Exam 3 Flashcards
(289 cards)
1
Q
During routine prenatal testing, a patient is diagnosed with human immunodeficiency virus infection. To help prevent perinatal transmission of human immunodeficiency virus to the fetus, which nursing action is best?
A
Provide written and oral education about the use of antiretroviral therapy during pregnancy.
2
Q
A recent laboratory results indicated an “undetectable” human immunodeficiency virus viral load. Which response is best by the nurse?
A
Educate the patient about the continued need for medications and ongoing laboratory monitoring.
3
Q
The nurse advises human immunodeficiency virus (HIV)-positive patients about blood draws to obtain a CD4+ count. Which information would be correct?
A
Laboratory tests should be done at the same laboratory at approximately the same time of day
4
Q
In collaboration with a patient on antiretroviral therapy, the nurse formulates a plan of care. Which items are appropriate to include in planning?
A
Viral load will become and remain undetectable.
The patient will not experience secondary infection.
New onset of symptoms and side effects will be promptly reported.
The patient will adhere to the medication regimen and will report any difficulties related to adherence.
5
Q
The nurse has instructed a patient diagnosed with human immunodeficiency virus (HIV) on the use of zidovudine. Which patient statement demonstrates an understanding of the mediation?
A
“I do not have to worry about taking the medication on an empty stomach or not.”
Antiretroviral agents do not stop the transmission of HIV, and patients need to continue standard precautions. Zidovudine (Retrovir, AZT) is not known for causing headaches or producing insomnia and does not require being taken with food.
6
Q
A patient diagnosed with human immunodeficiency virus (HIV) is in her first trimester of pregnancy and is reluctant to take any antiretroviral therapy (ART). What is the best response by the nurse?
A
Educate the patient about the relative risks/benefits of ART.
HIV can be transmitted in utero to the fetus; therefore, the nurse should provide information about the relative risks/benefits associated with ART therapy. One cannot state that ART therapy must be started immediately as it requires informed consent and patient agreement. As the individual is pregnant, a timely decision would be the best approach to help prevent transmission. ART therapy during pregnancy is aimed at both the mother and the fetus.
7
Q
A patient is receiving antiretroviral therapy (ART). Which outcome should the nurse identify as indicating a therapeutic response to the medication therapy?
A
CD4 T-cell increase
The expected outcome of ART is a suppression of HIV RNA levels and CD4 T-cell increases in patients. Elevated HIV RNA levels decreased T-cell reactivity, and increased immune system functioning are not indicative of a therapeutic response to medication therapy.
8
Q
Which intervention is a priority for a patient who is taking antiretroviral therapy (ART)?
A
Teach adherence to the medication regimen.
Although all of these interventions should be carried out, teaching adherence to the regimen is the highest priority.
9
Q
The health care provider is considering placing the patient on ritonavir. The patient tells the nurse that the patient has recently been diagnosed with type 2 diabetes mellitus. What is the nurse’s priority action?
A
Notify the health care provider of the new information.
The health care provider should be notified of this new information. Patients with diabetes mellitus or hyperglycemia may experience an exacerbation of their condition during ritonavir treatment.
10
Q
The patient has been started on stavudine (d4T). After taking the drug for 3 days, the patient contacts the nurse to report the onset of muscle pain and weakness. What is the nurse’s priority action?
A
Instruct the patient to hold doses of the medication until further notice.
The patient should not take any more doses of the medication until the health care provider can evaluate the patient. Muscle pain and weakness may be related to lactic acidosis, a serious side effect of the medication. The nurse’s scope of practice does not allow for adjusting the patient’s medication regimen.
11
Q
The patient has been taking ritonavir for a week and informs the nurse that the patient is experiencing occasional episodes of abdominal discomfort. What patient teaching will the nurse provide to the patient?
A
Reassure the patient that this is an expected side effect of the medication.
Instruct the patient to report episodes that increase in intensity or frequency.
Abdominal discomfort is an expected side effect of the medication and is not indicative of any significant problem with the medication. However, the patient should certainly report episodes of discomfort that increase in intensity and/or frequency. The patient should not be instructed to stop taking the medication at this time. Use of a symptom diary can assist with the reporting process. The patient should not add any over-the-counter medications.
12
Q
The father of a 4-month-old infant calls in to the clinic reporting that his child is having a reaction to immunizations. What is the most important piece of information the nurse should elicit?
A
The signs and symptoms the infant is experiencing
13
Q
The nurse is preparing to administer varicella vaccine to a young woman. Which of the following findings has the greatest implication for this young woman’s care?
A
The patient appears to be pregnant.
14
Q
A 38-year-old migrant farm worker is seen in the clinic with a cut to his arm from an old metal drum. The patient has sutures placed, and a tetanus, diphtheria, and acellular pertussis vaccine is given. What is the nurse’s most important action after the vaccine has been administered?
A
The nurse provides the patient with a vaccine information statement about the tetanus, diphtheria, and acellular pertussis vaccine in the patient’s primary language.
15
Q
The nurse is preparing to administer routine, recommended immunizations to an immunocompromised 1-year-old child. What is the most important information to know before administering a vaccination?
A
The type of vaccine to be administered to the child
16
Q
A 14-year-old girl requests a vaccination for human papillomavirus. After the nurse administers the first dose, which of the following is important to include in the patient’s teaching?
A
The date the patient needs to return to the clinic for the next human papillomavirus dose.
17
Q
Which of the following patients would be eligible to receive the influenza vaccine?
A
The child who is 18 months old.
Not eligible:
The patient who is taking care of her son with human immunodeficiency virus
The patient who is pregnant
The patient with an egg allergy
18
Q
With the help of an interpreter, the nurse has just immunized a 35-year-old woman with the tetanus, diphtheria, and acellular pertussis vaccine and the vaccine against measles, mumps, and rubella. It is essential that the nurse proceed with which action(s)?
