side effect should the nurse monitor? --------- CORRECT ANSWER-----------------Headache A nurse provides care to a client diagnosed with pulmonary tuberculosis with a new order for rifampin. Which information should the nurse include in the teaching? ---------CORRECT ANSWER-----------------Red orange discoloration of body fluids is common A client taking levofloxacin to treat a respiratory tract infection calls the office to report indigestion. The nurse should plan to make which recommendation? ---------CORRECT ANSWER-----------------Take an antacid at least 2 hours after taking the drug. A client taking lithium as maintenance therapy for bipolar disorder presents with confusion, coarse tremors, and dehydration. The nurse notes the client's latest serum lithium level is 1.4 mEq/L. Which action will the nurse take? ---------CORRECT ANSWER-----------------Hold the dose and notify the provider. The nurse is caring for a client on the telemetry unit who is receiving azithromycin IV or pneumonia. Which assessment finding would indicate a potentially serious adverse effect of this medication? ---------CORRECT ANSWER-----------------Palpations and chest pain A client with neuropathic pain tells the nurse, "I received a new prescription today for a medication that is typically given to people with seizures." The nurse should recognize that the client is referring to which drug? --------- CORRECT ANSWER-----------------gabapentin (Neurontin) A nurse is admitting a client with an exacerbation of asthma. When reviewing the healthcare provider's orders, the nurse should recognize that A nurse is caring for a client prescribed isoniazid. The nurse educates the client that ______ should be taken to minimize isoniazid's adverse effect of ______. ---------CORRECT ANSWER-----------------Vitamin B6 (Pyridoxine) /Peripheral Neuropathy A nurse informs a client of a new order for deep vein thrombosis (DVT) Which medication has most likely been ordered by the healthcare provider (HCP)? ---------CORRECT ANSWER-----------------Subcutaneous enoxaparin I nurse is caring for a client who is prescribed diphenhydramine. The client reports experiencing dry mouth. Which instruction should the nurse give the client? ---------CORRECT ANSWER-----------------"Chew frequently on sugarless gum" A nurse is caring for a client with angina and a new prescription for sublingual nitroglycerin tablets. Which instruction should the nurse include when educating the client about the medication? ---------CORRECT ANSWER-----------------Burning or stinging indicates the medication is potent. Ribavirin PO ---------CORRECT ANSWER-----------------used for treatment of hepatitis C Fidaxomicin PO ---------CORRECT ANSWER-----------------used for the treatment of C. diff Cefazolin IV ---------CORRECT ANSWER-----------------used for the treatment of UTI Sulfamethoxazole + trimethoprim PO ---------CORRECT ANSWER------------ -----used for surgical prophylaxis Fluconazole PO ---------CORRECT ANSWER-----------------used for the treatment of vaginal candida infections During medication administration, the nurse provides education to the client about their new prescription for pantoprazole. What statement's/ should the nurse include? Select all that apply. ---------CORRECT ANSWER-------------- ---Taken before meals /Notify provider if develop diarrhea / this medication may help prevent gastric ulcer/ This medication belongs to the proton pump inhibitor class A client has been recently prescribed a diuretic. Which client statement would indicate further teaching is needed? ---------CORRECT ANSWER----- ------------"I will stop this medication if I am urinating too often." The nurse cares for a client who develops crystalluria secondary to antibiotic therapy. Which nursing intervention is indicated to assist with this condtion? ---------CORRECT ANSWER-----------------Reinforcing the need for an increase in fluid consumption. Morphine Sulfate antidote. ---------CORRECT ANSWER----------------- Nalaxone/Narcan Alprazolam antidote. ---------CORRECT ANSWER-----------------Flumazenil Heparin antidote. ---------CORRECT ANSWER-----------------Protamine Sulfate Acetaminophen antidote. ---------CORRECT ANSWER----------------- Acetylcysteine A nurse is caring for a client with heart failure and a potassium level of 24 mEg/L. The nurse should identify which medication as the cause of the clients low potassium level? ---------CORRECT