1. -Discuss the use of metered-dose inhalers (MDIs) and the sequencing of medications.
..• Metered-dose inhalers (MDIs) are small, hand-held, pressurized devices that deliver a measured dose of drug with each actuation. Dosing is usually accomplished with 1 or 2 puffs. When 2 puffs are needed, an interval of at least 1 minute should separate the first puff from the second. When using an MDI, the patient must begin to inhale prior to activating the device. Hence, hand-lung coordination is required. MDIs can be difficult to use correctly. Hence patients will need a demonstration as well as written and verbal instruction. Even with optimal use, only about 10% of the dose reaches the lungs. About 80% impacts the oropharynx and is swallowed, and the remaining 10% is left in the device or exhaled.
• Several kinds of spacers are available for use with MDIs. All of these devices, which attach directly to the MDI, serve to increase delivery of drug to the lungs and decrease deposition of drug on the oropharyngeal mucosa (Fig. 75-2). Some spacers contain a one-way valve that activates upon inhalation, thereby obviating the need for good hand-lung coordination. Some spacers also contain an alarm whistle that sounds off when inhalation is too rapid. The ability of spacers to reduce drug deposition in the oropharynx is especially important for inhaled glucocorticoids.p. 889).
2. -Discuss the mode of action, side effects, and adverse effects of theophylline (Elixophyllin.)
A bronchodilator whose action is not firmly established - likely relaxation of smooth muscles of the bronchioles by blockade of adenosine receptors.
Oral used for maintenance therapy of chronic asthma. Less effective than B-2 agonists, but have a longer duration of action, especially useful for pts who have nocturnal attacks. Used IV in emergencies.
Narrow therapeutic range: 10-20 mcg/mL. Side effects: tachyardia, nausea, vomiting. Toxicity: serious adverse fx most likely to occur above 30 mcg/mL - severe dysrhythmias (vfib), convulsions, death may result from cardiorespiratory collapse.
3. -What would be most effective for treating seasonal and perennial rhinitis?
a. Pseudoephedrine (Sudafed)
b. Fluticasone propionate (Fluticasone)
c. Loratadine (Claritin)
d. Intranasal cromolyn sodium (Atrovent)
b. Fluticasone propionate (Fluticasone)**
4. -When using an intranasal sympathomimetic for allergic rhinitis, how is the drug discontinued?
• Rebound congestion develops when topical agents are used more than a few days. With prolonged use, as the effects of each application wear off, congestion becomes progressively worse. To overcome this rebound congestion, the patient must use progressively larger and more frequent doses. Hence, once established, rebound congestion can lead to a cycle of escalating congestion and increased drug use. The cycle can be broken by abrupt decongestant withdrawal. However, this tactic can be extremely uncomfortable. A less drastic option is to discontinue the drug in one nostril at a time. An even better option is to use an intranasal glucocorticoid (in both nostrils) for 2 to 6 weeks, starting one week before discontinuing the decongestant. Development of rebound congestion can be minimized by limiting topical application to 3 to 5 days. Accordingly, topical sympathomimetics are not appropriate for individuals with chronic rhinitis.(p. 909).
5. -In a patient with a history of angina, what is safest drug for allergic rhinitis?
INTRANASAL STEROIDS ARE THE BEST
• For treatment of allergic rhinitis, intranasal cromolyn [NasalCrom] is extremely safe, but only moderately effective. Benefits are much less than those of intranasal glucocorticoids. Cromolyn reduces symptoms by suppressing release of histamine and other inflammatory mediators from mast cells. Accordingly, the drug is best suited for prophylaxis—not treatment—and hence should be given before symptoms start. Responses may take a week or two to develop; patients should be informed of this delay. Adverse reactions are minimal—less than with any other drug for allergic rhinitis.. p. 909).
6. -A nurse is caring for an obese patient who is 3 days postoperative. Upon assessment, the nurse discoversthat the patient is short of breath, has respirations of 32/minute, and is coughing up pink, frothy sputum. The nurse should anticipate the administration of which medication?
a. Mannitol (Osmitrol)
b. Furosemide (Lasix)
c. Hydrochlorothiazide (HydroDIURIL)
d. Spironolactone (Aldactone)
b. Furosemide (Lasix)**
• These are signs of pulmonary edema. Treatment is Furosemide (Lasix) - most frequently prescribed loop diuretic
7. -A patient has been taking furosemide (Lasix) for 6 months. A prescriber has just started the patient on digoxin (Lanoxin). What assessment data should most concern the nurse prior to the administration of digoxin?