A
Provide a vaccine information statement in the patient’s preferred language for each vaccine received.
Document in the patient’s record the date; site and route of administration; vaccine type, manufacturer, lot number, and expiration date; and the name, business address, and title of the person administering the vaccine.
19
Q
Amoxicillin is prescribed for a patient who has a respiratory infection. The nurse is teaching the patient about this medication and realizes that more teaching is needed when the patient makes which statement?
A
This medication should not be taken with food.
20
Q
A patient is receiving amoxicillin. The nurse understands that the action of this drug is by which process?
A
Inhibition of bacterial cell wall synthesis
21
Q
A patient is receiving amoxicillin. The nurse understands that the action of this drug is by which process?
A
Inhibition of bacterial cell wall synthesis
22
Q
A patient has been prescribed amoxicillin. What does the nurse know is true about this medication?
A
It is used to treat respiratory infections
23
Q
A patient has been prescribed amoxicillin. What does the nurse know is true about this medication?
A
It is used to treat respiratory infections
24
Q
A patient is beginning isoniazid and rifampin treatment for tuberculosis. The nurse gives the patient which instruction?
A
Do not skip doses.
25
A patient is beginning isoniazid and rifampin treatment for tuberculosis. The nurse gives the patient which instruction?
Do not skip doses.
26
A patient taking isoniazid is worried about the negative effects of the drug. The nurse provides information knowing that which is an adverse effect of the drug?
Hepatotoxicity
27
A patient has been diagnosed with tuberculosis and is to begin antitubercular therapy with isoniazid, rifampin, and ethambutol. Which actions are appropriate for the nurse to do?
Encourage periodic eye examinations.
Advise the patient to report numbness and tingling of the hands or feet.
Alert the patient that body fluids may develop a red-orange color.
28
Which assessment finding would be a priority to report to the prescriber if it occurred after the administration a dose of penicillin IV?
Wheezing
Wheezing could indicate an allergic and possibly anaphylactic reaction to penicillin, requiring immediate intervention.
29
The nurse assumes care for a patient who is currently receiving a dose of intravenous Vancomycin infusing at 20 mg/min and notes red blotches beginning to appear on the patient’s face, neck, and chest. The nurse recognizes that this is?
most likely to be “red man” syndrome related to too rapid an infusion rate.
When vancomycin is infused too rapidly, “red man” syndrome may occur; the rate should be 10 mg/min to prevent this, so the rate needs to be decreased.
30
A 30-year-old female patient is prescribed amoxicillin. Which education should the nurse be prepared to provide?
“If taking oral contraceptives, use an additional form of birth control while taking this medication.”
Amoxicillin can decrease the effectiveness of oral contraceptives. The nurse should educate the patient to use an additional form of birth control when taking amoxicillin.
31
The nurse recognizes that a client who is allergic to penicillin is at increased risk for an allergy to which drug?
Ceftriaxone (Rocephin)
Clients who are allergic to penicillins have an increased risk of allergy to other beta-lactam antibiotics. The incidence of cross-reactivity between cephalosporins and penicillins is reported to be between 1% and 4%.
32
After completing a course of ciprofloxacin [Cipro] for a skin infection, the patient says, “I took the whole bottle of pills, but my infection hasn’t gotten any better.” Which additional information should the nurse recognize as most significant?
The patient takes antacids on a daily basis.
Antacids interfere with the absorption of quinolone antibiotics, such as ciprofloxacin [Cipro], and many other drugs; therefore, this patient has not received the full dosing regimen, which is required if ciprofloxacin is to be effective against the infection.
33
The nurse explains that the development of a new infection as a result of the elimination of normal flora by an antibiotic is referred to as a/an
Superinfection
Antibiotic therapy can destroy the normal flora of the body, which normally would inhibit the overgrowth of fungi and yeast. When the normal flora is decreased, these organisms can overgrow and cause a new infection, or superinfection.
34
For which serious adverse effect should the nurse closely monitor a patient who is taking Clindamycin (Cleocin)?
Clostridium difficile - associated diarrhea
35
A patient is prescribed levofloxacin (Levaquin) for pneumonia. The nurse identifies which following statement as incorrect?
Levofloxacin can cause hypertension.
Can be given orally or intravenously. The drug can cause hyperglycemia, not hypertension. It is a fluoroquinolone. Tendon rupture is a possible s/e.
36
A patient has been prescribed a tetracycline antibiotic. Which of the following patient teaching points should be included?
A majority of tetracyclines can not be taking with milk products, but doxycycline is okay to take with milk & food.
37
The nurse understands the reason for trough levels being monitored for the patient receiving an aminoglycoside is to decrease the chances of developing
Nephrotoxicity
If levels of aminoglycosides remain too high, there is increased risk of renal damage (nephrotoxicity) as well as ototoxicity
38
Which nursing intervention is the priority When a patient is receiving antiviral agents?
Promoting hydration
39
Before administration of the influenza vaccine to a patient, it is most important for the nurse to ask the patient if they are allergic to what?
Eggs
40
A healthcare provider has been exposed to HIV while caring for a patient. Following the post-exposure prophylaxis regimen (PEP), the healthcare provider will most likely receive treatment for how long?
4 weeks
41
When providing teaching for the patient being discharged home on antiretroviral therapy for HIV, which statement will the nurse include?
Do not eat raw fish
42
The nurse is preparing to administer IV antibiotics to a patient who is suffering from an infection. What is the priority intervention before administering the medications?
Obtain culture and sensitivity
43
The nurse is caring for a patient receiving an IV infusion of a glycopeptide, Vancomycin, and notices the patient is flushed and has warmth to the face and neck. The nurse recognizes this as Red Man syndrome. The nurse understands this is caused by what action?
