Test Bank for Pharmacological Aspects of Nursing Care 8Th Ed By Broyles Reiss Evans – Test Bank

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Pharmacological Aspects of Nursing Care 8Th Ed By Broyles Reiss Evans – Test Bank

CHAPTER 6: DRUG THERAPY FOR GERIATRIC CLIENTS

 

TRUE/FALSE

 

  1. The best way to determine if the client understands how to perform a self-care skill such as insulin administration is to have the client demonstrate the skill to the nurse.

 

ANS:  T                    PTS:   1                    REF:   p. 138, Box 6-2

OBJ:   Cognitive Level: Evaluation

 

  1. Alcohol-drug interaction is rarely a problem for the elderly, because older adults do not use alcohol.

 

ANS:  F

 

  Feedback
Correct Alcohol-drug interactions do occur because of alcohol use in the older adult.
Incorrect

 

 

PTS:   1                    REF:   p. 135            OBJ:   Cognitive Level: Comprehension

 

  1. Health promotion activities are not necessary for residents of long-term care facilities, because the activities will not improve the well-being of the residents.

 

ANS:  F

 

  Feedback
Correct Regardless of where they reside, elderly persons benefit from health promotion activities.
Incorrect

 

 

PTS:   1                    REF:   p. 136, Safe Nursing Practice 6-5   OBJ:   Cognitive Level: Knowledge

 

  1. Elderly clients may suffer prolonged effects from sedative drugs.

 

ANS:  T                    PTS:   1                    REF:   p. 133            OBJ:   Cognitive Level: Knowledge

 

  1. Elderly clients may have difficulty remembering specific instructions due to short-term memory loss.

 

ANS:  T                    PTS:   1                    REF:   p. 135            OBJ:   Cognitive Level: Knowledge

 

MULTIPLE CHOICE

 

  1. The nurse understands that when the elderly use oral medications there is:
a. increased hydrochloric acid secretion in the stomach.
b. shorter gastric emptying time.
c. slower intestinal movement.
d. greater gastric and intestinal blood flow.

 

 

ANS:  C

 

  Feedback
A Incorrect: Hydrochloric acid production is decreased.
B Incorrect: Gastric emptying time is increased.
C Correct: Due to decreased muscle tone, intestinal movements (peristalsis) slows.
D Incorrect: There is decreased gastric and intestinal blood flow.

 

 

PTS:   1                    REF:   p. 133            OBJ:   Cognitive Level: Comprehension

 

  1. To enhance drug absorption in providing drug therapy to elderly clients, when possible the nurse should:
a. administer liquid dosage forms.
b. administer sustained-release dosage forms.
c. administer drugs in a suppository dosage form.
d. use capsule instead of tablet dosage forms.

 

 

ANS:  A

 

  Feedback
A Correct: Liquid dosage forms absorb better in the GI tract considering all the factors influencing drug absorption in the older adult.
B Incorrect: Altered GI absorption negatively affects timed-released medication.
C Incorrect: Loss of muscle tone and intestinal villi decreases the absorption of rectal medications.
D Incorrect: Tablets and capsules absorption is similar.

 

 

PTS:   1                    REF:   p. 133 | p. 137, Safe Nursing Practice 6-3

OBJ:   Cognitive Level: Application

 

  1. The nurse understands which of the following is not associated with diminishing gastrointestinal absorption of drugs in the elderly?
a. consumption of high fiber foods
b. use of stimulant laxatives
c. reduction in the absorptive area in the GI tract
d. increased fluid consumption by the elderly

 

 

ANS:  D

 

  Feedback
A Incorrect: High fiber foods can reduce the absorption of certain drugs.
B Incorrect: The use of stimulant laxatives can reduce the absorption of medications.
C Incorrect: This will diminish gastrointestinal absorption.
D Correct: Increased fluid consumption would improve blood supply and thus increase drug distribution not absorption.

 

 

PTS:   1                    REF:   p. 133            OBJ:   Cognitive Level: Comprehension

 

  1. When caring for older adults, the nurse understands that the characteristic of drug absorption which is likely to occur with advancing age is:
a. increase in water content of the body
b. loss of muscle tissue
c. loss of fat as a proportion of total body mass
d. increased protein binding of drugs

 

 

ANS:  B

 

  Feedback
A Incorrect: There is a decrease in water content in the body.
B Correct: There is an age-related reduction in muscle tissue because of atrophy.
C Incorrect: Fatty tissue increases with age.
D Incorrect: There is a decreased protein-binding capacity with age.

 

 

PTS:   1                    REF:   p. 133            OBJ:   Cognitive Level: Comprehension

 

  1. When selecting an appropriate drug product for an elderly client, if possible, one should select a drug that is:
a. not dependent on liver metabolism. c. bound to plasma proteins.
b. not too water soluble. d. absorbed primarily in the stomach.

 

 

ANS:  A

 

  Feedback
A Correct: Liver metabolism decreases with age, so, when possible, the older adult should be prescribed medications that are not dependent on liver metabolism.
B Incorrect: Water-soluble drugs are the most appropriate for the older adult.
C Incorrect: There is decreased protein-binding capacity in the older adult.
D Incorrect: There is decreased gastric absorption ability in the older adult.

 

 

PTS:   1                    REF:   p. 133            OBJ:   Cognitive Level: Comprehension

 

  1. In determining an appropriate dose of a drug for an elderly client, which of the following should be considered?
a. decreased creatinine clearance c. decreased platelet level
b. increased liver metabolites d. increased hemoglobin level

 

 

ANS:  A

 

  Feedback
A Correct: This increases the risk of cumulative and toxic effects of medications.
B Incorrect: There is a decrease in liver metabolism resulting in decreased metabolites.
C Incorrect: The platelet count usually does not affect how the appropriate dosage of a drug is determined.
D Incorrect: The hemoglobin usually does not affect how the appropriate dosage of a drug is determined.

 

 

PTS:   1                    REF:   p. 134            OBJ:   Cognitive Level: Comprehension

 

  1. The nurse monitors an older adult for which of the following adverse drug reactions more commonly seen in elderly clients?
a. anaphylactic shock c. orthostatic hypotension
b. pseudomembranous enterocolitis d. discolored urine

 

 

ANS:  C

 

  Feedback
A Incorrect: This is no more common in the older adult.
B Incorrect: This is no more common in the older adult.
C Correct: Excessive sedation and orthostatic hypotension are adverse effects to drug therapy more common in the older adult.
D Incorrect: This is no more common in the older adult.

 

 

PTS:   1                    REF:   p. 136            OBJ:   Cognitive Level: Application

 

  1. When administering intramuscular injections to an elderly client, the nurse prepares to use which of the following injection sites:
a. deltoid. c. rectus femoris.
b. vastus lateralis. d. ventrogluteal.

 

 

ANS:  D

 

  Feedback
A Incorrect: The deltoid muscle should not be used, because it has lost much of its mass.
B Incorrect: The vastus lateralis muscle should not be used, because it has lost much of its mass.
C Incorrect: This is not an appropriate IM site.
D Correct: The ventrogluteal site is the most appropriate in the older adult especially, in an emaciated client, because of the size of the muscle in this site.

 

 

PTS:   1                    REF:   p. 137, Safe Nursing Practice 6-3

OBJ:   Cognitive Level: Application

 

  1. When preparing a teaching plan for elderly clients about their medications, the nurse understands that which factor is not true of elderly clients?
a. About 95% live in the community and are not institutionalized.
b. They have difficulty distinguishing blue and green.
c. They tend to be as compliant in using their medications as younger adults.
d. Many older adults experience short-term memory loss.