Lasix will lower K+ levels which can lead to digoxin toxicity. K+ levels must be monitored on any patient receiving both of these meds. CHECK POTASSIUM LEVELS. Safe range is 3.5 to 5.0
8. -A nurse is discussing the mechanism of action of spironolactone (Aldactone) with a group of nurses. The nurse states that spironolactone has been demonstrated to prolong survival as well as improve heart failure symptoms by what actions?
SPIRINOLACTONE BLOCKS ALDOSTERONE
Spirinolactone (Aldactone)--blocks the actions of aldosterone in the distal nephron. Since it acts to promote sodium uptake in exchange for potassium secretion, inhibition of aldosterone has the opposite effect: retention of potassium and increased secretion of sodium.
Spironolactone prolongs survival in patients with heart failure primarily by blocking receptors for aldosterone in the heart and blood vessels
9. -The nurse is instructing a patient receiving a cholesterol-lowering agent. Which information should the nurse include in the patient education?
a. "This medication will replace other interventions you have been trying."
b. "It is important for you to double your dose if you miss one in order to maintain therapeutic blood levels."
c. "Stop taking the medication if you experience constipation."
d. "You should continue your exercise program to increase your HDL serum levels."
d. "You should continue your exercise program to increase your HDL serum levels."**
Weight control, drugs alone do not work. TLC
10. -The nurse is reviewing the patient's medication and realizes that gemfibrozil (Lopid) and warfarin (Coumadin) are to be administered concomitantly. What finding concerns the nurse prior to administration?
Fibrates can increase the risk of bleeding in patients taking warfarin (an anticoagulant) .
Gemfibrozil displaces warfarin from plasma albumin, thereby increasing anticoagulant effects.
11. -The prescriber has ordered rosuvastatin (Crestor) for a patient with non-alcoholic-related cirrhosis. Which intervention would be most appropriate for the nurse prior to administration?
TALK TO PRESCRIBER, REVIEW LIVER FUNCTION LABS~ALT/AST
12. -The nurse has been caring for a patient who has been taking antibiotics for 3 weeks. Upon assessing the patient, the nurse notices the individual has developed oral thrush. Which of the following describes the etiology of the thrush?
Antibiotics trigger oral thrush by killing the mouth's normal population of bacteria. Once these normal bacteria are gone, Candida can grow without competition. People with dry mouth have less saliva and are more prone to developing thrush.
13. -The nurse is caring for a patient on a medical-surgical unit who has been experiencing fever of unknown origin. The prescriber has ordered a broad-spectrum antibiotic. Which intervention is the priority?
a. Administer the antibiotic immediately.
b. Administer antipyretics as soon as possible.
c. Obtain all cultures before the antibiotic is administered.
d. Delay administration of the antibiotic until the culture results are available.
c. OBTAIN ALL CULTURES BEFORE ABX ADMINISTERED
14. -A patient has just received a prescription for a 10-day course of penicillin for the treatment of strep throat. What patient education is essential for the nurse to provide?
Take the entire course of abx - do not stop taking the medicine once the sx have subsided.
15. -The patient's prescriber has ordered antibiotic combination therapy. The patient asks the nurse why two antibiotics are required. What is the benefit of combination therapy?
An additive response is one in which the antimicrobial effect of the combination is equal to the sum of the effects of the two drugs alone. A potentiative interaction (also called a synergistic interaction) is one in which the effect of the combination is greater than the sum of the effects of the individual agents
16. -The nurse, who is teaching a pharmacology refresher course to a group of nurses, is discussing selective toxicity, what is the significance of this?
Selective toxicity is the ability of an antibiotic to kill or suppress microbial pathogens without causing injury to the host.
17. -The nurse is discussing the mechanism of action of omeprazole (Prilosec) with a group of nursing students. What is the mechanism of action of omeprazole?
a. The duration of action is short because the drug has a short half-life.
b. Absorption occurs in the stomach when the pH is greater than 7
c. It irreversibly inhibits the enzyme needed to produce stomach acid.
d. the complete return of acid production occurs.