Infusing the medication too fast
44
A patient has been prescribed Levofloxacin (Levaquin) for a complicated, severe infection. The patient usually runs 6 miles daily, however, they now complain of pain in the back of the lower leg. Which is the priority nursing intervention for this patient?
Notify the provider immeidately for discontinuation of this medication
45
The nurse is completing their shift assessment and notices the client has yellowing sclera, skin, and dark urine. Which of the following medications does the nurse suspect is responsible for this reaction?
Cefazolin (Ancef)
46
What is the key enzyme that virus need to propagate?
RNA polymerase
47
What type of virus is HIV?
It’s an RNA virus
48
Which cells does HIV destroy?
CD4 and T cells
49
In HIV, the destruction of CD4 cells leads to what?
Immune defficiency
50
In those with HIV, what does the CD4 cell count indicate?
It is an indicative of immune function.
51
What are the stages of HIV infection?
Acute infection
Clinical latency
AIDS
52
What is the acute infection in HIV?
Large amounts of the virus are being produced in the body.
Is described as the “worst flu ever”
53
What is the clinical latency stage in HIV?
HIV reproduces at very slow levels, although it is still active.
During this period pt. May not have any symptoms & it can last up to 8 years or longer
54
What is the AIDS stage in HIV?
This happens when the CD4 cells fall bellow 200 cells/mm3. Pt are diagnosed with AIDS.
People typically survive 3 years without treatment.
55
How is HIV transmitted?
Sexual contact
Direct blood contact - IV, razors
Mother to child - direct contact during delivery, breast milk, shared circulation.
56
How is HIV spread?
Via intimate contact with blood, semen/vaginal fluids, and breast milk.
57
What are the treatment goals of ART?
Reduce HIV-associated morbidity and mortality Prolong the duration and quality of life Restore and preserve immunologic function Maximally and durably suppress plasma HIV (Viral load) Prevent HIV transmission
58
What is Immune Reconstitution Inflammatory Syndrome (IRIS)?
Related to disease or pathogen-specific inflammatory response in patients with antiretroviral therapy being initiated or changed.
It has 2 distinct entities.
May occur within the first 6 months of treatment.
59
What is paradoxical IRIS?
is an exacerbation of treated opportunistic infection
60
What is unmasking IRIS?
a response to an undiagnosed or subclinical opportunistic infection
61
What are the risk factors for IRIS?
Low CD4+ cell count
High baseline HIV RNA
(It is hard to diagnose)
62
What is the nurse’s role in ART?
Assessment of patient's physiologic and psychosocial health needs.
Patient teaching
Assess the patient's side effects/adverse effects
Drug regimen adherence
63
What are the ART non-adherence results?
HIV viral replication
Potential drug resistance
64
What are some suggestions to promote patient adherence?
Drug organizers
Mobile devices alarm
Drug map with pictures
Drug diary
Support system
Patient education
Patients are going to be taking 3-4 drugs at the same time.
65
ART nursing interventions
Provide information on the necessity of adhering to the drug regimen and regular health care
Provide opportunities for the patient and/or support persons to verbalize feelings
Encourage strategies to cope with drug side effects
Monitor lab reports
66
What is the goal of ART during pregnancy?
The goal is to prevent mother-to-child transmission
67
What is the infant PEP for HIV?
To be given the medication within 8 hours after birth.
Treated for 6 weeks after birth.
68
When should the Post-exposure prophylaxis regimens (PEP) be initiated?
Within hours of the event (or within 72 hours) and continued for 4 weeks.
69
What are the common reactions healthcare workers taking PEP have reported?
Nausea
Malaise
Fatigue
70
What are some antibiotic commonalities?
- Bacterial infections
- GI distress (n/v/d)
- Discuss back up contraception
- Complete full course of therapy
- Risk for supra-infection
- Risk for anaphylaxis/hypersensitivity
- At least 1 hour before or 2 hours after antacids
71
What are the treatments for antibacterial allergic reactions?
Antihistamine
Epinephrine
Bronchodilator
72
What are the mild allergic reactions of antibacterials?
Rash
Pruritus
Hives
73
What are the severe allergic reactions of antibacterials?
Anaphylactic Shock
- Bronchospasm, laryngeal edema
- Vascular collapse, cardiac arrest
74
What are antibacterials general adverse reactions?
Superinfection
-secondary infection due to normal flora killed, this usually occurs when treated for more than 1 week.
GI disturbances
N/V/D
Organ toxicity
75
Beta-Lactam (Penicillin, Amoxicillin)
Adverse side effects:
Nephrotoxic (BUN/Creatine)
Anaphylaxis
76
Beta-Lactam (Penicillin, Amoxicillin)
Nursing considerations:
Don’t take if allergic to cephalosporins
Don’t mix with aminoglycosides
Stop infusion for s/s of hypersensitivity
Obtain C&S before administering first dose.
77
Beta-Lactam (Penicillin, Amoxicillin)
MOA:
inhibits the enzyme in cell wall synthesis and has a bactericidal effect
78
Cephalosporins
Adverse side effects
Allergy: cross sensitivity with PCN
Nephrotoxic
Thrombocytopenia
Thrombophlebitis (IV)
Intestinal issues ( CDAD-c.diff)
79
Cephalosporins (beta- lactam antibiotics)
MOA:
inhibits bacterial cell wall synthesis causing cell lysis; bactericidal effect
80
Cephalosporins (beta- lactam antibiotics)
Nursing considerations
Disulfiram-like reaction: avoid alcohol (flushing, dizziness, headache, nausea, vomiting, muscular cramps)
Uricosurics: decrease cephalosporin excretion
81
Cephalosporins drugs (start in Cef or Ceph)
Cefazolin (Ancef) -1st generation
Ceftriaxone (Rocephin)- 3rd generation
82
Macrolides
Adverse side effects:
Ototoxicity
Hepatotoxicity
Tinnitus
83
Macrolides
Nursing care:
Erythromycin is used when allergy to PCN.