 

 

ANS:  C

 

  Feedback
A Incorrect: This is a true statement.
B Incorrect: This is a true statement.
C Correct: Noncompliance is a issue in the older adult resulting from a number of factors including memory loss and lack of adequate finances.
D Incorrect: This is a true statement.

 

 

PTS:   1                    REF:   p. 138            OBJ:   Cognitive Level: Comprehension

 

  1. Many elderly are prescribed eight or more medications per day. This is referred to as:
a. overdosage. c. multiple treatments.
b. polypharmacy. d. monotherapy.

 

 

ANS:  B

 

  Feedback
A Incorrect: Although an overdose or drug interaction may occur, this is not the definition of overdosage.
B Correct: This defines polypharmacy.
C Incorrect: Polypharmacy usually occurs because of treatment for multiple conditions.
D Incorrect: This is the use of one drug.

 

 

PTS:   1                    REF:   p. 131            OBJ:   Cognitive Level: Knowledge

 

An 80-year-old client lives with her daughter. The client takes six different prescription medications. Her health care provider has prescribed three additional medications.

 

  1. The nurse determines that which of the following is a priority nursing diagnosis for the client?
a. risk for social isolation due to confusion
b. altered health maintenance related to inability to manage costs of drug therapy
c. risk for injury related to drug interactions
d. noncompliance related to drug regimes

 

 

ANS:  C

 

  Feedback
A Incorrect: This is not an appropriate nursing diagnosis for the scenario.
B Incorrect: Because the client lives with her daughter, this would not be an appropriate nursing diagnosis without more information.
C Correct: One of the major risks with polypharmacy is the risk for drug interactions.
D Incorrect: Because the client lives with her daughter, this would not be an appropriate nursing diagnosis without more information.

 

 

PTS:   1                    REF:   p. 131            OBJ:   Cognitive Level: Application

 

  1. After the client begins taking the new medications, she develops periods of dizziness and confusion. The client’s daughter calls to ask the nurse what she should do. The nurse’s best response is:
a. “Don’t worry. Confusion and dizziness are side effects of the new medications. Keep giving them. Your mother should get over the side effects soon.”
b. “Keep your mother in bed for a while after giving the medications so she doesn’t fall and hurt herself.”
c. “Give the medications with food. The chance of side effects decreases when administered on a full stomach.”
d. “Call the health care provider as soon as possible to report these symptoms.”

 

 

ANS:  D

 

  Feedback
A Incorrect: This is not a responsible nursing statement.
B Incorrect: This is not the best response, although it addresses a safety issue.
C Incorrect: This is not the best response; not all medications should be taken with food. In addition, the nurse is diagnosing the problem, which is not in her scope of practice.
D Correct: The health care provider should be notified of the client’s symptoms, so possible adjustments to the medications or their dosages might be made.

 

 

PTS:   1                    REF:   p. 64              OBJ:   Cognitive Level: Application

 

  1. An 85-year-old male who was hospitalized for a fractured hip develops difficulty breathing. The client has been receiving IV therapy for three days. When the nurse assesses the client, moist respirations are ausculated, a full bounding pulse and pedal edema are palpated and distended neck veins are noted. Based on the assessment, the nurse believes the most probable cause for the client’s symptoms is:
a. fluid overload. c. fat embolus.
b. prolonged bed rest. d. inadequate diet.

 

 

ANS:  A

 

  Feedback
A Correct: This is a risk when administering IV fluids to the older adult.
B Incorrect: These are not the manifestations of prolonged bed rest.
C Incorrect: These are not manifestations of fat embolus.
D Incorrect: These are not manifestations of an inadequate diet.

 

 

PTS:   1                    REF:   p. 137            OBJ:   Cognitive Level: Comprehension

 

  1. An important function of nursing is teaching clients about their medications. When teaching an older adult, the nurse should use which of the following principles?
a. The elderly cannot learn new information, so teaching should be directed to the caregiver.
b. The elderly learn best using long teaching sessions.
c. It is important to try to tie medication administration times to the person’s daily schedule.
d. Reading materials are not necessary, because most elderly cannot read.

 

 

ANS:  C

 

  Feedback
A Incorrect: This is a false statement.
B Incorrect: Short teaching sessions are best.
C Correct: This action will increase learning for the older adult.
D Incorrect: This is a false statement.

 

 

PTS:   1                    REF:   p. 138, Box 6-2

OBJ:   Cognitive Level: Application

 

  1. Elderly clients are at risk for not getting prescriptions filled largely because:
a. they are not convinced that they need the medication.
b. they “feel fine” without taking more medications.
c. they fear that after purchasing medications, they may not be able to tolerate them.
d. they forget to do so.

 

 

ANS:  C

 

  Feedback
A Incorrect: This may be true, but is not the most common reason.
B Incorrect: This may be true, but is not the most common reason.
C Correct: This also ties into the financial aspect of the older adult.
D Incorrect: This may be true, but is not the most common reason.

 

 

PTS:   1                    REF:   p. 135            OBJ:   Cognitive Level: Comprehension

 

  1. To encourage compliance with the medication regime, the nurse may suggest to the health care provider to consider:
a. providing samples of newly prescribed medications.
b. discussing at length with the client the purpose of each new medication prescribed.
c. providing a social service referral to be certain that the client can afford the medications.
d. telling the client that the medication absolutely must be taken.

 

 

ANS:  A

 

  Feedback
A Correct: Samples would allow the older adult to see how he or she will respond to the medication.
B Incorrect: Teaching sessions should be short.
C Incorrect: Providing samples would be the first step; not all older adults need a social service referral.
D Incorrect: Older adults do not respond to being told they must do something without any input into the discussion.

 

 

PTS:   1                    REF:   p. 135            OBJ:   Cognitive Level: Application

 

  1. Which of the following conditions places the elderly client most at risk for drug-drug interactions?
a. The client sees just one health care provider.
b. The client shares medications with friends or family.
c. The client uses one pharmacy for all prescriptions.
d. The client is prescribed two prescription medications.

 

 

ANS:  B

 

  Feedback
A Incorrect: This would decrease the risk.
B Correct: Sharing medications with others poses a risk of drug-drug interactions because medical professionals cannot oversee a client taking someone else’s medication.
C Incorrect: This would decrease the risk.
D Incorrect: This would decrease the risk.

 

 

PTS:   1                    REF:   p. 138            OBJ:   Cognitive Level: Comprehension

 

  1. The nurse is preparing to administer oral medications to a client with visual impairment. The nurse should approach the client:
a. by loudly calling the client’s name to ensure being heard.
b. by approaching the client very quietly to prevent startling the individual.
c. by not speaking until being directly in front of the client.
d. by announcing oneself in a normal tone while entering the client’s room.

 

 

ANS:  D

 

  Feedback
A Incorrect: This is not an appropriate nursing action.
B Incorrect: This action probably would startle the client, especially one who is visually or hearing impaired.
C Incorrect: This action probably would startle the client, especially one who is visually or hearing impaired.
D Correct: The client is visually impaired not hearing impaired. The nurse should announce oneself while entering the client’s room.

 

 

PTS:   1                    REF:   p. 138            OBJ:   Cognitive Level: Application

 

  1. The nurse is preparing to administer a medication to a 65-year-old client. The nurse’s concern about the client’s ability to metabolize the medication is based on:
a. the loss of nephrons in the liver, decreasing its ability to metabolize.
b. the blood flow to the kidneys is dramatically decreased with age.
c. the blood flow in the liver decreases approximately 1%/year after age 25.
d. Gastric acid levels decrease, as well as intestinal motility.

