Pharmacology Exam 5 Questions and Answers,100% CORRECT

Pharmacology Exam 5 Questions and Answers Ch 38-44 PPT Questions 1. A patient is receiving Augmentin (amoxicillin and clavulanic acid) liquid solution through a PEG tube. What is the purpose of clavulanic acid? a. It works synergistically with the antibiotic to improve potency. b. It inhibits the action of the enzymes produced by beta-lactamase–producing bacteria. c. It protects the antibiotic from the harmful gastric acid secretions in the stomach. d. It enhances the absorption of the antibiotic in the small intestine. 2. When completing an admission assessment, the patient states that she is allergic to sulfa drugs. What will the nurse do next? a. Mark the allergy on her medical record. b. Place an “allergy” armband on the patient. c. Ask the patient for more information about the allergic reaction she had. d. Notify the physician about the patient’s allergy. 3. A patient has a prescription for a sulfa drug as treatment for a urinary tract infection. She is also taking an oral contraceptive, an oral sulfonylurea antidiabetic drug, and phenytoin for a history of seizures. Which drug may pose a potential serious interaction with the sulfa drug? a. The oral contraceptive b. The oral antidiabetic drug c. The phenytoin d. All of these 4. During intravenous quinolone therapy in an 88-year-old patient, which potential problem is of most concern when assessing for adverse effects? a. Hepatotoxicity b. Rhabdomyolysis c. Tendon rupture d. Nephrotoxicity 5. A patient is prescribed linezolid (Zyvox) to treat hospital-acquired pneumonia. It is most important for the nurse to determine if the patient is also taking which medication? a. A diuretic b. A selective serotonin reuptake inhibitor c. A cardiac glycoside d. A thyroid replacement drug 6. A 58-year-old man is receiving vancomycin as part of the treatment for a severe bone infection. After the infusion, he begins to experience some itching and flushing of the neck, face, and upper body. He reports no chills or difficulty breathing. The nurse should suspect: a. an allergic reaction has occurred. b. an anaphylactic reaction is about to occur. c. the medication will not be effective for the bone infection. d. the IV dose may have infused too quickly. 7. A group of office workers is concerned because a package was opened that contained a white powder substance. There is a concern that the white powder is anthrax. Which drug does the nurse anticipate being prescribed for the office workers? a. daptomycin (Cubicin) b. colistimethate (Coly-Mycin) c. ciprofloxacin (Cipro) d. quinupristin/dalfopristin (Synercid) 8. An 82-year-old woman is unable to take the influenza vaccine due to allergies, but she has been exposed to the virus through a family reunion. She does not yet have symptoms of the flu. Which option would be best for her? a. She should receive the flu vaccine as soon as possible. b. She should receive zanamivir (Relenza) in the inhalation form. c. She should begin oral oseltamivir (Tamiflu) therapy when symptoms begin. d. She should begin oral oseltamivir (Tamiflu) therapy as soon as possible. 9. A patient with HIV infection is seen in the clinic. The nurse notes that the patient is experiencing weight loss, chronic diarrhea, fever, and dropping CD4 counts. The nurse anticipates the patient is in which stage of HIV infection? a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4 10. A patient with active HIV has been taking zidovudine (Retrovir). Which potential adverse effect may limit the length of time this medication can be taken? a. Lactic acidosis b. Bone marrow suppression c. Hepatomegaly d. Fatigue 11. The nurse administers maraviroc (Selzentry) to a patient with HIV infection. It is most important for the nurse to monitor which of the following? a. CD4 count b. Bone marrow suppression c. Urinary output d. Liver function tests 12. A patient with tuberculosis has been taking antitubercular drugs. A sputum culture is ordered to test for acid-fast bacilli. When is the best time for the nurse to obtain the sputum culture? a. In the morning b. Noon c. Five o’clock in the evening d. Ten o’clock in the evening 13. A patient with a diagnosis of tuberculosis (TB) will be taking isoniazid (INH) as part of the anti-TB therapy. When reviewing the patient’s chart, the nurse finds documentation that the patient is a “slow acetylator.” This means that: a. the dosage of INH may need to be lower to prevent INH accumulation. b. the dosage of INH may need to be higher due to the slow acetylation process. c. he should not take INH. d. he will need to take a combination of anti-TB drugs for successful therapy. 14. A patient is receiving isoniazid (INH) for the treatment of tuberculosis. Which vitamin does the nurse anticipate administering with the INH to prevent isoniazid-precipitated peripheral neuropathies? a. Vitamin C b. Vitamin B12 c. Vitamin D d. Vitamin B6 15. Four weeks after beginning antitubercular drug therapy on an outpatient basis, the patient reports that he still experiences night sweats. What does the nurse identify as the main concern at this time? a. He is not taking his medication properly. b. More time is needed to see a therapeutic response. c. His infection may be resistant to the drug therapy ordered. d. He may have contracted a different strain of tuberculosis (TB). 16. A patient has an extremely severe infection with a Mycobacterium that is resistant to all but one antitubercular drug; however, the patient has had an allergic reaction to that drug in the past. What does the nurse anticipate as being ordered for this patient? a. A combination of antitubercular drugs will be chosen to fight the infection. b. The patient will receive the drug and supportive care to help him tolerate the antitubercular therapy. c. The patient will remain on isolation precautions until his cough clears. d. There is nothing that can be done with this patient. 17. A home care nurse is visiting a patient with a diagnosis of TB. The patient traveled abroad two months ago. He lives with his wife and 5-year-old son. The patient tells the nurse that he is concerned his son will also get TB so he wants to share his pills with his son. What is the best response by the nurse? a. “That is a good idea. Children should not be exposed to TB.” b. “You should give your son half of the dose you take.” c. “Do not share any of your medications with anyone. Contact your son’s health care provider to discuss your concerns.” d. “Children have an immune system that makes them immune to TB.” 18. The patient tells the nurse, “I had a shot after I returned from my trip overseas. I thought that was supposed to stop me from getting a tuberculosis infection.” What information regarding tuberculosis- related injections does the nurse identify as being true? a. BCG is used to prevent infection with tuberculosis for women of childbearing age. b. A positive result for a PPD test is indicated by redness at the site of injection. c. PPD is a diagnostic injection given intradermally to detect exposure to the TB organism. d. BCG is a vaccine injection derived from an activated strain of Mycobacterium bovis. 19. The patient’s wife is taking rifampin to prevent her from developing a tuberculosis infection. Which statement by the wife indicates that further teaching is needed? a. “Because my oral contraceptives will not work while I am taking rifampin, I will use another form of birth control.” b. “I will take the medication for one week and then stop.” c. “I will avoid prolonged exposure to the sun.” d. “My urine may turn a reddish color when taking rifampin.” 20. A patient has developed an aspergillosis infection. Which tissue does the aspergillosis affect? a. Skin b. Nails c. Blood d. Lungs 21. A patient is diagnosed with onychomycosis. The nurse anticipates use of which medication for the treatment of this condition? a. terbinafine (Lamisil) b. voriconazole (Vfend) c. fluconazole (Diflucan) d. amphotericin B (Amphocin, Fungizone) 22. A patient is receiving amphotericin B lipid complex. The nurse knows that an advantage of the lipid formulations of this drug is that they a. have a lower cost. b. can be administered quickly. c. take longer to be absorbed. d. cause fewer adverse effects. 