SIMILAR TO QUIZ QUESTION
c. It irreversibly inhibits the enzyme needed to produce stomach acid.**
18. -The nurse has provided education on factors that contribute to ulcer formation to her patient diagnosed with peptic ulcer disease (PUD). What must be included in patient teaching?
b. H.pylori infection
e. Decreased gastrin production
SIMILAR TO QUIZ QUESTION
b. H.pylori infection
19. -A patient is placed on a multidrug regimen that includes bismuth for treatment of peptic ulcer disease. The nurse should include what points when providing patient education?
BLACK TONGUE AND BLACK STOOL
• Bismuth can impart a harmless black coloration to the tongue and stool. Patients should be forewarned. Stool discoloration may confound interpretation of gastric bleeding. Long-term therapy may carry a risk of neurologic injury.918).
20. -When metronidazole (Flagyl) is a component of the H. pylori treatment regimen, what must be included in patient education?
AVOID ETOH WHEN ON FLAGYL
• Sucralfate [Carafate] is an effective antiulcer medication notable for minimal side effects and lack of significant drug interactions. The drug promotes ulcer healing by creating a protective barrier against acid and pepsin. Sucralfate has no acid-neutralizing capacity and does not decrease acid secretion.. p. 923).
• Under mildly acidic conditions (pH less than 4), sucralfate undergoes polymerization and cross-linking reactions. The resultant product is a viscid and very sticky gel that adheres to the ulcer crater, creating a barrier to back-diffusion of hydrogen ions, pepsin, and bile salts. Attachment to the ulcer appears to last up to 6 hours.p. 923).
21. -The nurse is providing patient education to an elderly patient being treated for duodenal ulcers. The prescriber has ordered sucralfate (Carafate). The patient asks the nurse how sucralfate helps heal ulcers. What is the nurse's response?
The drug promotes ulcer healing by creating a protective barrier against acid and pepsin.
22. -The nurse is providing education to a patient who has been prescribed both an antacid and ranitidine (Zantac). Which instruction should the nurse give the patient about taking the medications?
CAN'T TAKE TOGETHER---TAKE 1 HR APART
• Antacids can influence the dissolution and decrease absorption of ranitidine (and cimetidine) by raising gastric pH, but can be minimized by allowing 1 hour gap before administering this drug.
23. -A patient comes to the emergency department complaining of nausea, vomiting, and abdominal cramps. The nurse anticipates that the patient should receive what treatment?
can give zofran
do NOT give laxatives
24. -What information would be most important for the nurse to provide to a patient requesting a prn dose of magnesium hydroxide (Milk of Magnesia)?
1. Increase fluid intake.
2. Restrict liquids after taking the drug.
3. Use with mineral oil to avoid irritation.
4. Expect immediate results.
INCREASE FLUID INTAKE
*milk of magnesia alleviates constipation by increasing water absorption into the colon.
25. -A patient admitted to the unit for dehydration tells the nurse that he has not had a bowel movement in 5 days, and he typically has one daily. The nurse administers psyllium (Metamucil) as ordered and should monitor the patient for what side effect?
IF TAKE TOO MUCH METAMUCIL CAN LEAD TO IMPACTION
26. -The nurse on an oncology unit is caring for a patient with lung cancer. Prior to the next dose of cisplatin (Platinol-AQ), which antiemetic would the nurse most likely administer to the patient?
SEROTONIN RECEPTOR ANTAGONIST
There are four types of Serotonin Receptor Antagonists: Ondansetron (Zofran), Granisetron, Dolasetron, Palonosetron.
27. -The nurse is caring for a patient who is receiving chemotherapy. The patient complains of nausea and begins to vomit. The nurse administers ondansetron (Zofran) to alleviate the nausea. Which medication given concurrently with ondansetron would increase its effectiveness?
1. Dexamethasone (Decadron)
2. Ranitidine (Zantac)
3. Loperamide (Imodium).
4. Alosetron (Lotronex)
1. Dexamethasone (Decadron)**
28. -The nurse is preparing to administer dronabinol (Marinol) to a newly admitted patient. Prior to administration, the nurse reviews the patient's health history. Which patient would you need to question this medication?
a. The patient has a history of bradycardia.
b. The patient has a history of drug abuse.
c. The patient has acquired immunodeficiency syndrome (AIDS).
d. The patient has a history of psychiatric disorders.
d. The patient has a history of psychiatric disorders.**
29. -The nurse is preparing to administer diphenoxylate (Lomotil) to a patient who complains of diarrhea. For what side effects would the nurse observe the patient after administration of this medication?