 

 

ANS:  C

 

  Feedback
A Incorrect: The liver does not have nephrons.
B Incorrect: This is a true statement, but the question is about metabolism of medications.
C Correct: The decreased blood flow to the liver decreases its ability to metabolize drugs.
D Incorrect: Gastric acid levels are related to absorption, not metabolism.

 

 

PTS:   1                    REF:   p. 133            OBJ:   Cognitive Level: Comprehension

 

  1. The nurse is concerned about the multiple medications prescribed for an older client, because the more medications the client is taking:
a. the more likely the client will need social services assistance.
b. the more likely the client is to be compliant with medications.
c. the less likely the client is to experience medication errors.
d. the greater the risk for medication errors.

 

 

ANS:  D

 

  Feedback
A Incorrect: This is not necessarily true.
B Incorrect: The client is more likely to be noncompliant as medications become more complex in number.
C Incorrect: The client is more likely to experience drug-drug interactions.
D Correct: As the number of drugs taken increases, medication errors increase.

 

 

PTS:   1                    REF:   p. 134, Safe Nursing Practice 6-1

OBJ:   Cognitive Level: Comprehension

 

  1. When preparing to administer oral medications to a hospitalized elderly client, the nurse’s first action should be:
a. have the client get up to got to the bathroom to empty the bladder.
b. position the client in an upright position.
c. mix the medications in food on the client’s dinner tray.
d. restrain the client and administer the medications via nasogastric tube.

 

 

ANS:  B

 

  Feedback
A Incorrect: This would be done only if the client needed to void.
B Correct: This position will facilitate the movement of the medications into the stomach by gravity and decrease the risk of aspiration.
C Incorrect: There is no indication in the scenario that the client cannot swallow the medication. In addition, avoid mixing medication in client’s main food.
D Incorrect: There is no indication in the scenario that the client has a nasogastric tube, and clients are restrained only to prevent them from injuring themselves.

 

 

PTS:   1                    REF:   p. 137, Safe Nursing Practice 6-3

OBJ:   Cognitive Level: Application

 

  1. To evaluate a client’s understanding of the teaching given about medications, the nurse should:
a. have the client teach a family member about the client’s medications.
b. have the client take medications as will be done at home.
c. have a family member administer the client’s medications.
d. document that the teaching about medications was completed.

 

 

ANS:  D

 

  Feedback
A Correct: Having the client teach a friend or family member about the client’s medications is a good way for the nurse to evaluate the client’s understanding of the instructions.
B Incorrect: This will not provide evaluation concerning all of the aspects of medication teaching.
C Incorrect: This will not evaluate the client’s understanding of medication instructions.
D Incorrect: This will not evaluate the client’s understanding of medication instructions.

 

 

PTS:   1                    REF:   p. 138, Box 6-2                              OBJ:   Cognitive Level: Evaluation

 

  1. The elderly client refuses to take a newly prescribed medication. In response, the nurse responds:
a. “The doctor said you need to take the medication.”
b. “I don’t want to have to call you daughter to come in to stay with you.”
c. “Could you tell me you reason for not wanting to take the medication?”
d. “I’ll come back later and we’ll try again.”

 

 

ANS:  C

 

  Feedback
A Incorrect: This does not address the client’s refusal.
B Incorrect: This is posed as a threat, making the daughter a villain, and doesn’t address the client’s refusal.
C Correct: The most common reason for client refusals is lack of understanding about the medication.
D Incorrect: This does not address the client’s refusal.

 

 

PTS:   1                    REF:   p. 50, Safe Nursing Practice 2-11

OBJ:   Cognitive Level: Application

 

  1. When the nurse is preparing to draw up medication for a subcutaneous injection for an older adult client, the choice is:
a. a 1 mL syringe with a 5/8 inch, 25 gauge needle.
b. a 1 mL syringe with a 1 inch 27 gauge needle.
c. a 2 mL syringe with a 1/2 inch, 22 gauge needle.
d. a 3 mL syringe with a 1/4 inch, 28 gauge needle.

 

 

ANS:  A

 

  Feedback
A Correct: A maximum of 1 mL can be injected into subcutaneous tissue. A 1/2- to 5/8-inch needle with a 25-28-gauge needle is appropriate for a subcutaneous injection.
B Incorrect: This needle is too long and will probably enter the client’s muscle.
C Incorrect: The syringe and needle gauge are more appropriate for an IM injection.
D Incorrect: The syringe is too large for small calibrations and the 1/4-inch needle is used for intradermal injections.

 

 

PTS:   1                    REF:   p. 55, Table 2-7

OBJ:   Cognitive Level: Application

 

  1. The nurse confirm the client’s prescription for ampicillin 500 mg p.o. q.i.d. The p.o. addresses which of the seven rights?
a. right client c. right time
b. right medication d. right route

 

 

ANS:  D

 

  Feedback
A Incorrect: This abbreviation does not address right client.
B Incorrect: Ampicillin addresses the right medication.
C Incorrect: The abbreviation q.i.d. addresses right time.
D Correct: The abbreviation p.o. means by mouth (the route).

 

 

PTS:   1                    REF:   p. 48              OBJ:   Cognitive Level: Comprehension

 

  1. The nurse charts that the medication for Mr. Jones was administered at 0900 or 9 a.m. The nurse’s action addresses which right?
a. client c. medication
b. time d. documentation

 

 

ANS:  D

 

  Feedback
A Incorrect: The nurse’s action does not result in right client.
B Incorrect: The nurse’s action does not result in right time.
C Incorrect: The nurse’s action does not result in right medication.
D Correct: The nurse’s action results in right documentation.

 

 

PTS:   1                    REF:   p. 49              OBJ:   Cognitive Level: Application

 

  1. The nurse is preparing to administer an IM injection to her elderly client. The nurse places the palm of her hand on the greater trochanter, points her index finger toward the anterior superior iliac spine and middle finger toward the iliac crest to locate which IM site?
a. dorsogluteal c. deltoid
b. ventrogluteal d. vastus lateralis

 

 

ANS:  B

 

  Feedback
A Incorrect: These are not the correct anatomical landmarks for a dorsogluteal IM site.
B Correct: The nurse has identified the ventrogluteal IM site.
C Incorrect: These are not the correct anatomical landmarks for deltoid IM site.
D Incorrect: These are not the correct anatomical landmarks for vastus lateralis IM site.

 

 

PTS:   1                    REF:   p. 58, Figure 2-10

OBJ:   Cognitive Level: Comprehension

 

  1. Prescribed is carvedilol 3.125 mg p.o. twice a day. The pharmacy supplies 6.25 mg scored carvedilol tablets. The nurse will administer:
a. 1/2 tablet. c. 1 1/2 tablets.
b. 1 tablet. d. 2 tablets.

 

 

ANS:  A

 

  Feedback
A Correct: Divide 3.125 mg by 6.25 mg = 0.5 X tablet = 1/2 tablet.
B Incorrect: This is twice the dose prescribed.
C Incorrect: This is three times the dose prescribed.
D Incorrect: This is four times the dose prescribed.