23. Fifteen minutes after an infusion of amphotericin B was started, the patient begins to complain of fever, chills, muscle pain, and nausea. His heart rate has increased slightly, but his blood pressure is down to 100/68. What is the nurse’s priority? a. Notify the prescriber immediately. b. Recognize an impending anaphylactic reaction and stop the infusion. c. Assess for other symptoms of this expected infusion- related reaction. d. Slow the infusion to reduce these adverse effects. 24. A patient is taking nystatin (Mycostatin) in an oral troche form for oral candidiasis. Which instruction is correct? a. Allow the troche to dissolve slowly in the mouth. b. Swish the medication in the mouth and then swallow it. c. Chew the troche thoroughly to activate the medication. d. Swallow the troche whole without chewing. 25. When pyrimethamine is used to treat malaria, a sulfonamide antibiotic is often also used. The purpose of the antibiotic is to: a. treat the bacterial infections that often accompany malaria. b. allow the antimalarial drug to be effective in the exoerythrocytic phase. c. cause synergism, allowing for a stronger antimalarial effect. d. allow for reduced adverse effects because smaller doses of each drug are used. 26. Before administration of primaquine, it is most important for the nurse to assess the patient for a history of which condition? a. Asthma b. Diabetes mellitus c. Hypertension d. Rheumatoid arthritis 27. A male patient with an HIV infection has a severe case of P. jirovecii pneumonia (PJP) and needs to be treated with pentamidine. However, he is allergic to the inhaled form of this medication. Considering the seriousness of his condition, what does the nurse expect will be done in this situation? a. He will be given the inhaled form of pentamidine and be monitored closely. b. He will be given the pentamidine in an IM or IV injection and be monitored closely. c. Another drug, such as metronidazole (Flagyl), will be ordered. d. He will receive supportive care because he is unable to take the pentamidine. 28. A patient is taking metronidazole for amebiasis. What information should the nurse include in the patient teaching? a. How to check stool samples correctly and safely b. Metronidazole may precipitate hypertension c. Blurred vision is an expected effect of this medication, which will resolve with time d. To take the medication on an empty stomach 29. The nurse is administering medications. One patient has an order for aspirin 325 mg by mouth daily and another patient has an order for aspirin 650 mg 4 to 6 times daily (maximum 4 g/day). The nurse understands that the indication for the 325 mg of aspirin once daily is a. pain management. b. fever reduction. c. treatment of osteoarthritis. d. thromboprevention. 30. A hospitalized patient has an order for ketorolac (Toradol). The nurse notes that the order is only for 5 days. What is the reason for this? a. The patient’s pain should subside by that time. b. There are concerns about addiction to the drug. c. The drug can cause severe renal and gastrointestinal effects. d. The drug loses its effectiveness over time. 31. An 82-year-old woman is taking ibuprofen (Motrin) 3200 mg divided three times daily as treatment for arthritis. She has had no other health problems. What is the most important assessment for the nurse to monitor while the patient is on this therapy? a. Blood sugar b. Liver function studies c. Assessment of hearing d. Renal function studies 32. A patient is admitted with salicylate toxicity. When assessing the patient, the nurse anticipates which manifestation associated with salicylate toxicity? a. Bradycardia b. Hypoventilation c. Constipation d. Hyperglycemia 33. Which drug does the nurse associate with the development of potentially life-threatening skin adverse effects of exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis? a. probenecid b. colchicine c. febuxostat (Uloric) d. allopurinol (Zyloprim) 34. A patient is taking ibuprofen 800 mg three times a day by mouth as treatment for osteoarthritis. While taking a health history, the nurse finds out that the patient has few beers on weekends. What concerns would there be with the interaction of the alcohol and ibuprofen? a. Increased bleeding tendencies b. Increased chance for gastrointestinal bleeding c. Increased nephrotoxic effects d. Reduced antiinflammatory effects of the nonsteroidal antiinflammatory drug (NSAID) Ch 38-44 PPT Answers 1. Correct answer: B a. Rationale: The clavulanic acid works to inhibit the action of the enzymes produced by the bacteria, which would normally inactivate the antibiotic. 2. Correct answer: C a. Rationale: Some patients will say they are “allergic” to drugs when in fact what they experienced was a common and mild adverse effect. The nurse should clarify the patient’s statements with open-ended questions. 3. Correct answer: D a. Rationale: The combination of the sulfa drug with the oral contraceptive may reduce the effectiveness of the contraceptive. The combination with the oral antidiabetic drug may potentiate the hypoglycemic effect of the sulfonylurea drug, while the combination with phenytoin may potentiate the toxic effects of phenytoin. 4. Correct answer: C a. Rationale: A black box warning is required by the U.S. Food and Drug Administration for all quinolones because of the increased risk of tendonitis and tendon rupture with use of the drugs. This effect is more common in elderly patients, patients with renal failure, and those receiving concurrent glucocorticoid therapy (e.g., prednisone). 5. Correct answer: B a. Rationale: Linezolid has the potential to strengthen the vasopressor (prohypertensive) effects of various vasopressive drugs such as dopamine by an unclear mechanism. Also, there have been postmarketing case reports of this drug causing serotonin syndrome when used concurrently with serotonergic drugs such as the selective serotonin reuptake inhibitor (SSRI) antidepressants. It is recommended that the SSRI be stopped while the patient is receiving linezolid therapy if possible. 6. Correct answer: D a. Rationale: These symptoms are known as red man syndrome and may occur during or after an infusion of vancomycin. This syndrome is characterized by flushing and/or itching of the head, face, neck, and upper trunk area. Symptoms can usually be alleviated by slowing the rate of infusion to at least 1 hour. Red man syndrome is bothersome but usually not harmful. Rapid infusions may also cause hypotension. 7. Correct answer: C a. Rationale: Ciprofloxacin (Cipro) is the drug of choice for the treatment of anthrax (infection with Bacillus anthracis). 8. Correct answer: D a. Oseltamivir (Tamiflu) is the only one indicated for prophylaxis of influenza infection. Both oseltamivir and zanamivir can be used to treat active influenza illness. Treatment with oseltamivir and zanamivir ideally should begin within 2 days of symptom onset. 9. Correct answer: C a. Rationale: During stage 3, the infection progresses to a moderately symptomatic state. Weight loss, chronic diarrhea, and fever continues, and CD4 counts continue to drop. Opportunistic infections begin, including severe bacterial pneumonias and pulmonary tuberculosis (TB). Pulmonary TB is usually more severe in persons with AIDS and is currently the leading cause of death worldwide for HIV-infected patients. 10. Correct answer: B a. Rationale: The major dose-limiting adverse effect of zidovudine (Retrovir) is bone marrow suppression, and this is often the reason a patient with an HIV infection must be switched to another anti-HIV drug. 11. Correct answer: D a. Rationale: The antiretroviral drug maraviroc requires assessment of allergies and liver function as well as review of the list of medications the patient is taking because of the lengthy list of interacting drugs. 