ITS AN OPIOID--CONSTIPATION, EUPHORIA, BLURRED VISIONS
This drug is an opioid, and it's the only opioid used for diarrhea. When taking high doses, this drug can elicit morphine-like subjective responses.
30. -A patient with type I diabetes is eating breakfast at 0730. Blood sugars are on a sliding scale and are ordered AC and HS. The patient's blood sugar level is 317 mg/dL. What type of insulin should the nurse prepare to administer?
a. No insulin should be administered.
c. 70/30 mix
d. Lispro (Humalog)
d. Lispro (Humalog)**Rapid Acting.
(Lispro is probably the most ideal)
31. -What are short-term complications of diabetes?
Hyperglycemia, which, if allowed to persist, can lead to ketoacidosis. Hypoglycemia can lead to coma. Short term complications are more common with Type 1 Diabetes.
32. -An adolescent patient recently attended a health fair and had a serum glucose test. The patient telephones the nurse and says, "My level was 125 mg/dL. Does that mean I have diabetes?" What is the nurse's response?
NURSE SHOULD ASK IF PT FASTING WHEN TAKING BLOOD GLUCOSE
Excessive plasma glucose is diagnostic of diabetes. Three tests may be employed: a fasting plasma glucose (FPG) test, a casual plasma glucose test, and an oral glucose tolerance test (OGTT). Values diagnostic of diabetes are summarized in Table 56-2. To make a definitive diagnosis, the patient must be tested on two separate days, and both tests must be positive. Any combination of two tests (eg, two FPG tests; one FPG test and one OGTT) may be used.
33. -What is the most reliable measure for assessing diabetes control over the preceding 3-month period?
Glycosylated Hemoglobin (Hemoglobin A1c) is the test determining the average blood glucose levels over a period of months (3 months), and is used to monitor long-term glycemic control. Also confirms diabetes diagnosis for the two positive tests taken for diagnosis. Patients with diabetes should kepp their HbA1c below 7% total hemoglobin.
34. -A patient with type I diabetes reports mixing NPH and regular insulin to allow for one injection. How should the nurse instruct the patient?
MIX CLEAR TO CLOUDY
• First draw up regular insulin (short acting) then draw up NPH (intermediate).
35. -Insulin glargine is prescribed for a hospitalized patient who is diabetic. When will the nurse administer this drug?
GIVE ONCE A DAY AT BEDTIME. Duration of action is 24 hours.
36. -A patient in the ICU requires intravenous insulin. The nurse will prepare what type of insulin?
SHORT ACTING INSULIN ONLY!! Includes: regular insulin (U-100), insulin aspart, insulin lispro, and insulin glulisine
37. -Which patient has the highest risk for type II diabetes?
• An obese patient or a patient with a family history of diabetes. over 40 yrs
38. -An operating room nurse prepares a patient with type II diabetes for surgery. Which type of insulin will the surgical nurse have available?
IV REGULAR INSULIN
39. -A nurse is providing education for a patient beginning thyroid replacement therapy for hypothyroidism. What information provided by the nurse is most important?
a. Therapy should continue until all symptoms have resolved.
b. Medication should be taken as directed for 3 to 6 months.
c. Most patients require therapy for at least 1 year.
d. In most cases, treatment is likely to be lifelong.
d. In most cases, treatment is likely to be lifelong.
40. -The nurse has just received report and is assuming care of four patients. What are the priorities of the nurse taking care of the patient receiving human growth hormone?
The most important factor to monitor is the blood sugar because human growth hormone causes hyperglycemia. It is also important to monitor height and weight changes, but this does not take priority over blood sugar checks. Remember that GH is contraindicated for patients with PWS (Prader-Willi Syndrome). (Lehne p. 705)
41. -The mother of an 11-year-old is concerned because her child is not as tall as the other children in the class, and she requests that the child be treated with growth hormone. What response should the nurse provide regarding the indications for GH treatment in children?
HAS TO BE 2.25 STANDARD DEVIATIONS BELOW MEAN HEIGHT FOR SEX/AGE IN ORDER FOR KID TO GET GROWTH HORMONE.
-NEED TO BE DEFICIENT OF GROWTH HORMONE
42. -The gonadotropins, luteinizing hormone (LH) and follicle-stimulating hormone (FSH), are involved in which functions in women?