 

 

PTS:   1                    REF:   p. 102            OBJ:   Cognitive Level: Application

 

  1. The nurse is writing a client goal for the new elderly client just admitted. The nurse is using which part of the nursing process?
a. assessment c. implementation
b. evaluation d. planning

 

 

ANS:  D

 

  Feedback
A Incorrect: Assessment involves data collection and analysis.
B Incorrect: Evaluation is determining whether the goal for the client was achieved.
C Incorrect: This is nursing action.
D Correct: Planning is the identifying of goals and outcome criteria to measure the goal.

 

 

PTS:   1                    REF:   p. 40, Safe Nursing Practice 2-2

OBJ:   Cognitive Level: Application

 

  1. The nurse determines that the has client sustained no injury from self-administration of medications. This describes which part of the nursing process?
a. assessment c. evaluation
b. implementation d. nursing diagnosis

 

 

ANS:  C

 

  Feedback
A Incorrect: This involves data collection and analysis.
B Incorrect: This is nursing action.
C Correct: This is the achieved outcome.
D Incorrect: This is a NANDA (North American Nursing Diagnosis Association) statement based on assessment data.

 

 

PTS:   1                    REF:   p. 136            OBJ:   Cognitive Level: Evaluation

 

MULTIPLE RESPONSE

 

  1. When caring for the older adult, the nurse needs to remember that physiology changes associated with aging result in:
a. an increase in fatty tissue. c. an increase in gastric acid.
b. an decrease in liver drug metabolism. d. accelerates intestinal peristalsis.

 

 

ANS:  A, B

 

  Feedback
Correct a. and b. are the correct answer answers.
Incorrect c. and d. are incorrect, because there is a decrease in gastric acid and a slowing of intestinal peristalsis.

 

 

PTS:   1                    REF:   p. 133            OBJ:   Cognitive Level: Comprehension

 

  1. The nurse considers which of the following when counseling an elderly client about medication use?
a. potential alcohol use
b. proper medication storage
c. loss of long-term memory
d. risk of fluid overload from IM injections

 

 

ANS:  A, B

 

  Feedback
Correct a. and b. are important considerations.
Incorrect c. and d. Older adults lose short-term not long-term memory, and fluid overload is extremely unlikely from an IM injection, unless the medication being injected causes fluid retention.

 

 

PTS:   1                    REF:   p. 134 | p. 140

OBJ:   Cognitive Level: Comprehension

 

  1. Many elderly have physiological changes affecting response to medications. In addition, other factors may place the elderly at higher risk for drug-related problems. The nurse understands that those factors include all the following except:
a. short-term memory loss, making it difficult to remember instructions.
b. loss of smell, making it difficult to take unpleasant tasting medication.
c. visual loss, making it difficult to read labels on medication bottles.
d. hearing loss, making it more difficult to hear instructions.

 

 

ANS:  A, C, D

 

  Feedback
Correct a, c, and d represent factors that place older adults at higher risk for drug-related problems.
Incorrect b. loss of smell decreases the sense of taste

 

 

PTS:   1                    REF:   p. 135            OBJ:   Cognitive Level: Comprehension

 

COMPLETION

 

  1. Prescribed is oxycodone 5 mg/acetaminophen (APAP) 325 mg combined tablets, one every 4 hours as needed for pain. The pharmacy sends oxycodone 5 mg/APAP 325 mg tablets. The nurse can administer a maximum of ____________________ tablets in a 24-hour period.

 

ANS:

six

6

 

PTS:   1                    REF:   p. 103            OBJ:   Cognitive Level: Application

 

  1. The nurse is taking an elderly client’s medication history. The nurse is using the ____________________ phase of the nursing process?

 

ANS:  assessment

 

PTS:   1                    REF:   p. 39-40, Safe Nursing Practice 2-1

OBJ:   Cognitive Level: Comprehension

 

CHAPTER 7: ANTIMICROBIAL AGENTS

 

TRUE/FALSE

 

  1. Routine handwashing between clients is the most important health care professionals can help prevent the spread of nosocomial infections.

 

ANS:  T                    PTS:   1                    REF:   p. 197 | p. 200, Safe Nursing Practice 7-1

OBJ:   Cognitive Level: Comprehension

 

  1. Intramuscular injections of cephalosporins should be given in a large muscle to help decrease pain.

 

ANS:  T                    PTS:   1                    REF:   p. 210, Safe Nursing Practice 7-3

OBJ:   Cognitive Level: Application

 

  1. Oral antimicrobials agents should be taken with a full glass of water for best absorption.

 

ANS:  T                    PTS:   1                    REF:   p. 215

OBJ:   Cognitive Level: Comprehension

 

  1. Clients taking antitubercular medications should consume only small amounts of alcohol.

 

ANS:  F

 

  Feedback
Correct Clients taking isoniazid should avoid alcohol, because it could result in crystalluria.
Incorrect

 

 

PTS:   1                    REF:   p. 204            OBJ:   Cognitive Level: Comprehension

 

  1. People who are allergic to penicillins should be given cephalosporins to avoid allergic responses.

 

ANS:  F

 

  Feedback
Correct Clients who are allergic to penicillins also may have allergic reactions to cephalosporins.
Incorrect

 

 

PTS:   1                    REF:   p. 201, Safe Nursing Practice 7-3

OBJ:   Cognitive Level: Comprehension

 

MULTIPLE CHOICE

 

  1. In reconstituting an antibiotic in powder form, the nurse:
a. always uses normal saline.
b. uses as small a gauge needle as is available.
c. changes the needle used to reconstitute the medication before administering the drug to the client.
d. always administers the medication intramuscularly.

 

 

ANS:  C

 

  Feedback
A Incorrect: Most often the diluent is sterile water, but you must follow the manufacturer’s instructions or those in the current nursing reference.
B Incorrect: An 18-gauge needle is best.
C Correct: The nurse should change the needle, because there may be medication on the outside of the needle. Plus, the needle may have dulled while being inserted through the rubber stopper.
D Incorrect: Not all reconstituted medication is administered IM; most is administered IV.

 

 

PTS:   1                    REF:   p. 199 Box 7-2

OBJ:   Cognitive Level: Application

 

  1. The nurse is preparing to administer oral penicillin and plans to give it to the client:
a. every 12 hours, with breakfast and with dinner.
b. at bedtime, because it works better on an empty stomach.
c. with meals to decrease the risk of GI manifestations.
d. one-to-two hours before meals or two-to-three hours after meals.

 

 

ANS:  D

 

  Feedback
A Incorrect: Penicillin usually is administered every six hours, but this is determined by the health care provider.
B Incorrect: This is not a nursing action. The time is determined by the prescriber.
C Incorrect: Food may interfere with the absorption of oral penicillin.
D Correct: Oral penicillin should be administered on an empty stomach, because food may interfere with the absorption of oral penicillin.

 

 

PTS:   1                    REF:   p. 200, Safe Nursing Practice 7-2

OBJ:   Cognitive Level: Application

 

  1. To reduce the possibility of local tissue reactions to intramuscular injection of penicillin, the nurse:
a. replaces the needle that was used to withdraw medication from the vial.
b. places pressure on the site following injection.
c. uses a large-gauge needle for administration.
d. uses a small-gauge needle for administration.

 

 

ANS:  A

 

  Feedback
A Correct: If the needle is not changed, some medication adheres on the outside of the needle after withdrawal from the vial. This can cause local tissue reactions.
B Incorrect: This will help prevent the medication from seeping out the injection hole.
C Incorrect: This has no impact on preventing local tissue reactions.
D Incorrect: This has no impact on preventing local tissue reactions.