12. Correct answer: A a. Rationale: If the prescriber has ordered collection of a sputum specimen to test for acid-fast bacilli, it is best to obtain the sample early in the morning. The most common order is for three consecutive morning specimens, with a repeat specimen several weeks later. 13. Correct answer: A a. Rationale: When INH is taken by slow acetylators, the INH accumulates because there are not enough liver enzymes to break down the INH. Therefore, the dosages of INH may need to be adjusted downward to prevent toxicity. 14. Correct answer: D a. Rationale: Pyridoxine (vitamin B6) may be indicated to prevent isoniazid-precipitated peripheral neuropathies and numbness, tingling, or burning of the extremities. 15. Correct answer: C a. Rationale: The nurse should not jump to conclusions that the patient is not taking his medication properly. An improvement should start to occur within 2 weeks of starting drug therapy, but this may not occur if the patient’s TB is not sensitive to the prescribed drugs. An evaluation of the drug therapy will be needed. 16. Correct answer: B a. Rationale: It must be recognized that the urgency of treating a potentially fatal infection may have to be balanced against any prevailing contraindications. In extreme cases, patients are sometimes given a drug to which they have some degree of allergy with supportive care that enables them at least to tolerate the medication. Examples of such supportive care are treatment with antipyretics (e.g., acetaminophen), antihistamines (e.g., diphenhydramine), or even corticosteroids (e.g., prednisone, methylprednisolone). 17. Correct answer: C a. Rationale: Medications of any kind should never be shared with any other person. In particular, antitubercular drugs are age specific. Assessment of age is also important, because the likelihood of adverse reactions and toxicity is increased in elderly patients due to age-related liver and kidney dysfunction. Additionally, the safety of these drugs in children 13 years of age and younger has not been established. 18. Correct answer: C a. Rationale: PPD is a diagnostic injection given intradermally in doses of 5 tuberculin units (0.1 mL) to detect exposure to the TB organism. A positive result is indicated by induration (not erythema) at the site of injection and is known as the Mantoux reaction, named for the physician who described it. BCG is used in much of the world to vaccinate young children against tuberculosis. Although it does not prevent infection, evidence indicates that it reduces active tuberculosis by 60% to 80% and is even more effective at preventing more severe cases involving dissemination of infection throughout the body. 19. Correct answer: B a. Rationale: Antitubercular therapy is taken for long periods of time, often 24 months. Although this patient does not have an active infection at this time and is taking the rifampin to prevent an infection, the nurse should further investigate the length of time the medication is ordered. All other statements are true. 20. Correct answer: D a. Rationale: The primary tissue affected by aspergillosis is the lungs. 21. Correct answer: A a. Rationale: Terbinafine (Lamisil) is indicated for the treatment of onychomycosis (fungal infection of fingernail or toenail). Voriconazole (Vfend) is indicated for the treatment of invasive aspergillosis and other major fungal infections in patients who do not tolerate or respond to other antifungal drugs. Fluconazole (Diflucan) is indicated for the treatment of vaginal candidiasis, oropharyngeal and esophageal candidiasis, systemic candidiasis, and cryptococcal meningitis. Amphotericin B (Amphocin, Fungizone) is indicated for the treatment of systemic infections with broad spectrum of fungi. 22. Correct answer: D a. Rationale: Lipid formulations of amphotericin B have been developed in an attempt to decrease the incidence of its adverse effects and increase its efficacy. There are currently three lipid preparations of amphotericin B: amphotericin B lipid complex (Abelcet), amphotericin B cholesteryl complex (Amphotec), and liposomal amphotericin B (AmBisome). These lipid dosage forms have a much higher cost than conventional amphotericin B and for this reason are often used only when patients are intolerant of or have an infection refractory to nonlipid amphotericin B. 23. Correct answer: C a. Rationale: Almost all patients who receive amphotericin B experience fever, chills, hypotension, tachycardia, malaise, muscle and joint pain, anorexia, nausea and vomiting, and headache. For this reason, antihistamines, acetaminophen (an antipyretic), and antiemetics may be given as pretreatment to reduce these expected effects. 24. Correct answer: A a. Rationale: Oral troche or lozenge forms of this medication should be allowed to dissolve slowly in the mouth without chewing. 25. Correct answer: C a. Rationale: The combination of some antimalarial drugs with specific antibiotics results in synergistic effects, thus making the drugs more effective against the malarial infection. 26. Correct answer: D a. Rationale: Primaquine is contraindicated in patients with allergy or any disease states that may cause granulocytopenia (rheumatoid arthritis, systemic lupus erythematosus). Primaquine must be used with caution in patients with methemoglobinemia, porphyria, methemoglobin reductase deficiency, and glucose-6-phosphate dehydrogenase (G6PD) deficiency. 27. Correct answer: B a. Hypersensitivity is more common when the drug is administered by inhalation. An allergic reaction to the inhalational form does not preclude its administration by either the intramuscular or intravenous route, due to the seriousness of the Pneumocystis infection. 28. Correct answer: A a. When the patient is taking metronidazole for amebiasis, the nurse should include in the instructions how to check stool samples correctly and safely, and how to dispose of samples properly. Metronidazole may precipitate dizziness, so encourage the patient to be cautious in all activities until a response to the drug is noted and is consistent. Encourage the patient to contact the prescriber if there is any visual disturbance noted. The medication should be taken with food to decrease gastrointestinal upset. 29. Correct answer: D a. Rationale: "Low-dose" aspirin, such as 81 or 325 mg once daily, is given for thromboprevention. Dosages for pain, fever, or arthritis are much higher usually. 30. Correct answer: C a. Rationale: The main adverse effects of ketorolac include renal impairment, edema, gastrointestinal pain, dyspepsia, and nausea. It is important to note that the drug can only be used for 5 days because of its potential adverse effects on the kidney and gastrointestinal tract. 31. Correct answer: D a. Rationale: NSAIDs disrupt the prostaglandins, which stimulate vasodilation and increase renal blood flow. This disruption may precipitate chronic or acute renal failure in some patients, and elderly patients are at greater risk for this adverse drug reaction. 32. Correct answer: D a. Rationale: Manifestations of salicylate toxicity include increased heart rate, tinnitus, hearing loss, dimness of vision, headache, dizziness, mental confusion, lassitude, drowsiness, nausea, vomiting, diarrhea, sweating, thirst, hyperventilation, and hypoglycemia or hyperglycemia. 33. Correct answer: D a. Rationale: If the patient is taking allopurinol, assess the integrity of the skin due to potentially life-threatening skin adverse effects of exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis. 34. Correct answer: B a. Rationale: NSAIDs taken with alcohol may result in increased risk of gastrointestinal bleeding. Ch 45-49 PPT Questions 1. Which condition does the nurse anticipate when assessing a patient with tumor lysis syndrome? a. Hyperuricemia b. Hypophosphatemia c. Hypokalemia d. Hypercalcemia 2. A patient who is receiving high-dose chemotherapy with methotrexate is also receiving leucovorin. The purpose of the leucovorin is to: a. produce an additive effect with the methotrexate by increasing its potency against the cancer cells. b. reduce the incidence of cardiomyopathy caused by the methotrexate. c. add its antiinflammatory effects to the treatment regimen. d. reduce the BMS caused by the methotrexate. 