• In women, FSH acts on the ovaries to promote follicular growth and development.
• The role of LH in women is to promote ovulation and formation of the corpus luteum.p. 706).
43. -A public health nurse is providing education on antiviral medications to a group of medical-surgical nurses. What information about non-HIV antiviral drugs would demonstrate an understanding on these types of drugs?
a. "The advances made with antiviral drugs in the past decade surpass those made with antibacterial antibiotics."
b. "The ability to treat viral infections with drugs is limited."
c. "As a rule, antiviral drugs are safer than antibiotics."
d. "Clinically useful antiviral suppress the host cell's biological processes."
b. "The ability to treat viral infections with drugs is limited."**
44. -The nurse is providing education to a patient with recurrent herpes simplex genitalis. What information must be included in patient education?
THERE IS NO CURE. TREATMENT ONLY HELPS WITH SYMPTOMS
• Oral acyclovir is superior to topical therapy for initial genital infections and for recurrent infections. For patients with initial infection, oral therapy decreases formation of additional lesions and decreases the duration and severity of the initial episode. For patients with recurrent herpes genitalis, continuous oral therapy reduces the frequency at which lesions appear. When initial genital infection is especially severe, intravenous acyclovir may be indicated. Patients with primary or recurrent herpes genitalis should be informed that, although acyclovir can decrease symptoms, the drug does not eliminate the virus and does not produce cure. Patients should be advised to avoid all sexual contact when lesions are present, and should use a condom even when lesions are absent.
• In pregnant women with recurrent genital herpes, infection can be transmitted to the newborn during delivery. Treatment with acyclovir near term can suppress recurrence, and may thereby eliminate the need for a cesarean section, which would otherwise be required to prevent neonatal HSV exposure.1072).
45. -The nurse is providing patient education for a patient who is to start taking interferon. What is the most adverse effect of this drug?
a. Anxiety and agitation
d. Flulike syndrome
d. Flulike syndrome**
46. -An elderly patient who lives alone in the community is concerned about recent exposure to the flu and asks for an influenza vaccination. What patient education should the nurse provide?
a. "Because exposure has already occurred, the injection will not reduce the risk of developing flu this season."
b. "Protection against the flu should begin about 1 to 2 weeks after injection."
c. "A person should not receive the vaccine unless direct contact has been confirmed."
d. "The vaccine is given only if the exposure have been verified as type A influenza."
b. "Protection against the flu should begin about 1 to 2 weeks after injection."
47. -A patient comes to the sexually transmitted disease (STD) clinic and receives valacyclovir (Valtrex) for a herpes-zoster virus. When should the nurse instruct the patient to take the medication?
MEDICATION DOESN'T NEED TO BE TAKEN AT SET TIME AND DOESN'T NEED TO BE TAKEN WITH FOOD
• For patients with herpes zoster, the recommended dosage is 1000 mg 3 times a day for 7 days. Therapy should begin as soon as possible after symptom onset.p. 1073).
48. -After starting an antiviral protease inhibitor, a patient with HIV telephones the nurse, complaining, "I'm so hungry and thirsty all the time! I'm urinating 10 or 12 times a day." The nurse recognizes these findings are consistent with what sign and symptoms?
a. Pancreatic infiltration by HIV
b. Allergic reaction
c. Nonadherence to the antiviral regimen
49. -The nurse is caring for a patient on a protease inhibitor (PI). Upon review of the laboratory test results, the nurse notes that the patient has newly elevated plasma triglycerides and cholesterol. How will the provider manage these levels?
DIET AND EXERCISE
All PIs can elevate plasma levels of cholesterol and triglycerides. These effects may occur with or without redistribution of fat. Elevation of cholesterol can lead to atherosclerosis and associated cardiovascular events. Elevation of triglycerides can lead to pancreatitis. Changes in plasma lipids can be detected by monitoring lipid levels every 3 to 4 months. Potential interventions for hyperlipidemia include diet, exercise, and lipid-lowering drugs. However, benefits of these interventions have not been established. If lipid-lowering drugs are employed, lovastatin and simvastatin should be avoided. Why? Because inhibition of P450 by PIs can cause lovastatin and simvastatin to accumulate to dangerous levels.