No IM (ouch)
Loading dose
Monitor liver enzymes (AST/ALT)
Empty stomach
84
Macrolides
MOA:
Binds to 50S ribosomal subunits and inhibits protein synthesis
Broad spectrum
Bacterostatic: Low to moderate doses
Bactericidal: High doses
85
Macrolides drugs: (end in thromycin)
Azithromycin- Z-pac
Erythromycin- when allergic to PCN
86
Lincosamides
Adverse side effects
Colitis and anaphylactic shock
87
Lincosamides
Nursing care:
Incompatible with aminophylline, phenytoin (Dilantin), barbituates and ampicillin
88
Lincosamides
MOA:
inhibit bacterial protein synthesis
89
Lincosamides drugs:
Clindamycin
90
Glycopeptides
Adverse side effects:
Red man’s syndrome (slow infusion) Thrombophlebitis
Nephrotoxic (BUN/Cr)
Ototoxic
91
Glycopeptides
Nursing care:
Use as a last resort drug
Monitor for red man syndrome
Monitor vanco levels
-Trough levels to avoid toxicity (before next dose)
-Peak levels in renal patients (30 min after admin)
Baseline hearing
Infuse over 60 minutes (may give antihistamine)In
92
Glycopeptides
MOA:
inhibits cell wall synthesis, fights gram +s. aureus, bactericidal
93
Glycopeptides drugs:
Vancomycin
94
Tetracyclines
Adverse side effects:
Tooth discoloration prior to 8 years (yellow brown) Photosensitivity
Stomatitis
Hepatotoxicity
Nephrotoxicity
Photosensitivity
95
Tetracyclines
Nursing care:
Empty stomach, no dairy
Cover up when outside in the sun
Don’t use las half of pregnancy
Monitor kidney and liver function
96
Tetracycline drugs: (end in cycline)
Tetracycline
Doxycycline
97
Tetracyclines
MOA:
inhibit protein synthesis, broad spectrum, bacterial resistance
98
Aminoglycosides
Adverse side effects
Ototoxic
Nephrotoxic (BUN/Cr)
Photosensitivity
99
Aminoglycosides
Nursing care:
Monitor peak (after) and trough (before)
Monitor renal function and hearing loss
Baseline hearing exam
Do not mix with PCN in the same solution
100
Aminoglycosides
MOA:
Inhibit bacterial protein synthesis
Gram - (E. coli, proteus pseudomonas)
Bactericidal
101
Aminoglycosides drugs: (cin ending)
Gentamicin
102
The nurse is caring for a client receiving combination chemotherapy. The client asks why more than one drug is prescribed. Which response by the nurse would be correct?
"it has better response rates than single-drug chemotherapy."
103
Which information will the nurse tell the client concerning the side effects of chemotherapy?
Toxicities to normal cells cause the side effects
104
Which information will the nurse tell the client concerning the side effects of chemotherapy?
Toxicities to normal cells cause the side effects
105
An older adult client is diagnosed with advanced metastatic cancer and is scheduled to receive palliative chemotherapy. What response by the nurse is appropriate when the client questions the benefits of palliative chemotherapy if it will not kill the cancer cells?
"Quality of life is improved."
106
The client will be receiving chemotherapy that will lower the white blood cell count. Monitoring for which finding will be a nursing priority?
Change in temperature
107
The client has thrombocytopenia secondary to chemotherapy. Which nursing action would be most appropriate
Apply pressure to the injection site an assess for occult bleeding
108
Which mechanism of action is/are the primary function(s) of biologic response modifiers (BRMs)?
Need to revise this question
Slow the spread of tumor cells
Enhance host's normal immunologic function
Change cancer cells to behave more like healthy cells
Improve liver functioning
Replicate red blood cells
109
Before administering erythropoietin, which assessment would the nurse conduct?
Hemoglobin levels
110
Which body response occurs during the vascular phase of inflammation?
Vasodilation with increased capillary permeability
111
A client who is taking nonsteroidal anti-inflammatory drugs (NSAIDs) for arthritis complains of persistent heartburn. What further question(s) should the nurse ask the client about the heartburn?
"Do you take your drug with food?"
"What dosage of the NSAID are you taking?"
"Where is the heartburn located?"
"Have you noticed a change in the color of your bowel movements?"
112
A 4-year-old child was brought to the emergency room for continued fever despite taking aspirin. Which statement is correct about a 4-year-old receiving aspirin?
Aspirin has the potential to cause Reye syndrome in children
113
Fluoroquinolones MOA:
Interferes with enzymes DNA gyrase (blocks DNA replication)
Broad spectrum: bactericidal
114
Fluoroquinolones side effects:
Phototoxic
Achilles tendon rupture
Cardiac dysrhythmias
CV mortality
115
Fluoroquinolones nursing considerations:
Avoid caffeine
Infuse IV over 60-90 min
Avoid sunlight/heat lamps
Don’t give to <18 yeas old
Increase fluid to 2000 mL/d to avoid crystallurea
116
Fluoroquinolones drugs (floxacin ending):
Levofloxacin
Ciprofloxacin
117
Sulfonamides MOA:
Inhibits bacterial synthesis of folic acid
Bacteriostatic
118
Sulfonamides side effects:
Crystalluria
Blood dyscrasias
Photosensitivity
Nephrotoxic
119
Sulfonamides nursing care:
Taken in empty stomach
Interaction: folic acid, alcohol (disulfram effect)
Avoid during 3rd trimester
Monitor CBC
Monitor sore throat, bruising, or bleeding.
120
Sulfonamides drugs:
Trimethoprim & Sulfamethoxazole (Bactrim, Septra, TMP-SMZ)
Both drugs together in one compound cuase bacterial resistance to develop much more slowly
121
Which patient population are at higher risk for developing tuberculosis?