3. The nurse identifies which of the following as the most significant neurotoxin of the cytotoxic drug class? a. paclitaxel (Taxol) b. docetaxel (Taxotere) c. vincristine (Vincasar PFS) d. etoposide (Toposar) 4. A pregnant woman has been diagnosed with cancer and is meeting with her oncologist to plan treatment. Which statement about chemotherapy and pregnancy is true? a. She will have to wait until the baby is born before starting chemotherapy. b. The greatest risk of fetal harm from chemotherapy is during the third trimester. c. Chemotherapy treatment during the second or third trimester poses less risk to the fetus. d. Chemotherapy is unsafe during pregnancy, but radiation therapy is safe in low doses. 5. The nurse is caring for a patient who received chemotherapy 24 hours ago. The patient’s white blood cell count is 4,400 mcL. Which symptom, if experienced by the patient, should the nurse report to the prescriber immediately? a. Fatigue b. Diarrhea c. Fever d. Nausea and vomiting 6. When working with a patient who is neutropenic, the nurse identifies which as the most effective measure to prevent the patient from developing an infection? a. Administer prophylactic antibiotics. b. Stop administration of the chemotherapeutic drug. c. Perform hand hygiene. d. Vaccinate the patient to prevent bacterial infection. 7. Which cytotoxic antibiotic does the nurse identify as most likely to cause pulmonary fibrosis? a. Plicamycin b. mitoxantrone c. mitomycin d. bleomycin 8. Bevacizumab (Avastin) is an angiogenesis inhibitor. Which statement correctly describes the mechanism of action of an angiogenesis inhibitor? a. It inhibits the formation of blood cells. b. It inhibits the creation of new blood vessels in the tumor mass. c. It interferes with the synthesis of DNA in the cancer tumor. d. It causes cell death by inhibiting enzymes. 9. When handling and administering vesicant drugs, the nurse will: a. double flush the patient’s bodily secretions in the commode. b. use sterile towels to clean up after chemotherapy spills. c. mix chemotherapeutic drugs in the patient’s room. d. teach the patient how to administer parenteral chemotherapeutic drugs. 10. A patient’s chemotherapy has ended at 1800 on a Tuesday afternoon. When is it appropriate to start therapy with filgrastim? a. 1800 on Tuesday b. 0600 on Wednesday c. 1800 on Wednesday d. 1 week later, 1800 the next Tuesday 11. Which statement regarding use of MABs in the treatment of cancer does the nurse identify as being true? a. MABs are not as effective as other chemotherapy drugs. b. MABs have few adverse effects. c. MABs may cause flulike effects but do not cause the typical adverse effects associated with chemotherapy. d. MABs are only used in cases of last resort when other chemotherapy drugs have failed. 12. A 40-year-old female patient is seen in the clinic. She has been newly diagnosed with RA. Which medication does the nurse anticipate being ordered for the patient? a. Methotrexate b. adalimumab c. infliximab d. etanercept 13. Before administering methotrexate, it is most important for the nurse to assess the patient for: a. allergy to eggs. b. congestive heart failure. c. latent tuberculosis. d. hypothyroidism. 14. The patient is scheduled for discharge. Which information does the nurse include when teaching the patient about methotrexate therapy? a. You can expect to develop mouth sores that will improve with time when taking this medication. b. Administer the methotrexate injection daily in the early morning. c. Mix the methotrexate with sterile saline before administration. d. Administer the methotrexate subcutaneously into the thigh, abdomen, or upper arm, rotating injection sites. 15. The patient improves within the first 3 months of treatment with methotrexate. Six months later, the patient experiences worsening of symptoms. The prescriber will most likely order which monoclonal antibody for the treatment of RA? a. adalimumab (Humira) b. trastuzumab (Herceptin) c. rituximab (Rituxan) d. cetuximab (Erbitux) 16. The nurse should question the prescriber regarding use of cyclosporine for the treatment of which disease? a. Arthritis b. Psoriasis c. Irritable bowel disease d. MS 17. The nurse notes an order for the patient to receive an IV dose of methylprednisolone prior to administration of basiliximab. The nurse understands the rationale for this therapy as: a. decrease pain at infusion site. b. enhanced suppression of immune system. c. prevention of fluid retention. d. prevention of cytokine release syndrome. 18. A patient who had a kidney transplant is receiving cyclosporine orally in maintenance doses. What action would decrease the potency of this drug? a. Taking it with orange juice b. Taking it with milk c. Using a Styrofoam container to administer the drug d. Mixing it with chocolate milk 19. Which potential problem is of most concern for a patient receiving immunosuppressant drugs? a. Orthostatic hypotension b. Increased susceptibility to infections c. Neurotoxicity d. Peripheral edema 20. A patient is being discharged on cyclosporine therapy. Which statement by the patient indicates that more teaching is needed? “I will take the cyclosporine tablet with: a. Water.” b. Milk.” c. grapefruit juice.” d. apple juice.” 21. A male patient who received a kidney transplant 6 months ago is taking cyclosporine. The patient tells the nurse that he has started to take several herbal preparations. Which does not pose a possible problem for the patient? a. St. John’s wort b. Ginkgo c. Cat’s claw d. Echinacea 22. Before administering Gardasil, it is most important for the nurse to assess the patient for an allergy to: a. Yeast. b. Milk. c. Eggs. d. penicillin. 23. A patient has an order for the varicella vaccine. It is most important for the nurse to assess the patient for: a. use of high dose systemic steroids in the past month. b. allergy to aspirin. c. allergy to eggs. d. history of hypertension. 24. A patient with AIDS was cut by a rusty piece of metal while walking outside. He recalls that his last tetanus booster was more than 20 years ago. Which immunization therapy will he receive at this time? a. He cannot receive any type of immunization therapy. b. Tetanus immunoglobulin c. Tetanus toxoid, adsorbed d. Tetanus and diphtheria toxoid (Td) booster 25. The zoster vaccine (Zostavax) is used in which situation? a. To prevent chickenpox in children b. To prevent chickenpox in children who have been exposed to herpes zoster c. To prevent postherpetic neuralgia in patients who have shingles d. To prevent reactivation of the zoster virus that causes shingles in patients age 60 years and older 26. After immunizations at a well-baby check-up, a mother notes that her infant has redness and swelling at the injection site, is irritable, and has a fever of 99.9° F. She calls the clinic and is worried about her baby. Which action by the nurse is appropriate? a. Tell the mother there’s nothing to worry about and that these symptoms are normal and will go away. b. Tell the mother that she should bring her baby in to the office for an examination. c. Tell the mother that acetaminophen and rest should help to alleviate these symptoms, which are not unusual after immunizations. d. Complete a VAERS form. Ch 45-49 PPT Answers 1. Correct answer: A a. Rationale: Manifestations of tumor lysis syndrome include hyperphosphatemia, hyperkalemia, and hypocalcemia. These electrolyte abnormalities are often treated with diuretics such as mannitol, intravenous calcium supplementation, oral or rectal potassium exchange resin, and oral aluminum hydroxide. Hyperuricemia can lead to nephropathy, and hemodialysis may be required in severe cases of tumor lysis syndrome. 