 

 

PTS:   1                    REF:   p. 201            OBJ:   Cognitive Level: Application

 

A nurse working in a physician’s office has frequent contact with persons taking antibiotics. In order to be prepared to instruct clients in the proper use of antibiotics and to alert them to potential problems, the nurse reviews the following information about antibiotic therapy.

 

  1. Because of the likelihood of cross-sensitivity reaction, cephalosporins should be administered with extreme caution to clients with a history of allergic reaction to:
a. aminoglycosides. c. penicillins.
b. macrolides. d. tetracyclines.

 

 

ANS:  C

 

  Feedback
A Incorrect: There is no cross-hypersensitivity between penicillins and aminoglycosides.
B Incorrect: There is no cross-hypersensitivity between penicillins and macrolides.
C Correct: Because cephalosporins were developed as offshoots of penicillins, there may be cross-sensitivities between penicillins and cephalosporins.
D Incorrect: There is no cross-hypersensitivity between penicillins and tetracyclines.

 

 

PTS:   1                    REF:   p. 201, Safe Nursing Practice 7-3

OBJ:   Cognitive Level: Comprehension

 

  1. The likelihood of nephrotoxicity may be increased for clients taking cephalosporin antibiotics and:
a. loop diuretics. c. vitamin C.
b. sedatives. d. antacids.

 

 

ANS:  A

 

  Feedback
A Correct: If a client is taking furosemide with either cephalosporins or aminoglycosides, the risk of nephrotoxicity is increased.
B Incorrect: Sedatives do not increase the risk of nephrotoxicity when taken with cephalosporins.
C Incorrect: Vitamin C does not relate to nephrotoxicity.
D Incorrect: Antacids do not increase the risk of nephrotoxicity when taken with cephalosporins.

 

 

PTS:   1                    REF:   p. 201            OBJ:   Cognitive Level: Comprehension

 

  1. The absorption of most oral tetracyclines may be adversely affected by:
a. vitamin C. c. pork.
b. calcium-containing antacids. d. peppermint.

 

 

ANS:  B

 

  Feedback
A Incorrect: Vitamin C does not affect tetracycline absorption.
B Correct: Calcium, aluminum, or magnesium containing antacids or laxatives impair tetracycline absorption.
C Incorrect: Consuming pork does not affect tetracycline absorption.
D Incorrect: Peppermint does not affect tetracycline absorption.

 

 

PTS:   1                    REF:   p. 201 | p. 202, Safe Nursing Practice 7-4

OBJ:   Cognitive Level: Comprehension

 

  1. Tetracycline should not be given to:
a. children under eight years. c. persons with hypertension.
b. elderly persons. d. debilitated persons.

 

 

ANS:  A

 

  Feedback
A Correct: Because of the effects on teeth and bone development, tetracycline should not be taken by children under the age of eight.
B Incorrect: Tetracyclines are not contraindicated in the elderly.
C Incorrect: Tetracyclines are not contraindicated in persons with hypertension.
D Incorrect: Tetracyclines are not contraindicated in debilitated persons.

 

 

PTS:   1                    REF:   p. 202, Safe Nursing Practice 7-4

OBJ:   Cognitive Level: Comprehension

 

  1. A client is prescribed an aminoglycoside and the nurse understands that the usual route by which most aminoglycosides are administered is:
a. oral. c. topical.
b. parenteral. d. intrathecal.

 

 

ANS:  B

 

  Feedback
A Incorrect: Except for oral neomycin and occasional topical aminoglycosides, most are administered parenterally.
B Correct: Most aminoglycosides are administered parenterally.
C Incorrect: Aminoglycosides are only occasionally used topically.
D Incorrect: Aminoglycosides are rarely used intrathecally.

 

 

PTS:   1                    REF:   p. 202            OBJ:   Cognitive Level: Knowledge

 

  1. Clients taking aminoglycosides should have the functioning of the ____ tested before and during treatment.
a. liver. c. ulnar nerve.
b. eighth cranial nerve. d. vision.

 

 

ANS:  B

 

  Feedback
A Incorrect: The primary adverse effect of aminoglycosides is ototoxicity.
B Correct: This is to monitor for ototoxicity.
C Incorrect: Aminoglycosides are not associated with peripheral neuropathy.
D Incorrect: Aminoglycosides are not associated with visual changes.

 

 

PTS:   1                    REF:   p. 203, Safe Nursing Practice 7-5

OBJ:   Cognitive Level: Application

 

  1. Clients at risk of developing nephrotoxicity while taking aminoglycosides are:
a. those with urinary tract infections (UTI).
b. those who have upper respiratory infections (URI).
c. those with dehydration.
d. those being treated for sepsis.

 

 

ANS:  C

 

  Feedback
A Incorrect: These clients are not at increased risk for nephrotoxicity. Aminoglycosides are used to treat some UTIs.
B Incorrect: These clients are not at increased risk for nephrotoxicity.
C Correct: Clients who are dehydrated are at increased risk for nephrotoxicity if taking aminoglycosides, because the dehydration decreases renal perfusion.
D Incorrect: Aminoglycosides are used to treat sepsis.

 

 

PTS:   1                    REF:   p. 203            OBJ:   Cognitive Level: Comprehension

 

  1. Second-generation fluoroquinolones are frequently used to treat:
a. genitourinary infections. c. colitis.
b. upper respiratory infections. d. syphilis

 

 

ANS:  A

 

  Feedback
A Correct: Ciprofloxacin is a commonly used antibiotic to treat UTIs.
B Incorrect: Fluoroquinolones are used to treat lower respiratory infections.
C Incorrect: Fluoroquinolones are not used to treat colitis.
D Incorrect: Fluoroquinolones are not the drugs of choice for syphilis.

 

 

PTS:   1                    REF:   p. 168            OBJ:   Cognitive Level: Comprehension

 

  1. Carbapenems are contraindicated in clients with history of anaphylaxis with:
a. fluoroquinolones. c. aminoglycosides.
b. cephalosporins. d. all of the above.

 

 

ANS:  B

 

  Feedback
A Incorrect: Carbapenems are contraindicated in clients with history of anaphylaxis with the use of penicillins, cephalosporins, or other beta-lactam antibiotics.
B Correct: Carbapenems are contraindicated in clients with a history of anaphylaxis with the use of cephalosporins.
C Incorrect: Carbapenems are contraindicated in clients with history of anaphylaxis with the use of penicillins, cephalosporins, or other beta-lactam antibiotics.
D Incorrect: a and c are incorrect.

 

 

PTS:   1                    REF:   p. 168            OBJ:   Cognitive Level: Knowledge

 

A client visits the local clinic complaining of weight loss, afternoon sweats, and a productive cough. A general workup is conducted, resulting in a diagnosis of tuberculosis. The client is given prescriptions for isoniazid (INH) and para-aminosalicylic acid (PAS) and asked to return to the clinic in two weeks.

 

  1. The client asks why she will be taking two medications to treat her tuberculosis. The best response by the nurse is:
a. “Clients tend to develop bacterial resistance when only one medication is used.”
b. “Two medications are more effective against the tuberculosis organism.”
c. “The client suffers fewer adverse side effects when two drugs are taken.”
d. ”Treatment with two drugs takes half the time.”

 

 

ANS:  A

 

  Feedback
A Correct: Monotherapy is associated with the development of bacterial drug resistance.
B Incorrect: Although this is true, this is not the primary reason for using duel therapy.
C Incorrect: This is a false statement. Each medication carries its own adverse effects.
D Incorrect: This is a false statement. Drug therapy for TB is long term.