Alcohol addicted debilitated
Immunocompromised (HIV/AIDS)
122
A patient in preterm labor at 28 weeks is prescribed betamethasone 12 mg intramuscularly every 24 hours for 2 doses. The patient wants to know why she has to receive the drug. Which is the best response for the nurse to provide?
"It will hep the fetus' lungs mature more quickly"
123
A pregnant patient with iron deficiency anemia was prescribed ferrous sulfate twice daily. What laboratory value will show the first indication that the patient is responding to the iron supplement?
Increased reticulocyte count
124
Which baseline data would the nurse collect on a patient who is being induced at 41+ weeks gestation with intravenous oxytocin?
Fetal heart rate
Pulse rate and blood pressure
Uterine activity
Deep tendon reflexes
Type and crossmatch for blood
125
At which time frame is the best time to administer the standard dose of Rh0 (D) immune globulin?
At 28 weeks gestation and again within 72 hours of delivery
126
A baby is born at 30 weeks gestation and is having respiratory distress. Which class of drug would be given to help distend alveoli?
Surfactant replacement
127
A preterm neonate becomes cyanotic and the oxygen level decreases during surfactant administration. Which action would be most appropriate by the nurse?
Reposition the neonate to disperse the drug throughout the lungs
128
Which substance would be administered to a neonate born to a hepatitis B carrier to provide passive protection against hepatitis B?
Hepatitis B immune globulin
129
In which patients would combined hormone contraceptives (CHCs) be used with?
A 37-year old who smokes
A 38-year old who has diabetes
130
Which medical condition would sildenafil (Viagra) be contraindicated?
Unstable angina
131
A patient who is receiving androgen therapy takes prescribed drugs for cardiovascular disease, diabetes, and chronic obstructive pulmonary disease. Which drug-drug interaction can occur in this patient?
Androgens may decrease blood glucose levels and insulin doses must be adjusted
132
A 5-month-pregnant patient enters the clinic and states, “I have no money for any kind of vitamins, and I have never taken any.” What is the nurse’s initial intervention?
Screen the patient for fetal neural tube defects.
133
A pregnant patient is receiving magnesium sulfate to inhibit uterine contractions. The patient develops depressed reflexes and confusion. What is the nurse’s priority action?
Administer calcium gluconate.
134
The nurse is assessing a patient who has been taking ferrous sulfate prophylactically during pregnancy. Which assessment finding should require an intervention from the nurse?
The patient says she takes the ferrous sulfate with an antacid.
135
A pregnant patient complains of constipation and has not had a bowel movement in 5 days. What is the nurse’s first intervention?
Assess the patient’s fluid intake.
136
A pregnant patient who is in her first trimester states that she is constantly experiencing headaches. What is the nurse’s best response?
“What have you tried to treat the headaches?”
137
A 28-week primipara is experiencing contractions on a regular basis. Vaginal examination assessment confirms early cervical dilation. The drug terbutaline is ordered. Which maternal side effects should the nurse anticipate to observe in this patient?
Tachycardia and palpitations
Maternal side effects include tremors, dizziness, nervousness, tachycardia, hypotension, chest pain, palpitations, nausea, vomiting, hyperglycemia, and hypokalemia
138
A 28-week primipara is experiencing contractions on a regular basis. Vaginal examination assessment confirms early cervical dilation. The drug terbutaline is ordered. Given the fetus is at 28-week gestations, which additional drug should the nurse anticipate to be added to the mother’s drug regimen?
Dexamethasone
139
Which drugs are hepatotoxic?
Isoniazid (INH)
Azithromycin, erythromycin
Rifampin
140
Which drugs are nephrotoxic?
Amoxicillin
trimethoprim-sulfamethoxazole
Cefazolin
Aciclovir
141
Which drugs are both nephrotoxic and ototoxic?
Gentamicin
Vancomycin
142
Which drugs should be taken on an empty stomach?
tetracycline
Azithromycin
trimethoprim-sulfamethoxazole
143
These two classes of antibiotics should not be used if a client has an allergy to one of them?
Penicillins and cephalosporins
144
This drug can cause tooth discoloration. Dairy should be avoided.
Tetracyclines
145
These two drugs are not compatible and should not be used together
Gentamicin and amoxicillin
146
This drug can cause Achilles tendon rupture, photosensitivity, and caffeine should be avoided.
Ciprofloxacin
147
These two drugs require peak and through monitoring.
Gentamicin and vancomycin
148
Clients should avoid alcohol on these drugs due to a disulfiram-like reaction.
Cephalexin, Cefazolin, and trimethoprim-sulfamethoxazole.
149
This drug can cause red man syndrome and should be administered slowly over 60 minutes. It should only be used to teat serious strep and staph infections like MRSA, VRE.
Vancomycin
150
This drug can cause crystalluria, blood dyscrasias, and photosensitivity.
Trimethoprim-sulfamethoxazole
151
These drugs cause photosensitivity
Tetracyclines
Trimethoprim-sulfamethoxazole
Aminoglycosides (gentamicin and neomycin)
152
This drug is taken with food, can cause kidney damage an is used for viruses.
Aciclovir
153
Can cause virilization, acne, and skin irritation are common during drug therapy; monitor bone growth in children; avoid in BPH, pregnancy.
Testosterone
154
May cause decreased libido, ED, orthostatic hypotension. Used for BPH, tablets may be crushed for oral administration. Category X
Finasteride
155
This drug can cause orange discoloration of bodily fluids.
Rifampin
156
True or false: Antibiotic therapy should be completed in full, even if clients feel better; clients should also use a back-up form of contraception & are at a higher risk for suprainfections.