ANSWER----------------- Furosemide The nurse is monitoring a client for adverse reactions to propylthiouracil (PTU). Which adverse reaction should the nurse monitor for in this client? -- -------CORRECT ANSWER-----------------bleeding A nurse is providing education to an adult client who has a new prescription for a tetracycline antibiotic. Which instruction should the nurse include in the Education? ---------CORRECT ANSWER-----------------wear sunscreen while outside A client arrives at the emergency department complaining of black stool after having diarrhea for two days and taking bismuth subsalicylate. Which response should the nurse provide to the client? ---------CORRECT ANSWER-----------------This is a side effect of the medication Antacids containing aluminum salts commonly causes ____ --------- CORRECT ANSWER-----------------Constipation Antacids containing calcium salts commonly causes _____ --------- CORRECT ANSWER-----------------Constipation + Kidney Stones What are the adverse effects of adsorbents [antidiarrheal drugs]? --------- CORRECT ANSWER-----------------increased bleeding time, constipation, dark stool, confusion, tinnitus, metallic taste, blue gums What are the adverse effects of anti-motility drugs? ---------CORRECT ANSWER-----------------urinary retention, impotence [ED], headache, dizziness, anxiety, drowsiness, bradycardia, hypotension, dry skin, flushing, and blurred vision What are the adverse effects of opiates? ---------CORRECT ANSWER------- ----------drowsiness, dizziness, lethargy, nausea, vomiting, constipation, hypotension, urinary retention, flushing, respiratory depression What are the two most common toxicities associated with amino glycoside administration? ---------CORRECT ANSWER-----------------nephrotoxicity [renal damage] ototoxicity [affect hearing + balance function] Major adverse effects are caused by anti fungal drugs when administered in combination with ampothericin B. What actions should the health care professional initiate? ---------CORRECT ANSWER-----------------Administer pre medications [antipyretic or acetaminophen, antihistamine, antiemetic, and corticosteroid] to minimize or prevent infusion related reactions fever, chills, hypotension, tachycardia, malaise, muscle and joint pain, anorexia, nausea, vomiting, and headache **During IV infusions, monitor patient q15-30 minutes** Which antibiotic is indicated to treat MRSA infection through IV administration? ---------CORRECT ANSWER-----------------Vancomycin [Vancocin] **parenteral form used to treat bone, joint, and bacterial blood infections from staphylococcus spp.** What are the most common adverse effects associated with Vancomycin drug administration? ---------CORRECT ANSWER-----------------Red man syndrome- flushing and itching of head, face, neck, and upper trunk area when drug is infused too quickly hypotension from drug being infused too quickly additive neuromuscular blocking effects in patients taking neuromuscular blockers **alleviate adverse effects by slowing rate of infusion of drug dose over 1 HOUR** The health care provider MUST monitor serum drug levels to ensure therapeutic levels and prevent toxicity during vancomycin drug administration. What are the inappropriate levels and associated adverse effects? ---------CORRECT ANSWER-----------------< 5 mcg/mL --> reduced antibacterial effect > 50 mcg/mL --> ototoxicity and nephrotoxicity What is the drug mechanism of action of vancomycin? ---------CORRECT ANSWER-----------------binds to bacterial cell wall --> immediate inhibition of cell wall synthesis --> bacterial death The oral drug form of vancomycin is indicated to treat which infection? ------ ---CORRECT ANSWER-----------------C. Difficile and staphylococcal enterocolitis poor absorption from GI tract What is important before administering antibiotic drug therapy? --------- CORRECT ANSWER-----------------It is ESSENTIAL to obtain cultures from appropriate sites BEFORE beginning antibiotic therapy to identify the causative organism and potential antibiotic susceptible to determine if empire therapy is effective for destroying the bacteria What is important when initiating treatment of Oseltamivir [Tamiflu] or Zanamivir [Relenza] indicated for influenza infections? ---------CORRECT ANSWER-----------------Treatment NEEDS to begin within TWO DAYS of symptom onset What are the four stages of HIV infection according to the WHO model? ---- -----CORRECT