 

 

PTS:   1                    REF:   p. 181            OBJ:   Cognitive Level: Application

 

  1. A client with TB is prescribed isoniazid (INH), rifampin, and pyridoxine. The nurse understands that pyridoxine is used in this combination to:
a. increase the action of INH and rifampin.
b. decrease the side effects of rifampin.
c. prevent INH-induced peripheral neuropathy.
d. increase the absorption of INH and rifampin.

 

 

ANS:  C

 

  Feedback
A Incorrect: Pyridoxine does not increase the action of INH and rifampin.
B Incorrect: Pyridoxine does not decrease the side effects of rifampin.
C Correct: Pyridoxine is used to prevent peripheral neuropathy associated with decreased levels of pyridoxine caused by INH.
D Incorrect: Pyridoxine does not increase INH or rifampin absorption.

 

 

PTS:   1                    REF:   p. 204, Safe Nursing Practice 7-6

OBJ:   Cognitive Level: Comprehension

 

  1. Some persons metabolize isoniazid (INH) more rapidly than others. It is important for the nurse to remember that:
a. nearly all Caucasians and African Americans are rapid acetylators.
b. nearly all Asians are slow acetylators.
c. slow acetylators are more likely to experience drug toxicity.
d. rapid acetylators have increased isoniazid effectiveness

 

 

ANS:  C

 

  Feedback
A Incorrect: Fifty percent of Caucasians and African Americans are slow acetylators.
B Incorrect: The majority of Asians and Eskimos are rapid acetylators.
C Correct: Slow acetylators are more likely to have the drug accumulate in their bodies to toxic levels.
D Incorrect: Regardless of how rapid or slowly INH is metabolized, it does not affects its effectiveness.

 

 

PTS:   1                    REF:   p. 181            OBJ:   Cognitive Level: Comprehension

 

The client is an elderly man who experiences frequent bladder infections because of an enlarged prostate gland. On his last visit to the physician, he was prescribed a sulfonamide and methenamine mandelate (Mandelamine). In the past, the client has taken phenazopyridine (Pyridium) and nalidixic acid (NegGram) for treatment of these infections. The nurse provides instruction about fluid intake and appropriate administration of the medication, and advises the client to call if he has any problems.

 

  1. Two days later, the client calls the nurse to report a sore throat, fever, and jaundice. The nurse should advise the client to:
a. decrease the dose of the sulfonamide.
b. go to bed and rest.
c. call the health care provider tomorrow, if he feels worse.
d. stop the sulfonamide and see the health care provider as soon as possible.

 

 

ANS:  D

 

  Feedback
A Incorrect: The drug must be stopped, and the client should see his prescriber as soon as possible, as these may be manifestations of a blood dyscrasia.
B Incorrect: This is not the appropriate advice.
C Incorrect: This is not the appropriate advice.
D Correct: The drug must be stopped and the client should see his prescriber as soon as possible, as these may be manifestations of a blood dyscrasia.

 

 

PTS:   1                    REF:   p. 204            OBJ:   Cognitive Level: Application

 

  1. Clients taking phenazopyridine (Pyridium) for the treatment of a urinary tract infection should be told:
a. to limit their fluid intake.
b. to avoid the use of acidic juices
c. that their urine may decrease in volume.
d. that their urine may turn orange-red.

 

 

ANS:  D

 

  Feedback
A Incorrect: Clients taking antimicrobial agents for any type of infection should be encouraged to consume 3,000-4,000 mL of fluid/day.
B Incorrect: Clients with urinary tract infections should be encouraged to drink acidic fluids to acidify the urine.
C Incorrect: Phenazopyridine does not decrease urine output.
D Correct: Phenazopyridine normally causes the client’s urine to turn orange-red, which may frighten the client (who may believe there is bleeding).

 

 

PTS:   1                    REF:   p. 205, Safe Nursing Practice 7-7

OBJ:   Cognitive Level: Application

 

  1. The nurse understands that the proper solution for administration of amphotericin B (Fungizone) is:
a. normal saline. c. Ringer’s lactate.
b. dextrose 5% in water. d. any sterile IV solution.

 

 

ANS:  B

 

  Feedback
A Incorrect: Amphotericin B is incompatible with normal saline.
B Correct: IV solutions of amphotericin should be added to infusion of dextrose and water only.
C Incorrect: Amphotericin B is incompatible with LR.
D Incorrect: IV solutions of amphotericin should be added to infusion of dextrose and water only.

 

 

PTS:   1                    REF:   p. 206, Safe Nursing Practice 7-8

OBJ:   Cognitive Level: Application

 

  1. The nurse should monitor clients receiving IV infusions of amphotericin B (Fungizone) for:
a. hypernatremia. c. hypokalemia.
b. respiratory acidosis. d. hypercalcemia.

 

 

ANS:  C

 

  Feedback
A Incorrect: Amphotericin B is not associated with the development of hypernatremia.
B Incorrect: Amphotericin B is not associated with the development of respiratory acidosis.
C Correct: Clients receiving amphotericin B can develop hypokalemia.
D Incorrect: Amphotericin B is not associated with the development of hypercalcemia.

 

 

PTS:   1                    REF:   p. 206, Safe Nursing Practice 7-8

OBJ:   Cognitive Level: Application

 

  1. Prior to administering vidarabine (Vira-A) to a client, the nurse should:
a. inquire if the client is pregnant c. inquire if the client is allergic to eggs
b. prepare to administer it orally d. prepare an intramuscular injection

 

 

ANS:  A

 

  Feedback
A Correct: Vidarabine should not be administered to pregnant clients.
B Incorrect: Vidarabine is administered intravenously.
C Incorrect: Egg allergies do not pose a risk to a client receiving vidarabine.
D Incorrect: Vidarabine is administered intravenously.

 

 

PTS:   1                    REF:   p. 207            OBJ:   Cognitive Level: Application

 

A client is hospitalized several times over the course of six months with complications related to AIDS. The client has received medication for the treatment of viral and fungal diseases and is now using pentamidine (Nebupent) aerosol to prevent the development of Pneumocystis carinii pneumonia and also is taking zidovudine (Retrovir).

 

  1. When preparing the client’s pentamidine (Nebupent) powder, the nurse:
a. inserts the powder into the client’s nebulizer for inhalation.
b. reconstitutes the powder with bacteriostatic sterile water.
c. pours the powder into a medicine cup and mixes it with tap water.
d. reconstitutes the powder with sterile bacteriostatic normal saline.

 

 

ANS:  B

 

  Feedback
A Incorrect: Powder should not be inhaled by a client.
B Correct: The powder should be reconstituted with 6 mL of bacteriostatic sterile water.
C Incorrect: This medication is reconstituted using sterile technique.
D Incorrect: The powder should not be reconstituted using normal saline.

 

 

PTS:   1                    REF:   p. 195            OBJ:   Cognitive Level: Application

 

  1. A client with HIV is prescribed pentamidine IM daily for 14 days. The client weighs 121 pounds. What dose should be prescribed for this client?
a. 4 mg c. 220 mg
b. 55 mg d. 500 mg

 

 

ANS:  C

 

  Feedback
A Incorrect: This dose is too small.
B Incorrect: This dose is too small.
C Correct: The recommended dose of pentamidine IM is 4 mg/kg. Divide 121 pounds by 2.2 = 55 kg, then multiply 55 kg by 4 mg = 220 mg.
D Incorrect: This is over twice the safe recommended dose.