50. -The nurse wants to evaluate a nursing student's understanding of chemotherapy. The nurse asks, "Which factors would be a major obstacle to successful chemotherapy?"
a. "The patient's reluctance about the doses administered."
b. "The patients degree of nausea."
c. "The toxicity of anticancer drugs to normal tissues."
d. "Difficulty attaining and maintaining venous access."
c. "The toxicity of anticancer drugs to normal tissues."**
51. -A nurse is evaluating a patient who is receiving outpatient chemotherapy. The nurse checks the patient's neutrophil count and notes that it is 900 cells/mm3. What intervention by the nurse would be most appropriate?
a. Skip the next dose of chemotherapy and notify the prescriber
b. Discontinue chemotherapy, because it is at a dangerous level.
c. Hospitalize the patient, because there is a risk of possible infection
d. Continue to monitor the neutrophil count carefully, in case it continues to drop.
d. Continue to monitor the neutrophil count carefully, in case it continues to drop.**
Chemotherapy is not stopped unless the patient's neutrophil counts drop below 500 cells/mm3.
52. -The nurse is caring for a newly admitted patient who has been receiving chemotherapy as an outpatient. The nurse notes that the patient's gums and nose are bleeding. Laboratory test results confirm severe thrombocytopenia. What will the nurse expect the prescriber to order?
a. Vitamin K
b. Erythropoietin (Epogen)
c. A unit of packed red blood cells
d. Platelet infusion
d. Platelet infusion**
53. -Based on an in-patient oncology unit, who will the nurse see first?
c. The patient with a fever of 100.3 deg F
54. The nurse is caring for a patient who would like to try a natural alternative to help alleviate some anxiety. The patient tells the nurse, "I plan to start taking valerian. I think it will relieve some of my anxiety." What patient education is essential for the nurse to provide?
Has sedative effects. Use w/ caution, especially driving, heavy machinery, and other sedatives like alcohol.
• Prolonged use may cause headache, nervousness, or cardiac abnormalities.
As with benzodiazepines, there may be a risk of paradoxical excitation and physical dependence.
• In theory, valerian can potentiate the actions of other drugs with CNSdepressant actions. Among these are alcohol, benzodiazepines, barbiturates, opioids, antihistamines, and centrally acting skeletal muscle relaxants. These combinations should be used with caution.. p. 1271).
55. -What demonstrates understanding of the use of herbal medications in patients?
Herbal medications can interact with conventional medicines.
• Perception that herbs are safer and "healthier" than conventional drugs
• Sense of control over one's care
• Emotional comfort from taking action
• Cultural influence
• Limited access to professional care
• Lack of health insurance
• Media hype and aggressive marketing
• Recommendation from family and friends
56. -What is true about herbal supplement labels?
Can't claim to diagnose, treat, cure, or prevent any disease. However, can insinuate specific benefits.
MUST STATE This product is not intended to diagnose, treat, cure, or prevent any disease. However, the label is allowed to make claims about the product's ability to favorably influence body structure or function.
• Under the provisions of the DSHEA, there is no assurance that a product actually contains what the label proclaims: the package may contain ingredients that are not listed, or it may lack ingredients that are listed.
57. -The nurse is obtaining a health and medication history from a patient. The patient discloses daily use of St. John's wort in addition to prescription drugs. What effects of this drug would most concern the nurse?
ITS EFFECT ON THE METABOLISM OF OTHER DRUGS
"Interacts adversely with many drugs..
58. -The nurse is performing the preoperative history for a patient admitted for abdominal surgery when the 52-year-old patient states that she takes ginger root daily. Why should the nurse place an immediate call to the surgeon?
• Ginger can inhibit production of thromboxane by platelets, and can thereby suppress platelet aggregation. Accordingly, ginger can increase the risk of bleeding in patients receiving antiplatelet drugs (eg, aspirin) or anticoagulants (eg, warfarin, heparin). p. 1267).
59. -The nurse is performing a physical assessment on a patient with tuberculosis who takes rifampin (Rifadin). What are the expected findings?
a. peripheral neuropathy
d. red-orange tinged urine
d. red-orange tinged urine**
60. -A patient is beginning therapy for active tuberculosis (TB). The patient asks, "Why do I have to take so many drugs?" What is the nurse's best response?
TO PREVENT MULTIPLE RESISTANCE
Antituberculosis regimens must always contain two or more drugs to which the infecting organism is sensitive. This then reduces the risk of drug resistance and can reduce incidence of relapse.