ANSWER-----------------1. **Asymptomatic infection** ○ Few weeks or months after initial exposure to virus ○ Asymptomatic but show signs of lymphadenopathy What is the term for a infection that a patient acquires while receiving treatment for another condition in the health care setting? --------- CORRECT ANSWER-----------------Health-Care Associated Infection [Nosocomial] Infection was NOT present at the time of admission but appears 48 hours post admission Difficult to treat b/c causative agents have been exposed to strong antibiotics previously making the organism more resistant and virulent occurs in patients who are immunocompromised = increased vulnerability Which class of antibiotics are intended to treat UTI's, RTI's, pneumocystis jirovecii pneumonia, and staph. infections caused by MRSA? --------- CORRECT ANSWER-----------------Sulfonamides - bacteriostatic antibiotic - administer with 2000 to 3000 mL of fluid per 24 hours - broad spectrum antibiotic - exposure to sun during drug therapy --> photosensitivity --> sunburn - Drugs = sulfamethoxazole and trimethoprim How long MUST carbapenem [-PENEM] antibiotics be administered? ---------CORRECT ANSWER--------- --------1 hour [60 minutes] Which beta-lactam antibiotic's most serious adverse effect is drug-induced seizure activity but is reduced with dosage adjustment? ---------CORRECT ANSWER-----------------Carbapenem's Which antibiotic class should the health care provider monitor for an allergic reaction in patients for AT LEAST 30 minutes AFTER drug administration? ---------CORRECT ANSWER-----------------Penicillin Which class of antibiotics are recognized by [-MYCIN]? ---------CORRECT ANSWER-----------------Macrolide's Which class of antibiotics should NOT be administered with milk, antacids, or iron because these items reduces absorption of the oral drug form? ------ ---CORRECT ANSWER-----------------Tetracycline - administer with 6-8 ounces of water [ALL antibiotics] Which class of antibiotics should NOT be administered to children < 8 years of age, and pregnant and/or nursing women? ---------CORRECT ANSWER-----------------Tetracycline - binds to calcium in teeth --> teeth discoloration - drug passes through breast milk What information is essential during the education session for the patient regarding antibiotic therapy? ---------CORRECT ANSWER-----------------Take antibiotics EXACTLY as prescribed and for the length of time prescribed; DO NOT stop taking the medication early, even if they feel better What are the four organisms that are resistant to one or more classes of antimicrobial drugs? ---------CORRECT ANSWER-----------------MRSA VRE ESBL's KPC What is the term for serum drug levels or serum drug concentration routinely monitored; making adjustments depending on laboratory results to prevent toxicity? ---------CORRECT ANSWER-----------------Therapeutic drug monitoring Amino glycosides are monitored due to nephrotoxicity [kidney toxicity --> compromised renal function] and ototoxicity [ear toxicity --> hearing loss] resulting from drug therapy What is the term for the measure of the lowest drug concentration needed to kill a certain standard amount of bacteria? ---------CORRECT ANSWER-- ---------------Minimum inhibitory concentration [MIC] Amino glycosides NEED to be 8x higher than MIC to be effective! What is the term for the amount of time the drug is ABOVE the MIC; critical for maximal bacterial kill? ---------CORRECT ANSWER-----------------Time- dependent killing What is the term for the drug plasma concentration that is ABOVE the MIC for most effective bacterial kill? ---------CORRECT ANSWER----------------- Concentration-dependent killing once-daily dosing or multiple-day dosing [1 per q6h] peak [highest] drug level - only monitored during multiple dosing NOT once daily b/c its short lived and drops within a reasonable time frame trough [lowest] drug level What are the adverse effects of quinolone? ---------CORRECT ANSWER---- -------------bacterial overgrowth [superinfection w/ long term use] prolonged QT interval on ECG Tendinitis and tendon rupture seizures Metronidazole [Flagyl] ---------CORRECT ANSWER------------------ used to treat anaerobic organisms [itraabdominal and gynecologic infections] - used to treat protozoal infections [amebiasis and trichomoniasis] - interferes with microbial DNA synthesis - oral and parenteral drug forms [oral used for antibiotic associated colitis