 

 

PTS:   1                    REF:   p. 195            OBJ:   Cognitive Level: Application

 

  1. All of the following are true about zidovudine (Retrovir) except:
a. it may cause anemia and low granulocyte counts.
b. clients may develop flulike symptoms.
c. clients cannot transmit HIV while taking zidovudine
d. clients taking it should avoid the use of acetaminophen (Tylenol).

 

 

ANS:  C

 

  Feedback
A Incorrect: This statement is true and client should be monitored for these adverse effects.
B Incorrect: This statement is true.
C Correct: Zidovudine is a virustatic agent not virucidal, so clients can still transmit HIV while receiving treatment.
D Incorrect: This is a true statement.

 

 

PTS:   1                    REF:   p. 208            OBJ:   Cognitive Level: Comprehension

 

  1. Antimicrobial agents that inhibit growth of bacteria, allowing the host’s immunological defenses to complete the job of destroying the organism, are called:
a. bactericidal. c. antibiotics.
b. bacteriostatic. d. infectious.

 

 

ANS:  B

 

  Feedback
A Incorrect: Bactericidal agents have a killing effect on bacteria.
B Correct: Bacteriostatic agents inhibit the growth of bacteria, but do not actively kill the bacteria that are present.
C Incorrect: Some antibiotics are bacteriocidal and some are bacteriostatic.
D Incorrect: Antimicrobial agents are used to treat infectious diseases.

 

 

PTS:   1                    REF:   p. 150            OBJ:   Cognitive Level: Knowledge

 

  1. What is a major disadvantage of using broad-spectrum antibmicrobial agents to treat infections?
a. They are only effective against a small number of microorganisms.
b. They destroy normal flora, enabling superinfections to develop.
c. They are especially effective against viruses.
d. They are more likely to cause an allergic reaction.

 

 

ANS:  B

 

  Feedback
A Incorrect: This is not a true statement.
B Correct: This is the disadvantage the broad-spectrum antimicrobials.
C Incorrect: Most of our broad-spectrum antimicrobials are antibacterials.
D Incorrect: This is not a true statement.

 

 

PTS:   1                    REF:   p. 151            OBJ:   Cognitive Level: Knowledge

 

  1. It is generally not advisable to use a bactericidal and bacteriostatic agent at the same time because:
a. the cost is prohibitive.
b. both agents work in the same manner.
c. the bacteriostatic agent may interfere with the action of the bactericidal agent.
d. they will cause an allergic response in the client.

 

 

ANS:  C

 

  Feedback
A Incorrect: This is not a true statement.
B Incorrect: Bacteriostatic and bactericidal do not have the same action.
C Correct: Bacteriostatic agents may interfere with the action of the bactericidal agents.
D Incorrect: This is not necessarily true.

 

 

PTS:   1                    REF:   p. 150            OBJ:   Cognitive Level: Knowledge

 

  1. A client was admitted to the hospital with pneumonia. The client’s health care provider prescribes “Zinacef, (a second generation cephalosporin) 2 grams IV q8h.” While preparing to administer the first dose of Zinacef, the nurse notices that the client has a penicillin allergy. The best action by the nurse is to:
a. administer the Zinacef as prescribed, but watch the client carefully for any signs of an allergic reaction.
b. ask the pharmacist if another antibiotic can be substituted for the Zinacef.
c. give the Zinacef as prescribed.
d. hold the Zinacef and notify the health care provider of the client’s allergy to penicillin.

 

 

ANS:  D

 

  Feedback
A Incorrect: It should be held until the nurse collaborate with the health care provider.
B Incorrect: This is not the scope of practice for a pharmacist.
C Incorrect: With an allergy to penicillin, there is an increased risk of allergic reactions to cephalosporin.
D Correct: This is the appropriate action by the nurse.

 

 

PTS:   1                    REF:   p. 201, Safe Nursing Practice 7-3

OBJ:   Cognitive Level: Application

 

  1. A client is diagnosed with gram-negative sepsis. The nurse anticipates which of the following cephalosporin agents to be prescribed?
a. cefepime HCl c. amikacin
b. cephalexin d. cefozolin sodium

 

 

ANS:  A

 

  Feedback
A Correct: Cefepime HCl is a fourth-generation cephalosporin. Fourth-generation cephalosporins are used against gram-negative infections.
B Incorrect: Cephalexin is a first-generation cephalosporin used to treat gram-positive microorganisms.
C Incorrect: Amikacin is an aminoglycoside.
D Incorrect: Cefozolin sodium is a first-generation cephalosporin used to treat gram-positive microorganisms.

 

 

PTS:   1                    REF:   p. 164, Table 7-2

OBJ:   Cognitive Level: Comprehension

 

  1. The nurse is teaching a client about the risk of antibiotic-resistant microorganism. Which response by the client indicates that more teaching is needed?
a. “I will be sure to complete my entire prescription.”
b. “I will be sure to avoid direct sunlight until my doxycycline prescription is finished.”
c. “I will watch for itching or a rash while I am taking penicillin V.”
d. “If this medication doesn’t work within five days, I will quit taking it and make an appointment with my doctor.”

 

 

ANS:  D

 

  Feedback
A Incorrect: This is evidence of client understanding.
B Incorrect: This is evidence of client understanding.
C Incorrect: This is evidence of client understanding.
D Correct: Clients should not stop taking an antibiotic without the direction of their health care provider.

 

 

PTS:   1                    REF:   p. 198, Box 7-1                              OBJ:   Cognitive Level: Evaluation

 

  1. For a client receiving tetracycline, the nurse needs to instruct to:
a. take medication with meals.
b. have potassium level checked.
c. avoid juices when taking this drug.
d. take medication one-to-two hours before or two-to-three hours after meals.

 

 

ANS:  A

 

  Feedback
A Correct: Tetracyclines should not be taken on an empty stomach.
B Incorrect: Oral penicillin may alter potassium levels, but taking penicillin does not require a potassium level to be drawn.
C Incorrect: Juices do not need to be avoided when taking tetracyclines.
D Incorrect: Tetracyclines should not be taken on an empty stomach.

 

 

PTS:   1                    REF:   p. 202, Safe Nursing Practice 7-4

OBJ:   Cognitive Level: Application

 

  1. A client with cystic fibrosis is being treated with IV ceftazidime and gentamicin. The nurse should:
a. isolate the client. c. instruct the client to avoid sunlight.
b. monitor for nephrotoxicity. d. perform a hearing test.

 

 

ANS:  B

 

  Feedback
A Incorrect: There is no evidence that the client requires isolation.
B Correct: The use of a cephalosporin and aminoglycoside increases the risk of nephrotoxicity.
C Incorrect: These medications do not cause photosensitivity.
D Incorrect: Gentamicin can cause ototoxicity, but this does not increase with the concurrent use of a cephalosporin.

 

 

PTS:   1                    REF:   p. 201            OBJ:   Cognitive Level: Application

 

  1. When teaching a client taking ciprofloxacin (Cipro), the nurse should instruct the client to avoid:
a. taking the medication with meals.
b. antacids four hours before and two hours after oral dosing.
c. direct sunlight.
d. taking medication with vitamins without iron.

 

 

ANS:  B

 

  Feedback
A Incorrect: Taking Cipro with meals will decrease the N/V (nausea and vomiting) associated with this drug.
B Correct: Antacids interfere with the absorption of ciprofloxacin.
C Incorrect: Ciprofloxacin is not associated with photosensitivity.
D Incorrect: Cipro should not be taken with iron.