2. Correct answer: D a. Rationale: Leucovorin “rescue” is prescribed to reduce the BMS that is associated with high-dose methotrexate therapy. 3. Correct answer: C a. Rationale: Vincristine is the most significant neurotoxin of the cytotoxic drug class, but it continues to be used in part because of its relative lack of BMS. Special care must be taken not to inadvertently give vincristine via the intrathecal route. Several deaths have been reported because of this error. 4. Correct answer: C a. Rationale: Both radiation and chemotherapy treatments can cause significant permanent fetal harm or death. The greatest risk is during the first trimester. Chemotherapy treatment during the second or third trimester is more likely to improve maternal outcome without significant fetal risk. However, radiation treatment poses great risk to the fetus throughout pregnancy and should be reserved for the postpartum period if possible. Prepubertal patients are more resilient, however, and can have normal puberty and fertility. 5. Correct answer: C a. Rationale: Fever is the principal early sign of infection, especially in those with a low white blood cell count. The presence of a fever is of utmost concern and should be reported immediately. A normal white blood cell count is 4500 to 10,000 mcL. 6. Correct answer: C a. Rationale: Risk of infection from leukopenia or neutropenia or immunosuppression is one of the more significant adverse effects that requires close attention. Following Standard Precautions and using good handwashing technique are most important in preventing transmission of infection in the hospital and home settings. 7. Correct answer: D a. Rationale: Bleomycin is most likely to cause pulmonary fibrosis and pneumonitis. Plicamycin is most likely to cause tissue damage in the event of extravasation. Mitoxantrone is most likely to cause cardiovascular toxicity, and mitomycin is most likely to cause liver, kidney, and lung toxicities. 8. Correct answer: B a. Rationale: Bevacizumab (Avastin) is the first approved angiogenesis inhibitor. Angiogenesis is the creation of new blood vessels that supply oxygen and other blood nutrients to growing tissues. In the case of malignant tumors, angiogenesis that occurs within the tumor mass promotes continued tumor growth. As a tumor enlarges, its central tissues gradually die off (necrosis). However, its outer portion continues to grow, often to fatal proportions, with blood supplied through angiogenesis. Thus, inhibiting this process offers a promising new mechanism for antineoplastic drug action. 9. Correct answer: A a. Rationale: When providing care to patients receiving vesicant drugs as well as handling and administering these drugs, the nurse should double flush the patient’s bodily secretions in the commode and use special hampers for the disposal of all items that come in contact with the patient, including used personal protective equipment. If a spill occurs, the nurse should use special spill kits to clean up even the smallest chemotherapy spills. Nurses who are specially trained, current, and certified should administer chemotherapeutic agents. 10. Correct answer: C a. Rationale: Filgrastim and sargramostim have significant drug interactions when given with myelosuppressive antineoplastic drugs. Typically, filgrastim and sargramostim are not given within 24 hours of administration of myelosuppressive antineoplastics. 11. Correct answer: C a. Rationale: Because these drugs only target cancer cells, they do not have the adverse effects that are typically associated with chemotherapy. However, they do cause acute symptoms that are similar to classic allergy or flulike symptoms. As a result, these symptoms are managed during therapy. 12. Correct answer: A a. Rationale: For the treatment of RA, the recommend therapy with nonbiologic DMARDs usually begins with methotrexate or leflunomide for most patients. Biologic DMARDs are generally reserved for patients whose disease does not respond to methotrexate or leflunomide. The biologic DMARDs include etanercept, infliximab, adalimumab, abatacept, and rituximab. 13. Correct answer: C a. Rationale: Before administering DMARDs, it is important for the nurse to assess the patient for contraindications to the use of DMARDs such as active bacterial infections, active herpes, active or latent tuberculosis, and acute or chronic hepatitis B or C. 14. Correct answer: D a. Rationale: Methotrexate should be administered subcutaneously into the thigh, abdomen, or upper arm, rotating injection sites. Methotrexate should not be administered with other solutions and without use of a filter. Methotrexate is taken weekly. The development of stomatitis should be reported to the prescriber immediately. 15. Correct answer: A a. Rationale: Adalimumab (Humira) is indicated for the treatment of severe, progressive RA for which other RA therapies have failed. Trastuzumab (Herceptin) is indicated for the treatment of breast cancer. Rituximab (Rituxan) is used for the treatment of non-Hodgkin’s lymphoma, and cetuximab (Erbitux) is indicated for the treatment of metastatic colorectal cancer. 16. Correct answer: D a. Rationale: Cyclosporine (Sandimmune, Neoral, Gengraf) is an immunosuppressant drug that is indicated for the prevention of organ rejection as well as the treatment of other immunologic disorders, such as various forms of arthritis, psoriasis, and irritable bowel disease. 17. Correct answer: D a. Rationale: Both basiliximab and daclizumab, both injectable dosage forms, are associated with an allergic-like reaction known as cytokine release syndrome. It may be severe and even involve anaphylaxis, so patients are usually premedicated with corticosteroids (e.g., IV methylprednisolone) to try to avoid or alleviate this problem. 18. Correct answer: C a. Rationale: Cyclosporine should not be mixed in a Styrofoam container because the medication has been found to adhere to the inside wall of the cup or container. 19. Correct answer: B a. Rationale: Neurotoxicity and edema may be a problem with some immunosuppressants (not orthostatic hypotension), but a heightened susceptibility to opportunistic infections is a major risk factor in immunosuppressed patients. 20. Correct answer: C a. Rationale: Common drug interactions to assess for when patients take cyclosporin include estrogens, protease inhibitors, HMG-CoA reductase inhibitors, clarithromycin, phenytoin, phenobarbital, St. John’s wort, nonsteroidal antiinflammatory drugs, and grapefruit juice. 21. Correct answer: B a. Rationale: The potential for interactions between immunosuppressant drugs and herbal preparations should not be overlooked. For example, the enzyme-inducing properties of St. John’s wort have been demonstrated to reduce the therapeutic levels of cyclosporine and cause organ rejection. The immunostimulant properties of cat’s claw and echinacea may be similarly undesirable in transplant recipients because they have effects that are opposite those of the immunosuppressants. 22. Correct answer: A a. Rationale: The nurse should not administer the papillomavirus vaccine (Gardasil, Cervarix) to patients with allergies to yeast or patients who have a documented allergic reaction to the first injection of the vaccine. 23. Correct answer: A a. Rationale: Varicella vaccine is not to be given to immunodeficient patients or to patients who have received high doses of systemic steroids in the previous month. It is also recommended that salicylates be avoided for 6 weeks after administration of varicella vaccine because of the possibility of Reye’s syndrome. 24. Correct answer: B a. Rationale: Vaccines and toxoids rely on a person’s immune system to work. Patients who are immunocompromised (as in those receiving immunosuppressive therapy and those with AIDS) may not benefit from vaccines or toxoids because they are unable to mount an immune response. In these situations, passive immunizing drugs such as immunoglobulins are warranted. 