or C. diff] What are the adverse effects of Metronidazole [Flagyl] drug administration? ---------CORRECT ANSWER-----------------metallic taste, vomiting, diarrhea, dizziness, headache, GI discomfort [take with food], nasal congestion, reversible neutropenia and thrombocytopenia When administering Mycostatin [anti-fungal] for oral candiasis, what is important to remember? ---------CORRECT ANSWER-----------------Allow the mycostatin to dissolve SLOWLY in the mouth DO NOT chew When administering Nystatin as an oral lozenge, what is important to remember? ---------CORRECT ANSWER-----------------The oral form should slowly and completely dissolve in the mouth, NOT chewed or swallowed When administering Nystatin suspension, what is important to remember? - --------CORRECT ANSWER-----------------Suspension should be SWISHED thoroughly in the mouth as long as possible before SWALLOWING **swish and swallow** What is the mechanism of action of a virus? ---------CORRECT ANSWER--- --------------Virus fuses, or attaches to host cell --> enters cell --> uses host cell DNA/RNA for replication, or production of viral nucleic acids --> new virus particle --> bud through host cells plasma membrane --> exit host cell --> infect other host cells [cytopathic effect] Which herpes simplex virus is associated with cold sores or fever blisters? - --------CORRECT ANSWER-----------------HSV-1 Which herpes simplex virus is associated with genital herpes? --------- CORRECT ANSWER-----------------HSV-2 Which antiviral drug is used to suppress the replication of HSV-1, HSV-2, and VZV and is the drug of choice for treatment of initial and recurrent infections? ---------CORRECT ANSWER-----------------Acyclovir [Zovirax] What are the adverse effects of Acyclovir [Zovirax] drug administration? ---- -----CORRECT ANSWER-----------------nausea, diarrhea, headache, burning when topically applied Which antiviral drug is administered via inhalation form in hospitalized infants with severe lower respiratory tract infections caused by RSV? -------- -CORRECT ANSWER-----------------Ribavirin [Virazole] Which antiviral drug is indicated to treat CMV ? ---------CORRECT ANSWER-----------------Ganciclovir [Cytovene] - ophthalmic form used to treat CMV retinitis [common opportunistic virus with HIV patients --> blindness] - used to prevent CMV disease in high risk patients [organ transplant recipients] - dose-limiting toxicity = bone suppression/toxicity Which two antiviral drugs are indicated to treat influenza A virus ? --------- CORRECT ANSWER-----------------Amantadine [Symmetrel] and Rimantadine [Flumadine] - Rimantadine has a longer half life and causes fewer adverse effects What does it mean when an HIV patient presents with the following: toxoplasmosis of the brain, candidiasis of lungs, esophagus, and trachea, p. jirovecii pneumonia, CMV disease, HSV infection, extra pulmonary TB, kaposi sarcoma, or HIV wasting syndrome? ---------CORRECT ANSWER--- --------------According to the CDC, if a patient presents with one of the mentioned opportunistic infections, the patient has transitioned from HIV to AIDS Which antimalarial drug is most effective for eradicating malaria infection during the EXOERYTHROCITIC phase? ---------CORRECT ANSWER------- ----------Primaquine What are the adverse effects of antimalarial drug therapy? --------- CORRECT ANSWER-----------------Primarily gastrointestinal [nausea, vomiting, diarrhea, anorexia, abdominal pain] Which antiprotozoal drug is used to treat mild to moderate pneumocystis jirovecii pneumonia ? ---------CORRECT ANSWER-----------------Atovaquone [Mepron] Which antiprotozoal drug is used to treat active p. jirovecii pneumonia and prophylactics treatment for those at risk of recurrent episodes of this condition in patients with HIV and AIDS ? ---------CORRECT ANSWER------ -----------Pentamidine [NebuPent, Pentam 300] What is important when initiating anthelmintic drug therapy? --------- CORRECT ANSWER-----------------Causative worm in infected host MUST be accurately identified BEFORE treatment begins by analyzing feces, urine, blood, sputum, or tissue from infected host for ova and/or larvae from worm parasite Which anthelmintic drug is the ONLY drug available OTC and is used for the treatment of intestinal ROUND WORM infections [ascariasis and enterobiasis] ? ---------CORRECT ANSWER-----------------Pyrantel [Pin-X] Which anthelmintic drug is used to treat FLUKE WORM