True
157
Can cause GI distress but should be taken on an empty stomach, will turn stools green/black, can cause constipation. Liquid forms can stain skin: dilute with juice (OJ), sip with straw, rinse after.
Ferrous sulfate (PO)
158
This drug can cause hypertension, increase your risks for clots, cause seizures, headache or body aches. Hemoglobin should not exceed 11.
Epoetin Alfa
159
May cause priapism, concurrent use with nitrates (nitroglycerin) can cause severe hypotension, not safe for clients the CVD, take approx. 1 hour prior to sexual activity, avoid grapefruit juice.
Sildenafil (viagra)
160
Prevents neural tube defects in pregnancy, essential in the production of DNA and erythropoiesis
Folic acid
161
This drug can cause bone pain, increase in WBC count, splenomegaly or even splenic rupture
Filgrastim
162
Available for various candidiasis infections and cryptococcal meningitis. Well absorbed PO, well tolerated by most.
Flucanozole (Diflucan)
163
Available OTC. Used for ringworm, jock itch, athletes foot. Yeast infections (topical)
Miconazole (Monistat)
164
Given to infants to prevent vitamin K-deficiency bleeding (VKDB). Administer within 1 hour after birth.
Vitamin K
165
Given to prevent blindness caused by STIs to the lower conjunctival sac of each eye, from the inner canthus to the outer canthus of the eye.
Erythromycin eye ointment
166
Given to Rh(-) pregnant person to prevent incompatibility.
RhoGAM
167
Combination vaccine protecting against whooping cough. Recommended for older children, adults, and during each pregnancy.
Tetanus, Diphtheria, Pertussis Vaccine (Tdap)
168
Live vaccine, therefore not recommended in pregnancy or immunocompromised.
MMR vaccine
169
Can cause swelling, redness, tenderness at the injection site; low-grade fever, HA, malaise, aches.
Vaccines in general side effects
170
For infants , pregnant individuals, adults >75 to protect against virus
RSV Vaccine
171
Protects against a bacteria, not recommended to children >5 or adults unless they have certain medical conditions.
Haemophilus Influenzae Type B Vaccine (Hib)
172
Medication that can be used to protect against stroke; can cause GI discomfort, toxicity, Reye’s syndrome, increases risk for bleeding.
Aspirin (ASA)
173
No anti-inflammatory effects, max of 4g/day to avoid toxicity, overdose can cause liver damage.
Acetaminophen (Tylenol)
174
This medication can cause GI upset, impaired kidney function, increases risk for bleeding, heart attack and stroke.
Ibuprofen (Advil)
175
This medication can cause GI distress (take with food), drink 2-3L of water, dietary changes.
Allopurinol (Zyloprim)
176
What is allopurinol (Zyloprim) used for?
Prevention of attack of gouty arthritis and nephropathy
177
Immunosuppressant drug used to prevent organ rejection; can cause hypertension and immunosuppression.
Cyclosporine (Gengraf)
178
Less likelihood of GI upset, can double the risk of heart attack & stroke long term.
Celecoxib (Celebrex)
179
TNF inhibitor, given subcutaneously; can cause injection site reaction, headache, nausea, increased risk of infection.
Adalimumab (Humira)
180
Hepatotoxic, can cause bone marrow suppression, oral/GI ulcers, anorexia; category X.
Methotrexate
181
True or False: Drugs used to treat HIV/AIDS can cause myelosuppression, which includes agranulocytosis, thrombocytopenia, & aplastic anemia.
True
182
Toxicity: absent reflexes. RR <12 that can lead to cardiac depression and death;
Antidote: calcium gluconate
Magnesium sulfate
183
Tocolytics- drugs used to decrease uterine contractility
Terbutaline
Magnesium sulfate
184
Used for labor induction/augmentation; can cause uterine hyper-stimulation/tachysys tole, uterine rupture
Oxytocin
185
Interferons, colony-stimulating factors, monoclonal antibodies
Used to assist the bodies immune system
186
Used to treat breast cancer; can cause hot flashes and DVT
Tamoxifen
187
Antineoplastic drugs
Cisplatin
Doxorubicin
Tamoxifen
188
Antiviral drug that treats hepatitis and cancer; can cause flu-like symptoms, fatigue, anorexia
Interferon alpha 2B
189
The nurse assesses a patient who is receiving doxorubicin intravenously. The nurse determines extravasation has occurred. The first action of the nurse is to
Stop the IV infusion os doxorubicin
190
Which nursing intervention is designed to treat the most common side effects of filgrastim (Neupogen)?
Provide analgesia to relieve bone pain
191
When working with a patient receiving epoetin alpha (Procrit), it is most important for the nurse to assess the patient for the development of:
fluid retention and allergic reactions
192
A pregnant patient who is prescribed a liquid iron supplement complains that her teeth have become discolored. What is the proper response by the nurse?
"This is a normal reaction to liquid iron supplementation. You can minimize it by drinking the supplement through a straw."
193
The nurse identifies which of the following as a clinical manifestation of maternal magnesium sulfate toxicity?
Lethargy
194
The nurse knows that the correct instillation of the eye ointment used for newborn eye prophylaxis is
into the lower conjunctival sac
195
A pregnant client requests information regarding which foods are iron-rich. The nurse knows which foods contain high iron content.
Red meat
Beans
Spinach
196
The nurse is caring for a client in pre-term labor. Which assessment findings is a cause for concern with a patient receiving a Magnesium Sulfate infusion?
Decreased deep tendon reflexes
197
The nurse is caring for a patient who presents to the emergency department complaining of chest pain. The patient reports taking sildenafl (Viagra) for erectile dysfunction. The nurse knows which medications is contraindicated with the use of phosphodiesterase inhibitors.
Nitrates
198
A client presents in the office for her annual physical examination and pap smear. The client asks about a prescription for comprehensive oral contraceptives. The healthcare provider reviews the patient's past medical history and recognizes which contraindication for the use of oral contraceptives.