25. Correct answer: D a. Rationale: Zoster vaccine (Zostavax) is a vaccine for the prevention of herpes zoster. The vaccine is recommended for patients 60 years and older to prevent reactivation of the zoster virus that causes shingles. The vaccine does not prevent postherpetic neuralgia. It can be given to patients who have already had shingles. The vaccine should not be used for the prevention of chickenpox and should not be given to children. 26. Correct answer: C a. Rationale: These minor reactions may be treated with acetaminophen and rest. Reactions that are more serious or unusual should be reported with a VAERS form. Ch 38 Questions 1. When reviewing the allergy history of a patient, the nurse notes that the patient is allergic to penicillin. Based on this finding, the nurse would question an order for which class of antibiotics? a. Tetracyclines b. Sulfonamides c. Cephalosporins d. Quinolones 2. The nurse is providing teaching to a patient taking an oral tetracycline antibiotic. Which statement by the nurse is correct? a. “Avoid direct sunlight and tanning beds while on this medication.” b. “Milk and cheese products result in increased levels of tetracycline.” c. “Antacids taken with the medication help to reduce gastrointestinal distress.” d. “Take the medication until you are feeling better.” 3. When reviewing the medication orders for a patient who is taking penicillin, the nurse notes that the patient is also taking the oral anticoagulant warfarin (Coumadin). What possible effect may occur as the result of an interaction between these drugs? a. The penicillin will cause an enhanced anticoagulant effect of the warfarin. b. The penicillin will cause the anticoagulant effect of the warfarin to decrease. c. The warfarin will reduce the anti-infective action of the penicillin. d. The warfarin will increase the effectiveness of the penicillin. 4. A patient is receiving his third intravenous dose of a penicillin drug. He calls the nurse to report that he is feeling “anxious” and is having trouble breathing. What will the nurse do first? a. Notify the prescriber. b. Take the patient’s vital signs. c. Stop the antibiotic infusion. d. Check for allergies. 5. A patient is admitted with a fever of 102.8° F (39.3° C), origin unknown. Assessment reveals cloudy, foul-smelling urine that is dark amber in color. Orders have just been written to obtain stat urine and blood cultures and to administer an antibiotic intravenously. The nurse will complete these orders in which sequence? a. Blood culture, antibiotic dose, urine culture b. Urine culture, antibiotic dose, blood culture c. Antibiotic dose, blood and urine cultures d. Blood and urine cultures, antibiotic dose 6. During drug therapy with a tetracycline antibiotic, a patient complains of some nausea and decreased appetite. Which statement is the nurse’s best advice to the patient? a. “Take it with cheese and crackers or yogurt.” b. “Take each dose with a glass of milk.” c. “Take an antacid with each dose as needed.” d. “Drink a full glass of water with each dose.” 7. The nurse is monitoring a patient who has been on antibiotic therapy for 2 weeks. Today the patient tells the nurse that he has had watery diarrhea since the day before and is having abdominal cramps. His oral temperature is 101° F (38.3° C). Based on these findings, which conclusion will the nurse draw? a. The patient’s original infection has not responded to the antibiotic therapy. b. The patient is showing typical adverse effects of antibiotic therapy. c. The patient needs to be tested for Clostridium difficile infection. d. The patient will need to take a different antibiotic. 8. The nurse is monitoring for therapeutic results of antibiotic therapy in a patient with an infection. Which laboratory value would indicate therapeutic effectiveness of this therapy? a. Increased red blood cell count b. Increased hemoglobin level c. Decreased white blood cell count d. Decreased platelet count 9. The nurse is reviewing the sputum culture results of a patient with pneumonia and notes that the patient has a gram-positive infection. Which generation of cephalosporin is most appropriate for this type of infection? a. First generation b. Second generation c. Third generation d. Fourth generation 10. A patient will be having oral surgery and has received an antibiotic to take for 1 week before the surgery. The nurse knows that this is an example of which type of therapy? a. Empiric b. Prophylactic c. Definitive d. Resistance 11. A patient has a urinary tract infection. The nurse knows that which class of drugs is especially useful for such infections? a. Macrolides b. Carbapenems c. Sulfonamides d. Tetracyclines 12. During drug therapy for pneumonia, a female patient develops a vaginal superinfection. The nurse explains that this infection is caused by: a. large doses of antibiotics that kill normal flora. b. the infection spreading from her lungs to the new site of infection. c. resistance of the pneumonia-causing bacteria to the drugs. d. an allergic reaction to the antibiotics. 13. The nurse is preparing to use an antiseptic. Which statement is correct regarding how antiseptics differ from disinfectants? a. Antiseptics are used to sterilize surgical equipment. b. Disinfectants are used as preoperative skin preparation. c. Antiseptics are used only on living tissue to kill microorganisms. d. Disinfectants are used only on nonliving objects to destroy organisms. 14. A patient with a long-term intravenous catheter is going home. The nurse knows that if he is allergic to seafood, which antiseptic agent is contraindicated? a. Chlorhexidine gluconate (Hibiclens) b. Hydrogen peroxide c. Povidone-iodine (Betadine) d. Isopropyl alcohol 15. During antibiotic therapy, the nurse will monitor closely for signs and symptoms of a hypersensitivity reaction. Which of these assessment findings may be an indication of a hypersensitivity reaction? (Select all that apply.) a. Wheezing b. Diarrhea c. Shortness of breath d. Swelling of the tongue e. Itching f. Black, hairy tongue 16. The nurse is reviewing the medication history of a patient who will be taking a sulfonamide antibiotic. During sulfonamide therapy, a significant drug interaction may occur with which of these drugs or drug classes? (Select all that apply.) a. Opioids b. Oral contraceptives c. Sulfonylureas d. Antihistamines e. Phenytoin (Dilantin) f. Warfarin (Coumadin) Ch 38 Answers 1. ANS: C a. Allergy to penicillin may also result in hypersensitivity to cephalosporins. The other options are incorrect. 2. ANS: A a. Drug-related photosensitivity occurs when patients take tetracyclines, and it may continue for several days after therapy. Milk and cheese products result in decreased levels of tetracycline when the two are taken together. Antacids also interfere with absorption and should not be taken with tetracycline. Counsel patients to take the entire course of prescribed antibiotic drugs, even if they feel that they are no longer ill. 3. ANS: A a. Administering penicillin reduces the vitamin K in the gut (intestines); therefore, enhanced anticoagulant effect of warfarin may occur. The other options are incorrect. 4. ANS: C a. Hypersensitivity reactions are characterized by wheezing; shortness of breath; swelling of the face, tongue, or hands; itching; or rash. The nurse should immediately stop the antibiotic infusion, have someone notify the prescriber, and stay with the patient to monitor the patient’s vital signs and condition. Checking for allergies should have been done before the infusion. 5. ANS: D a. Culture specimens should be obtained before initiating antibiotic drug therapy; otherwise, the presence of antibiotics in the tissues may result in misleading culture and sensitivity results. The other responses are incorrect. 