61. -A patient has been receiving amphotericin B (Fungizone) for systemic mycoses. The nurse most likely would monitor for which signs and symptoms in this patient?
INFUSION REACTIONS AND RENAL DAMAGE OCCUR IN ALL PATIENTS
62. -A public health nurse is conducting research to reduce the occurrence of urinary tract infections (UTIs) among the public. What patients would have the highest risk for developing a urinary tract infection?
OLDER PT'S WITH A FOLEY
Women of child-bearing age are more prone to UTIs because their urethras are SHORT, and located in close proximity to the rectum and vagina, where bacteria congregate.
63. -The nurse is caring for a patient receiving gentamicin (Garamycin) intravenously (IV). What statement by the patient would most concern the nurse?
CAUSES NEPHROTOXICITY & OTOTOXICITY
• Like all other aminoglycosides, gentamicin is toxic to the kidney and inner ear. Caution must be exercised when combining gentamicin with other nephrotoxic or ototoxic drugs. Gentamicin is inactivated by penicillins and should not be mixed with these drugs in the same IV solution.p. 1022).
c. neuromuscular blockade
64. -A patient with type I diabetes mellitus comes to the clinic with complaints of low blood sugar. The nurse questions the patient regarding adherence with medications. The patient states that she gives herself more insulin per dose so she doesn't have to take it as often. Which factors should the nurse educate the patient about as affecting the patient's response to the medication?
Daily dosing must be based on caloric intake. Giving herself more per dose would make her hypoglycemic and she runs the risk of ketoacidosis or coma. Not taking enough would make her hyperglycemic, which would only exacerbate her condition. Because she is replacing insulin she can't produce herself, she should be cautioned to dose based upon normal physiological responses. A normal functioning pancreas secretes insulin in response to blood glucose levels, and blood glucose levels depend upon the specific QUANTITIES of carbohydrates eaten, and subsequently absorbed.
65. A nurse counsels a patient using two different types of asthma inhalers: a short-acting beta2 agonist and a corticosteroid. When the patient questions the purpose of the steroid inhaler, what would the nurse's best response be ?
a. work rapidly in acute attacks.
b. are used as prophylaxis for chronic asthma
c. help prevent respiratory infections
d. are used only when exposed to environmental allergens.
b. are used as prophylaxis for chronic asthma**
66. During education by the nurse what best demonstrates understanding of glucocorticoids?
"They promote carbohydrate, lipid, and protein metabolism."
"They are produced in decreased amounts during times of stress."
"They reduce the serum sodium and glucose levels."
"They stimulate defense mechanisms to produce immunity."
BE CAREFUL OF OPPORTUNISITIC INFECTIONS AND LOOK FOR THRUSH
a "They promote carbohydrate, lipid, and protein metabolism."**
67. A patient complains of vomiting, diarrhea, and insomnia. During the assessment, the patient begins having seizures. The nurse suspects theophylline toxicity. What actions would be the nurse's priority intervention?
At the first indication of toxicity, dosing with theophylline should stop. Absorption can be decreased by administering activated charcoal together with a cathartic. Ventricular dysrhythmias respond to lidocaine. Intravenous diazepam may help control seizures (p. 897).
68. A patient is beginning therapy for active tuberculosis (TB). The patient asks, "Why do I have to take so many drugs?" What is the nurse's best response?
TO PREVENT DRUG RESISTANCE
69. The nurse describes a typical course of therapy to a patient newly diagnosed with active tuberculosis. What would this be?
TYPICAL COURSE IS 6 MONTHS
FOR 2 MONTHS---TAKE 4 DRUGS
FOR 4 MONTHS---TAKE 2 DRUGS
70. A patient who has been diagnosed with multidrug-resistant tuberculosis asks how long the treatment regimen will last.
71. An adult has active tuberculosis, as diagnosed by sputum examination and culture. In evaluating the patient's response to therapy, the nurse would want to see which finding?
IMPROVED X-RAY WITHIN 3 MONTHS
72. A patient being followed for latent tuberculosis has been on isoniazid therapy for 2 months. While reviewing the laboratory test results, the nurse notes that the liver function test results have become grossly abnormal. The nurse expects which course of action to be ordered?
CHANGE THE MEDS
73. The nurse is caring for a patient who is HIV positive and is taking zidovudine (Retrovir). Before administering the medication, the nurse should monitor which laboratory values?