Blood clots
199
A client is 28 weeks pregnant and in the office for prenatal care. Which of the following blood types for the mother would indicate the need for the administration of RhoGAM?
O-
A-
AB-
200
What is the purpose of oseltamivir (Tamiflu)?
Shorten the influenza illness by 1-3 days
201
When is remdesivir (Veklury) used?
To treat COVID-19 in hospitalized high-risk patients
202
What is the purpose behind using combination drug trealments, such as with chemotherapy, treatment of TB, and in ART?
Reduce drug resistance
Target the virus/ bacteria at different parts of the cell cycle
Reduce side effects associated with one drug
203
When treating viruses, such as HIV, what is the purpose of the medications?
Stop the virus from replicating
204
Which drug is used in pre and post-HIV exposure and pregnancy as prophylaxis against HIV?
Zidovudine
205
Which are symptoms of aspirin overdose?
Ringing in the ears
Vertigo
Bronchospasm
206
Which are part of neutropenic precautions?
Avoid sick people
Seek medical help immediately for a fever
Practice good oral care
Practice food safety
207
Which drug is given to patients at risk for preterm delivery (24-34 weeks gestation) to aid with fetal lung development:
Betamethasone
208
Which drug can be given to soften, thin, and dilate the cervix for induction?
Dinoprostone
209
Which is true about CHC (combined hormonal contraceptives)?
They do not protect from STIs
Antibiotics decrease the effectiveness
Side effects include cardiovascular effects such as DVT, MI, and stroke
210
True or false: If you miss one dose of your CHC it is no longer effective.
False
211
Within how much time from unprotected intercourse does a client need to take levonorgestrel-synthelic progesterone (Plan B One Step) in order for it to be effective?
72 hours
212
Drugs used to treat tuberculosis:
Isoniazid (INH)
Rifampin
213
Isoniazid MOA:
Inhibits bacterial cell wall synthesis by interfering with lipid and DNA synthesis
214
What are the uses of isoniazid?
Treatment of active TB
Prophylactic measure against TB (if exposed)
215
Isoniazid side effects:
Peripheral neuropathy
Hepatotoxicity
Vit. 6 deficiency
Ototoxicity
216
Rifampin MOA:
Inhibits bacterial RNA polymerase
217
Rifampin uses:
1st line drug for active TB
Prevention if exposed to H. Influenza
Staph aureus treatment
218
What does rifampin do to the bodily fluids?
Turns them orange or red-orange.
They might also stain clothing and contact lenses.
219
Rifampin side effects:
Dyspepsia
Blurred vision
Bleeding
220
What are some nursing considerations?
Take on an empty stomach with a full glass of water
Watch for s/s of hepatitis
221
What are some systemic antifungals? (Azoles)
Miconazole (monistat)
Fluconazole (diflucan)
222
Miconazole uses:
Ringworm
Jock itch
Athletes foot
Yeast infections
223
Miconazole route:
Topical (cream, powder, spray powder)
224
Miconazole side effects:
Vaginal irritation
Burning
Itching
Diarrhea
SOB
225
Fluconazole uses:
Various candidiasis infections
Cryptococcal meningitis
226
Fluconazole route:
Po (well absorbed)
Topical (well tolerated for most)
227
Fluconazole nursing considerations:
Pregnancy category C
Increased risk of cleft lip and palate.
Oral contraceptives
Warfarin
228
What are inflammation s/s?
Heat
Redness
Swelling
Pain
Loss of function
229
NSAIDs MOA:
Inhibit the biosynthesis of prostaglandins
230
NSIDs work by:
Analgesic effect (mild to moderate)
Antipyretics
Inhibit platelet aggregation
Reduce inflammation (mimic effects of corticosteroids)
231
Aspirin uses:
Reduce pain
Inflammation
Fever
Arterial thromboembolism prophylaxis
232
Aspirin side effects:
Tinnitus, vertigo (signs of overdose)
GI distress
Thrombocytopenia (due to bleeding)
233
Aspirin nursing considerations:
Don’t give to patients with peptic ulcer disease.
Avoid during 3rd trimester (unless prescribed)
Reye syndrome in kids (especially if taken with antibiotics)
Bronchospasm in asthmatic patients
234
Aspirin overdose signs:
Mild:
Tinnitus, dizziness, HA, confusion, sweating, drowsiness, thirst, N/V/D
Severe:
Convulsions, cardiovascular collapse, coma, metabolic acidosis.
235
Celecoxib (celebrex) MOA:
Selectively inhibits COX-2 enzyme without the inhibition of COX-1
236
What are the uses of Celecoxib?
Decreased inflammation and pain.
Treats OA/AR
237
Celecoxib side effects:
Peripheral edema
Cough
Dyspepsia
Pain
238
What are the advantages of taking Celecoxib?
For patients that need high doses of anti-inflammatory drugs (arthritis) and decreased risk of GI bleeding.
239
What are the disadvantages of taking Celecoxib?
It doubles the risk of heart attack (strokes) if taken long term.
240
Prednisone/ prednisolone (corticosteroids) MOA:
Control inflammation by suppressing or preventing many of the components of the inflammatory process at the injured site.
241
Prednisone/prednisolone uses:
Frequently used to control arthritic flare-ups.
Make sure to taper off the medication
Not the drug of choice for arthritis because the numerous side effects.
242
Prednisone/prednisolone side effects:
Kushings
Hyperglycemia
Decreased immunity
Osteoporosis
Adrenal cortisoid insufficiency
243
What are immunosuppressive drug agents?
Methotrexate (mexate, rheumatrex)
Azathioprione (Imuran)
Cyclosporine (gengraf)
244
What are immunosuppressive agents used for?
To suppress the inflammatory process of rheumatoid arthritis when other treatments fail.