infections and SOME TAPE WORM infections ? ---------CORRECT ANSWER----------------- Praziquantel [Biltricide] Which anthelmintic drug is used to treat TAPE WORMS and ROUD WORMS ? ---------CORRECT ANSWER-----------------Albendazole [Albenza] What are the most common adverse effects of antimalarial drug therapy? -- -------CORRECT ANSWER-----------------nausea, vomiting, diarrhea, dizziness, and headache - ringing in ears, hearing decreases, visual difficulties, abdominal pain What are the three preventative strategies against HAI's? --------- CORRECT ANSWER-----------------hand washing disinfection [bacteriCIDAL; used ONLY in nonliving objects] antiseptic [bacterioSTATIC; used ONLY on living tissue] What is important to assess when a patient verbalizes that they have an allergy to a certain drug? ---------CORRECT ANSWER-----------------Ask patients open ended questions to describe allergic reactions to determine the actual severity of reported medication allergy Flushing, itching, hives, anxiety, fast irregular pulse, throat and tongue swelling --> anaphylactic shock [suffocate from drug-induced respiratory arrest] Which monobactam drug is indicated to treat moderately severe systemic infections and UTI's through IV drug administration? ---------CORRECT ANSWER-----------------Azteonam [Azactam] Adverse effects = rash, nausea, vomiting, and diarrhea What are the adverse effects associated with tetracycline drug administration? ---------CORRECT ANSWER------------------ discoloration of permanent teeth, tooth enamel hypoplasia, retard fetal skeletal development during pregnancy - photosensitivity [avoid sunlight and tanning beds] - alteration of intestinal and vaginal flora --> diarrhea, vaginal candida, or pseudomembranous colitis - GI upset, enterocolitis, maculopauplar rash Which amino glycoside drug is commonly used for bacterial decontamination of GI tract BEFORE surgical procedures ? --------- CORRECT ANSWER-----------------Neomycin Which amingoglycoside is MOST commonly used? ---------CORRECT ANSWER-----------------Gentamicin Which cells of the gastric gland are the primary site of action for drugs used to treat acid related disorders? ---------CORRECT ANSWER----------------- Parietal Cells Sodium Bicarbonate Antacids ---------CORRECT ANSWER------------------ Highly soluble - Fast onset BUT short duration of action - buffers acidic properties of HCL - may lead to metabolic alkalosis - sodium content may cause problems in patients with HTN, HF, or renal insufficiency [sodium --> water retention --> increase pressure] Administered to patients with renal disease b/c more easily excreted What is the issue with long term antacid self medicating? ---------CORRECT ANSWER-----------------May mask symptoms of serious underlying conditions such as malignancy or bleeding ulcers [if symptoms remain ongoing, seek medical evaluation] Increased urinary pH --> increase/decrease excretion of acidic drugs and increase/decrease excretion of basic drugs ---------CORRECT ANSWER---- -------------Increase excretion of acidic drugs Decrease excretion of basic drugs Increased stomach pH --> increase/decrease absorption of basic drugs and increase/decrease absorption of acidic drugs ---------CORRECT ANSWER-- ---------------Increase absorption of basic drugs Decreases absorption of acidic drugs Which acid controlling drug class is associated with [-IDINE]? --------- CORRECT ANSWER-----------------H2 Receptor Antagonist Blockers - Cimetidine [Tagamet] - Ranitidine [Zantac] - Famotidine [Pepcid] - Nizatidine [Axid] Which acid controlling drug class causes CNS adverse effects including **sedation, confusion, and disorientation** and MUST be monitored in elderly patients? ---------CORRECT ANSWER-----------------H2 Receptor Antagonists Blockers Which class of acid controlling drugs are indicated to treat the following: GERD, PUD, erosive esophagitis, upper GI tract bleeding, Zollinger-Elison Syndrome ? ---------CORRECT ANSWER-----------------H2 Receptor Antagonist Blockers What are the adverse effects of Cimetidine? ---------CORRECT ANSWER--- --------------Impotence [ED] and gynecomastia in male patients What are the adverse effects of Ranitidine and Famotidine ? --------- CORRECT ANSWER-----------------Thrombocytopenia [deficiency of blood platelets] Which acid controlling drug class is associated with [-AZOLE] ? --------- CORRECT ANSWER-----------------Proton Pump Inhibitors [PPI] -Lansoprazole [Prevacid] - Omeprazole [Prilosec] - Rabeprazole [AcipHex] - Pantoprazole [Protonix] - Esomeprazole [Nexium] When should H2 Receptor Antagonists be administered with Antacids? ----- ----CORRECT ANSWER-----------------1 to 2 hours BEFORE antacids are given for OPTIMAL results NOT administered with antacids Which class of acid controlling drugs are indicated for H. pylori infections? - --------CORRECT ANSWER-----------------PPI's + Antibiotics for one to two weeks Which class of acid controlling drugs are indicated for first line drug therapy for: erosive esophagitis, GERD, active duodenal ulcers and active benign gastric ulcers, zollinger-ellison syndrome, NSAID induced ulcer, stress ulcer, h. pylori infections? ---------CORRECT ANSWER-----------------PPI's Long term use of proton pump inhibitors results in what? ---------CORRECT ANSWER-----------------osteoporosis --> risk of hip, wrist, and spine fractures pneumonia Should PPI's be taken with or without food? ---------CORRECT ANSWER--- --------------Take medication on an empty stomach at least 1 hour before eating b/c food may decrease absorption of PPI Which type of laxative is similar in action to dietary fiber? ---------CORRECT ANSWER-----------------Bulk Forming Absorb water --> intestine --> increases bulk --> distends bowel to initiate reflex bowel activity --> bowel movement **Powder drug form + LOTS of water [if not enough water, obstruct throat] Which type of laxative is referred to as a stool softener or lubricant? --------- CORRECT ANSWER-----------------Emollient Which emollient drug is indicated for stool softening effects? --------- CORRECT ANSWER-----------------Docusate salts [Colace, Surfak] Which emollient drug is indicated for lubricating effects? ---------CORRECT ANSWER-----------------Mineral oil Which laxative drug class has the fastest onset? ---------CORRECT ANSWER-----------------Saline Magnesium hydroxide [milk of magnesia] magnesium sulfate magnesium citrate Which class of laxatives are used for treatment of constipation SECONDARY to opioid use and bowel resection surgery? --------- CORRECT ANSWER-----------------Peripherally Acting Opioid Antagonists Which peripherally acting opioid antagonist drug is administered to terminally ill [hospice] patients ONLY w/ opioid induce constipation? --------- CORRECT ANSWER-----------------Methylnaltrexone [Relistor] Which peripherally acting opioid antagonist drug is used to accelerate GI recovery time following bowel resection surgery? ---------CORRECT ANSWER-----------------Alvimopan [Entereg] How much water should bulk forming laxatives be administered with? ------- --CORRECT ANSWER-----------------AT LEAST 240 mL or 8 oz. of water ALL laxatives should be taken with 6-8 oz. of water What are alternative methods to laxative use? ---------CORRECT ANSWER-----------------high-fiber diet and increased fluid intake What are indications of fluid + electrolyte imbalance associated with laxative use? ---------CORRECT ANSWER-----------------severe abdominal pain, muscle weakness, cramps, and/or dizziness Which condition is considered a chronic intestinal discomfort characterized by cramps, diarrhea, and/or constipation? ---------CORRECT ANSWER------ -----------Irritable Bowel Syndrome ** Avoid irritating foods and/or taking OTC laxatives or antidiarrheal drugs What is the term used to describe an unpleasant feeling that precedes vomiting; if it does not subside or relieved by medication --> vomiting? ------ ---CORRECT ANSWER-----------------Nausea What is the term for forcible emptying or expulsion of gastric acid and intestinal contents through the mouth? ---------CORRECT ANSWER---------- -------Vomiting or Emesis What class of drugs are used to prevent and relieve nausea and vomiting by blocking one of the vomiting pathways by blocking the stimulus that induces vomiting? ---------CORRECT ANSWER-----------------Antiemetic drugs Which antidopaminergic [antiemetic] drug is used to treat and prevent postoperative nausea and vomiting HOWEVER is associated with cardiac dysrhythmia? ---------CORRECT ANSWER-----------------Droperidol Which serotonin blocker [-SETRON] an antiemetic drug is used to treat and prevent chemotherapy induced nausea and vomiting, postoperative nausea and vomiting, and nausea and vomiting associated with pregnancy? --------- CORRECT ANSWER-----------------Ondansetron [Zofran] Also used for radiation induced nausea and vomiting