Hematologic status - hemoglobin concentration and neutrophil counts. Should be monitored before tx and at least every 4 weeks thereafter.
Hemoglobin levels may fall significantly within 2-4 weeks of initiating therapy, neutrophil counts may not fall until after week 6. For patients who develop severe anemia (Hb < 5 gm/dL or down 25% from baseline) or severe neutropenia (< 750 cells/mL or down 50% from baseline), therapy should be interrupted until there is evidence of bone marrow recovery. If neutropenia and anemia are less severe, a reduction in dosage may be sufficient. Transfusions may permit some patients to continue drug use.
74. The nurse is performing a physical assessment on a patient who is receiving treatment with abacavir, zidovudine, and lamivudine (Trizivir). The patient complains of fatigue. Upon further assessment, the nurse finds a rash and notes that the patient has a temperature of 101.1° F. What is the nurse's best course of action?
Adverse effects are like those seen with each component taken separately. Abacavir can cause potentially fatal hypersensitivity reactions. Early manifestations include fever, rash, fatigue, GI symptoms, and respiratory symptoms. If these develop, treatment should be interrupted while an evaluation is conducted. If hypersensitivity cannot be ruled out, the drug should be discontinued permanently.
76. The nurse is obtaining a health history from a 70-year-old patient. The patient states that, in addition to other medications and herbals supplements, he takes saw palmetto daily. What health problems does the nurse suspect the patient is using it?
• To relieve urinary symptoms associated with benign prostatic hypertrophy (BPH)
78. The nurse is administering morning medications. A patient questions the nurse, "How does the drug know where to go?" The nurse's best response to the patient is based on the understanding that a drug that elicits only those responses for which it is given is considered ___________.
79. A nurse is teaching a continuing education class on pharmacology. The nurse is evaluating the participants' knowledge and poses the question, "When a disease process triggers increased metabolism of the drug, the disease has altered the drug's ___________."
80. A patient with a history of hepatomegaly secondary to cirrhosis is admitted to a medical-surgical unit. Among the patient's many medications, acetaminophen (Tylenol) is prescribed. The nurse understands that this drug should not be used in patients with impaired liver function. Which term describes the nurse's understanding of the
81. A prescriber orders a drug that is considered "off label." A patient asks what "off label" means. The nurse correctly explains that "off label" is _____________.
A use other than that for which the drug is approved by the FDA.
82. During a lecture the instructor discusses drug-to-drug interactions. The students recall that the risk of serious drug-to-drug interactions is directly proportional to the ________.
Number of drugs being taken
83. An hour after taking a medication, a nurse notes that the patient displays urticaria and pruritus. What is the nurse's priority action?
1.When instructing an asthmatic client to use a metered-dose inhaler properly, the nurse should include which of the following instructions?
a. Avoid shaking the canister
b. Administer three puffs, wait 2 minutes, and administer two more
c. Puff the inhaler doses in rapid succession
d. An interval of at least 1 minute should separate the first puff from the second
d. An interval of at least 1 minute should separate the first puff from the second**
A physician prescribes albuterol and beclomethasone inhalers for an asthmatic patient. The nurse should:
a. Question the prescription; two inhalers should not be prescribed concurrently
b. Administer the albuterol first; wait 5 minutes; and administer the beclomethasone
c. Administer either inhaler; wait 30 minutes; and administer the other inhaler
d. Administer the beclomethasone first; wait 5 minutes; and administer the albuterol
b. Administer the albuterol first; wait 5 minutes; and administer the beclomethasone**
2. 6. A nurse evaluates an asthmatic patient who has developed tachycardia and dysrhythmias. Which laboratory result would confirm that these signs are the result of theophylline toxicity?
a. A serum theophylline level below 10 mcg/mL
b. A serum theophylline level above 25 mcg/mL
c. A serum theophylline level between 12 and 15 mcg/mL
d. A serum theophylline level abouve 1 mcg/mL
b. A serum theophylline level above 25 mcg/mL**
30) A patient with type I diabetes is eating breakfast at 0730. Blood sugars are on a sliding scale and are ordered AC and HS. The patient's blood sugar level is 317 mg/dL. What type of insulin should the nurse prepare to administer?
a. No insulin should be administered
c. 70/30 mix
d. lispro (Humalog)
d. lispro (Humalog)