Antiorgan transplant rejection
245
Methotrexate uses:
Rheumatoid arthritis
Psoriasis
Treat leukemias
Tumors
Inhibits enzyme as involved in nucleotide synthesis (prevents cell division)
246
Methotrexate adverse reactions:
Hepatotoxicity
Bone marrow suppression
Severe lung infections
247
Methotrexate nursing considerations:
Monitor for black/tarry stools
Bleeding gums
Loss of appetite
Asses for infection
Avoid NSAIDs
Avoid during pregnancy
248
Adalimumab (Humira) MOA:
Disrupts inflammatory process
249
Adalimumab uses:
Reduce joint swelling
Tenderness
Inflammation
Slow joint destruction of rheumatoid arthritis
Crohn’s
UC
Plaque psoriasis
250
Adalimumab route:
Subcutaneous
251
Adalimumab side effects:
Infection
Rash
Antibody formation
252
Cyclosporine (Gengraf) MOA:
Immunosuppressive drug
253
Cyclosporine uses:
Prevent organ rejection
Treats other immune diseases
254
Cyclosporine side effects:
Increased BUN, Cr
Hypertension
Immunossupression (infection)
255
Cyclosporine nursing considerations:
Teach infection prevention
Avoid grapefruit
Administer same time each day
Contraindicated in pt with uncontrolled hypertension
Hepatic impatient
Concurrent Nephrotoxic agent use.
256
What is the patho of gout?
Is an inflammatory disease of joints, tendons, and other tissues due to a defect in purine metabolism leading to uric acid accumulation.
257
What is an antigout drug?
Allopurinol (Zyloprim) uric acid inhibitor
258
Is Allopurinol long or short term?
Long term
Takes about 6 months to start working
259
Allopurinol nursing interventions:
Monitor CBC, liver enzymes, and renal function.
Tell pt to get early eye exams for visual changes (thinning of the eye)
Increase fluid intake to increase uric acid excretion
Make sure kidney function is intact
260
What influences cancer development?
Genetics
Infective
Environment
Dietary
261
What are the 2 types of anti cancer drugs?
Cell cycle nonspecific(CCNS):
They work during any phase
Cell cycle specific (CCS):
They target a specific cell cycle phase
262
Cancer chemotherapy
Is not selective to cancer cells
Can be used as combination therapy
This can decrease drug resistance
Enhance tumoricidal effects
Reduces drug toxicity
Can be used with corticosteroids
263
Chemotherapy side effects
Infertility
Thrombocytopenia
Myelosuperession
Alopecia (loss of hair)
Fatigue
Stomatitis
Extravasation when using IV administration
264
Cisplatin (antineoplastic) MOA:
Inhibits DNA synthesis and cell growth.
Cell cycle nonspecific
265
Cisplatin uses:
Treats advanced cancer of the bladder, ovaries, and testicles.
266
Cisplatin side effects:
Ototoxicity
Renal disease
Neuropathy
Hair loss
Appetite loss
267
Cisplatin nursing considerations:
Monitor signs of leukopenia
Thrombocytopenia
Unusual weakness and fatigue
268
Doxorubicin uses:
Advanced cancer of the bladder, ovaries, and thyroid
IV can cause extravasation, use pic line preferably.
269
Tamoxifen MOA
Is a selective estrogen receptor modulator.
Produces estrogenic and anti-estrogen effects.
270
Tamoxifen uses:
Treats breast cancer
271
Tamoxifen side effects:
Hot flashes
DVT
272
Tamoxifen nursing considerations:
Avoid pregnancy and breastfeeding
Contraceptives education
Monitor CBC CMP
273
What are the biologic response modifiers and what aer they used for?
Interferons
Colony-stimulating factors
Monoclonal antibodies
They are used to assist the body immune system
274
What are BRM functions
Enhance host immunologic function
Destroy/interfere with tumor activities
Promote differentiation of stem cells
275
What are monoclonal antibodies?
Teutonic are larger molecules that exert their effects mostly on specific cell membrane surface proteins
They act like immunotherapy drugs
They find and attack cancer cells
Route IV
They end in mab
276
What are interferons (Alfa 2B)?
It is an antiviral drug that treats hepatitis and cancer.
277
Interferon Alfa 2B side effects:
Flu like symptoms
Fatigue
Anorexia
278
Interferon Alfa 2B nursing considerations:
Monitor for infections
Autoimmune disorders
Mental illness
279
What are colony-stimulating factors?
They regulate growth, maturation, and differentiation of bone marrow stem cells
Decrease the length of post-treatment neutropenia
Permit the delivery of higher doses of drugs
Prevent severe thrombocytopenia after myelosuppressive chemotherapy
280
What are the drugs that are Erythropoietin stimulating agent?
Epoetin Alfa (procrit epogen)
281
Epoetin Alfa MOA:
Signals the bone marrow to make more red blood cells
Takes a couple of days to work.
282
Epoetin Alfa uses:
Treatment of anemia of chronic renal failure
283
Epoetin Alfa side effects:
Hypertension
Arthralgia
Chest pain
Thrombosis (headache)
284
Epoetin Alfa nursing considerations:
Monitor hemoglobin
Do not administer with hemoglobin 11g/dL or grater
If history of blood clots do not give drug.
285
What is the drug for granulocyte colony stimulating factor?
Filgrastim (Neupogen)
286
Filgrastim MOA:
Stimulates production, maturation, and activation of neutrophils within the bone marrow
287
Filgrastim uses:
Prevention of neutropenia and associated infection in pt who have received bone marrow depressing antineoplastics
288
Filgrastim Side effects:
Leukocytosis, splenomegarly/rupture
Bone pain
289
Filgrastim nursing considerations:
Don’t give 24 hours before/after chemotherapy
Monitor neutrophil count.