6. ANS: D a. Oral doses should be given with at least 8 ounces of fluids and food to minimize gastrointestinal upset; however, antacids and dairy products will bind with the tetracycline and make it inactive. 7. ANS: C a. Antibiotic-associated diarrhea is a common adverse effect of antibiotics. However, it becomes a serious superinfection when it causes antibiotic-associated colitis, also known as pseudomembranous colitis or simply C. difficile infection. This happens because antibiotics disrupt the normal gut flora and can cause an overgrowth of Clostridium difficile. The most common symptoms of C. difficile colitis are watery diarrhea, abdominal pain, and fever. Whenever a patient who was previously treated with antibiotics develops watery diarrhea, the patient needs to be tested for C. difficile infection. If the results are positive, the patient will need to be treated for this serious superinfection. 8. ANS: C a. Decreased white blood cell counts are an indication of reduction of infection and are a therapeutic effect of antibiotic therapy. The other options are incorrect. 9. ANS: A a. First-generation cephalosporins provide excellent coverage against gram-positive bacteria but limited coverage against gram-negative bacteria. 10. ANS: B a. Prophylactic antibiotic therapy is used to prevent infection. Empiric therapy involves selecting the antibiotic that can best kill the microorganisms known to be the most common causes of an infection. Definitive therapy occurs once the culture and sensitivity results are known. Resistance is not a type of antibiotic therapy. 11. ANS: C a. Sulfonamides achieve very high concentrations in the kidneys, through which they are eliminated. Therefore, they are often used in the treatment of urinary tract infections. 12. ANS: A a. Normally occurring bacteria are killed during antibiotic therapy, allowing other flora to take over and resulting in superinfections. The other options are incorrect. 13. ANS: D a. Antiseptics primarily inhibit microorganisms but do not necessarily kill them. They are applied exclusively to living tissue. Disinfectants are able to kill organisms and are used only on nonliving objects. 14. ANS: C a. Iodine compounds are contraindicated in patients with allergies to seafood. The other options are incorrect. 15. ANS: A, C, D, E a. Hypersensitivity reactions may be manifested by wheezing; shortness of breath; swelling of the face, tongue, or hands; itching; or rash. 16. ANS: B, C, E, F a. Sulfonamides may potentiate the hypoglycemic effects of sulfonylureas in diabetes treatment, the toxic effects of phenytoin, and the anticoagulant effects of warfarin, which can lead to hemorrhage. Sulfonamides may also reduce the efficacy of oral contraceptives. Ch 39 Questions 1. When a patient is on aminoglycoside therapy, the nurse will monitor the patient for which indicators of potential toxicity? a. Fever b. White blood cell count of 8000 cells/mm3 c. Tinnitus and dizziness d. Decreased blood urea nitrogen (BUN) levels 2. The nurse is administering a vancomycin (Vancocin) infusion. Which measure is appropriate for the nurse to implement in order to reduce complications that may occur with this drug’s administration? a. Monitoring blood pressure for hypertension during the infusion b. Discontinuing the drug immediately if red man syndrome occurs c. Restricting fluids during vancomycin therapy d. Infusing the drug over at least 1 hour 3. Which nursing diagnosis is appropriate for a patient who has started aminoglycoside therapy? a. Constipation b. Risk for injury (renal damage) c. Disturbed body image related to gynecomastia d. Imbalanced nutrition, less than body requirements, related to nausea 4. A patient who has been hospitalized for 2 weeks has developed a pressure ulcer that contains multidrug-resistant Staphylococcus aureus (MRSA). Which drug would the nurse expect to be chosen for therapy? a. Metronidazole (Flagyl) b. Ciprofloxacin (Cipro) c. Vancomycin (Vancocin) d. Tobramycin (Nebcin) 5. A patient is receiving aminoglycoside therapy and will be receiving a beta-lactam antibiotic as well. The patient asks why two antibiotics have been ordered. What is the nurse’s best response? a. “The combined effect of both antibiotics is greater than each of them alone.” b. “One antibiotic is not strong enough to fight the infection.” c. “We have not yet isolated the bacteria, so the two antibiotics are given to cover a wide range of microorganisms.” d. “We can give a reduced amount of each one if we give them together.” 6. The nurse is reviewing the medication orders for a patient who will be receiving gentamicin therapy. Which other medication or medication class, if ordered, would be a potential interaction concern? a. Calcium channel blockers b. Phenytoin c. Proton pump inhibitors d. Loop diuretics 7. The nurse checks the patient’s laboratory work prior to administering a dose of vancomycin (Vancocin) and finds that the trough vancomycin level is 24 mcg/mL. What will the nurse do next? a. Administer the vancomycin as ordered. b. Hold the drug, and administer 4 hours later. c. Hold the drug, and notify the prescriber. d. Repeat the test to verify results. 8. A patient has been diagnosed with carbapenemase-resistant Enterobacteriaceae (CRE). The nurse expects to see orders for which drug? a. Dapsone (Cubicin), a miscellaneous antibiotic b. Ciprofloxacin (Cipro), a quinolone c. Linezolid (Zyvox), an oxazolidinone d. Colistimethate sodium (Coly-Mycin), a polypeptide antibiotic 9. A 79-year-old patient is receiving a quinolone as treatment for a complicated incision infection. The nurse will monitor for which adverse effect that is associated with these drugs? a. Neuralgia b. Double vision c. Hypotension d. Tendonitis and tendon rupture 10. The nurse is administering intravenous vancomycin (Vancocin) to a patient who has had gastrointestinal surgery. Which nursing measures are appropriate? (Select all that apply.) a. Monitoring serum creatinine levels b. Restricting fluids while the patient is on this medication c. Warning the patient that a flushed feeling or facial itching may occur d. Instructing the patient to report dizziness or a feeling of fullness in the ears e. Reporting a trough drug level of 11 mcg/mL and holding the drug f. Reporting a trough drug level of 24 mcg/mL and holding the drug 11. A patient will be receiving nitrofurantoin (Macrodantin) treatment for a urinary tract infection. The nurse is reviewing the patient’s history and will question the nitrofurantoin order if which disorder is present in the history? (Select all that apply.) a. Liver disease b. Coronary artery disease c. Hyperthyroidism d. Type 1 diabetes mellitus e. Chronic renal disease Ch 39 Answers 1. ANS: C a. Dizziness, tinnitus, hearing loss, or a sense of fullness in the ears could indicate ototoxicity, a potentially serious toxicity in a patient. Nephrotoxicity is indicated by rising blood urea nitrogen and creatinine levels. Fever may be indicative of the patient’s infection; a white blood cell count of 7000 cells/mm3 is within the normal range of 5000 to 10,000 cells/mm3. 2. ANS: D a. Infuse the medication over at least 1 hour to reduce the occurrence of red man syndrome. Adequate hydration (at least 2 L of fluid in 24 hours) during vancomycin therapy is important for the prevention of nephrotoxicity. Hypotension may occur during the infusion, especially if it is given too rapidly. 3. ANS: B a. Patients on aminoglycoside therapy have an increased risk for injury caused by nephrotoxicity. The other options are incorrect. 4. ANS: C a. Vancomycin is the drug of choice for the treatment of MRSA. The other drugs are not used for MRSA. 5. ANS: A a. Aminoglycosides are often used in combination with other antibiotics, such as beta-lactams or vancomycin, in the treatment of various infections because the combined effect of the two antibiotics is greater than that of either drug alone. 6. ANS: D a. Concurrent use of aminoglycosides, such as gentamicin, with loop diuretics increases the risk for ototoxicity. The other drugs and drug classes do not cause interactions. 7. ANS: C a. Optimal blood levels of vancomycin are a trough level of 10 to 20 mcg/mL. Measurement of peak levels is no longer routinely recommended, and only trough levels are commonly monitored. Blood samples for measurement of trough levels are drawn immediately before administration of the next dose. Because of the increase in resistant organisms, many clinicians use a trough level of 15 to 20 mcg/mL as their goal. These trough levels mean that even just before the next dose is due, when drug levels should be low, the drug levels are actually too high. 8. ANS: D a. Colistimethate (Coly-Mycin), commonly referred to as colistin, is now being used again, often as one of the only drugs available to treat CRE. The other options are incorrect. 9. ANS: D a. A black-box warning is required by the U.S. Food and Drug Administration for all quinolones because of the increased risk for tendonitis and tendon rupture with use of the drugs. This effect is more common in elderly patients, patients with renal failure, and those receiving concurrent glucocorticoid therapy (e.g., prednisone). The other options are not common adverse effects. 10. ANS: A, C, D, F a. Constant monitoring for drug-related neurotoxicity, nephrotoxicity, ototoxicity, and superinfection remain critical to patient safety. Monitor for nephrotoxicity by monitoring serum creatinine levels. Ototoxicity may be indicated if the patient experiences dizziness or a feeling of fullness in the ears, and these symptoms must be reported immediately. Vancomycin infusions may cause red man syndrome, which is characterized by flushing of the neck and face and a decrease in blood pressure. In addition, adequate hydration (at least 2 L of fluids every 24 hours unless contraindicated) is most important to prevent nephrotoxicity. Optimal trough blood levels of vancomycin are 10 to 20 mcg/mL; therefore, the drug should not be administered when there is a trough level of 24 mcg/mL. 11. ANS: A, E a. Nitrofurantoin is contraindicated in cases of known drug allergy and also in cases of significant renal function impairment, because the drug concentrates in the urine. Because adverse effects include hepatotoxicity, which is rare but often fatal, the nurse should also question the order if liver disease is present. The other options are not contraindications. Ch 40 Questions 1. A patient who is diagnosed with shingles is taking topical acyclovir, and the nurse is providing instructions about adverse effects. The nurse will discuss which adverse effects of topical acyclovir therapy? a. Insomnia and nervousness b. Temporary swelling and rash c. Burning when applied d. This medication has no adverse effects. 2. A patient who has undergone a lung transplant has contracted cytomegalovirus (CMV) retinitis. The nurse expects which drug to be ordered for this patient? a. Acyclovir (Zovirax) b. Ganciclovir (Cytovene) c. Ribavirin (Virazole) d. Amantadine (Symmetrel) 3. An infant has been hospitalized with a severe lung infection caused by the respiratory syncytial virus (RSV) and will be receiving medication via the inhalation route. The nurse expects which drug to be used? a. Acyclovir (Zovirax) b. Ganciclovir (Cytovene) c. Amantadine (Symmetrel) d. Ribavirin (Virazole) 4. A patient who is HIV- positive has been receiving medication therapy that includes zidovudine (Retrovir). However, the prescriber has decided to stop the zidovudine because of its dose-limiting adverse effect. Which of these conditions is the dose-limiting adverse effect of zidovudine therapy? a. Retinitis b. Renal toxicity c. Hepatotoxicity d. Bone marrow suppression 5. The nurse is administering intravenous acyclovir (Zovirax) to a patient with a viral infection. Which administration technique is correct? a. Infuse intravenous acyclovir slowly, over at least 1 hour. b. Infuse intravenous acyclovir by rapid bolus. c. Refrigerate intravenous acyclovir. d. Restrict oral fluids during intravenous acyclovir therapy. 6. A patient is receiving cidofovir (Vistide) as part of treatment for a viral infection, and the nurse is preparing to administer probenecid, which is also ordered. Which is the rationale for administering probenecid along with the cidofovir treatment? a. Probenecid has a synergistic effect when given with cidofovir, thus making the antiviral medication more effective. b. The probenecid also prevents replication of the virus. c. Concurrent drug therapy with probenecid reduces the nephrotoxicity of cidofovir. d. The probenecid reduces the adverse gastrointestinal effects of cidofovir. 7. A patient is taking a combination of antiviral drugs as treatment for early stages of a viral infection. While discussing the drug therapy, the patient asks the nurse if the drugs will kill the virus. When answering, the nurse keeps in mind which fact about antiviral drugs? a. They are given for palliative reasons only. b. They will be effective as long as the patient is not exposed to the virus again. c. They can be given in large enough doses to eradicate the virus without harming the body’s healthy cells. d. They may also kill healthy cells while killing viruses. 8. A young adult calls the clinic to ask for a prescription for “that new flu drug.” He says he has had the flu for almost 4 days and just heard about a drug that can reduce the symptoms. What is the nurse’s best response to his request? a. “Now that you’ve had the flu, you will need a booster vaccination, not the antiviral drug.” b. “We will need to do a blood test to verify that you actually have the flu.” c. “Drug therapy should be started within 2 days of symptom onset, not 4 days.” d. “We’ll get you a prescription. As long as you start treatment within the next 24 hours, the drug should be effective.” 9. The nurse is providing counseling to a woman who is HIV positive and has just discovered that she is pregnant. Which anti-HIV drug is given to HIV-infected pregnant women to prevent transmission of the virus to the infant? a. Acyclovir (Zovirax) b. Zidovudine (Retrovir) c. Ribavirin (Virazole) d. Foscarnet (Foscavir) 10. A patient who is diagnosed with genital herpes is taking topical acyclovir. The nurse will provide which teaching for this patient? (Select all that apply.) a. “Be sure to wash your hands thoroughly before and after applying this medicine.” b. “Apply this ointment until the lesion stops hurting.” c. “Use a clean glove when applying this ointment.” d. “If your partner develops these lesions, then he can also use the medication.” e. “You will need to avoid touching the area around your eyes.” f. “You will have to practice abstinence when these lesions are active.” 11. A patient is in the HIV clinic for a follow-up appointment. He has been on antiretroviral therapy for HIV for more than 3 years. The nurse will assess for which potential adverse effects of long-term antiretroviral therapy? (Select all that apply.) a. Lipodystrophy b. Liver damage c. Kaposi’s sarcoma d. Osteoporosis e. Type 2 diabetes Ch 40 Answers 1. ANS: C a. Transient burning may occur with topical application of acyclovir. The other options are incorrect. 2. ANS: B a. Ganciclovir is indicated for the treatment of cytomegalovirus retinitis. Acyclovir is used for herpes simplex types 1 and 2, herpes zoster, and chickenpox; amantadine is used for influenza type A; and zanamivir is used for influenza types A and B. 3. ANS: D a. The inhalational form of ribavirin (Virazole) is used primarily in the treatment of hospitalized infants with severe lower respiratory tract infections caused by RSV. The other drugs listed are not used for the treatment of RSV. 4. ANS: D a. Bone marrow suppression is often the reason that a patient with HIV infection has to be switched to another anti-HIV drug such as didanosine. The two drugs can be taken together, cutting back on the dosages of both and thus decreasing the likelihood of toxicity. The other options are incorrect. 5. ANS: A a. Intravenous acyclovir is sta