 

 

PTS:   1                    REF:   p. 170            OBJ:   Cognitive Level: Application

 

  1. A client is prescribed azithromycin for a respiratory infection. The nurse understands that this agent is a:
a. fluoroquinolone. c. carbapenem.
b. tetracycline. d. macrolide.

 

 

ANS:  D

 

  Feedback
A Incorrect: Azithromycin is a macrolide antimicrobial.
B Incorrect: Azithromycin is a macrolide antimicrobial.
C Incorrect: Azithromycin is a macrolide antimicrobial.
D Correct: Azithromycin is a macrolide antimicrobial.

 

 

PTS:   1                    REF:   p. 160 | p. 167, Table 7-4               OBJ:   Cognitive Level: Knowledge

 

  1. A nurse working in a health care providers office sees a number of cases of the most common tick-transmitted disease, which is:
a. Rocky Mountain spotted fever (RMSF).
b. Lyme disease.
c. aspergillosis.
d. histoplasmosis.

 

 

ANS:  B

 

  Feedback
A Incorrect: Although tick-transmitted, RMSF is not the most common.
B Correct: Lyme disease is the most common tick-transmitted disease in the U.S.
C Incorrect: This is a fungal disease.
D Incorrect: This is a fungal disease.

 

 

PTS:   1                    REF:   p. 181            OBJ:   Cognitive Level: Knowledge

 

  1. When preparing amphotericin B, the nurse understands it:
a. should never be reconstituted with a solution containing a bacteriostatic agent.
b. should always be reconstituted with bacteriostatic 5% dextrose in water.
c. usually has a precipitate in the solution, so this is not an abnormal finding and should be administered.
d. seldom causes phlebitis in peripheral intravenous access.

 

 

ANS:  A

 

  Feedback
A Correct: Amphotericin B should not be reconstituted with saline or sterile water containing a bacteriostatic agent.
B Incorrect: Amphotericin is not reconstituted with 5% dextrose in water.
C Incorrect: Never use a solution of amphotericin that contains a precipitate.
D Incorrect: Amphotericin is caustic to peripheral veins, so they should be monitored for phlebitis.

 

 

PTS:   1                    REF:   p. 206, Safe Nursing Practice 7-8

OBJ:   Cognitive Level: Comprehension

 

  1. When planning assignments for a pediatric unit, the charge nurse should not assign a pregnant nurse to a child receiving:
a. acyclovir. c. ribavirin.
b. vidarabine. d. zidovudine.

 

 

ANS:  C

 

  Feedback
A Incorrect: Caring for a client receiving acyclovir is not contraindicated for a pregnant nurse.
B Incorrect: Caring for a client receiving vidarabine is not contraindicated for the pregnant nurse; however, a pregnant individual should not take vidarabine.
C Correct: Because of terogenic effects of this drug, no pregnant individual should enter the room of a client during inhalation administration of ribavirin.
D Incorrect: Caring for a client receiving zidovudine is not contraindicated for the pregnant nurse.

 

 

PTS:   1                    REF:   p. 192            OBJ:   Cognitive Level: Application

 

  1. Prior to administering vidarabine to a client, the nurse should:
a. prepare to administer the agent by IV bolus,
b. attach a filter to the vidarabine infusion.
c. monitor the client during therapy for the development of a UTI.
d. locate the ventrogluteal IM injection site.

 

 

ANS:  B

 

  Feedback
A Incorrect: This drug should not be infused rapidly or by IV bolus.
B Correct: A filter is used for vidarabine infusions.
C Incorrect: This drug is not associated with the development of urinary tract infections.
D Incorrect: This drug is administered by intravenous infusion.

 

 

PTS:   1                    REF:   p. 207, Safe Nursing Practice 7-9

OBJ:   Cognitive Level: Application

 

  1. When administering IV vancomycin, the nurse should:
a. monitor the client for ototoxicity.
b. maintain the client on complete bed rest.
c. infuse this drug over a minimum of one hour.
d. infuse this agent as an IV bolus.

 

 

ANS:  C

 

  Feedback
A Incorrect: This is not an adverse effect of vancomycin, but rather of aminoglycosides.
B Incorrect: This action is not necessary.
C Correct: To decrease the risk of nephrotoxicity, infuse this drug over a minimum of one hour.
D Incorrect: This drug should not be infused IV bolus. To decrease the risk of nephrotoxicity, infuse this drug over a minimum of 1 hour.

 

 

PTS:   1                    REF:   p. 177, Table 7-7

OBJ:   Cognitive Level: Application

 

  1. Infusing vancomycin through a central venous access would prevent:
a. nephrotoxicity associated with peripheral infusion of vancomycin.
b. pain and phlebitis associated with peripheral infusion.
c. the need for adult doses to be diluted in a minimum of 200 mL of dextrose or normal saline.
d. having to infuse vancomycin for more than 60 minutes.

 

 

ANS:  B

 

  Feedback
A Incorrect: The vascular access does not affect the nephrotoxicity associated with vancomycin.
B Correct: Central venous access is preferred because of the high incidence of pain and phlebitis in peripheral veins from vancomycin infusions.
C Incorrect: Regardless of the vascular access, adult doses need to be diluted in a minimum of 200 mL of dextrose or normal saline
D Incorrect: Regardless of the vascular access, vancomycin needs to be infusing for a minimum of 60 minutes.

 

 

PTS:   1                    REF:   p. 177            OBJ:   Cognitive Level: Comprehension

 

  1. A client with AIDS is prescribed didanosine and zidovudine. The nurse should include which of the following in teaching for this client?
a. take acetaminophen for a headache.
b. take these medications around-the-clock.
c. stop taking these drugs, if you experience flu-like symptoms.
d. take nonsteroidal anti-inflammatory agents (NSAIDs) for joint pain

 

 

ANS:  B

 

  Feedback
A Incorrect: Acetaminophen should be avoided.
B Correct: These medications should be taken around-the-clock to maintain a blood level of the drugs.
C Incorrect: This is a common adverse effect that normally disappears after the first week of therapy.
D Incorrect: NSAIDs should be avoided.

 

 

PTS:   1                    REF:   p. 208 | p. 209, Safe Nursing Practice 7-10

OBJ:   Cognitive Level: Application

 

  1. A client is prescribed ketoconazole. The nurse understand that this agent a/an:
a. cephalosporin. c. antiviral.
b. aminoglycoside. d. antifungal.

 

 

ANS:  D

 

  Feedback
A Incorrect: Ketoconazole is an antifungal agent.
B Incorrect: Ketoconazole is an antifungal agent.
C Incorrect: Ketoconazole is an antifungal agent.
D Correct: Ketoconazole is an antifungal agent.

 

 

PTS:   1                    REF:   p. 185            OBJ:   Cognitive Level: Comprehension

 

MULTIPLE RESPONSE

 

  1. The nurse observes for which of the following manifestations of an allergic reaction in a client receiving penicillin?
a. nephrotoxicity c. urticaria
b. pruritis d. dyspnea

 

 

ANS:  B, C, D

 

  Feedback
Correct b, c, and d are manifestations of an allergic reaction to penicillin.
Incorrect Nephrotoxicity is an adverse effect usually associated with vancomycin.

 

 

PTS:   1                    REF:   p. 154            OBJ:   Cognitive Level: Comprehension

 

  1. When teaching a client who is prescribed a tetracycline, the nurse should instruct the client to avoid:
a. dairy products. c. vitamin B-12.
b. zinc. d. iron.

 

 

ANS:  A, B, D

 

  Feedback
Correct a, b, and d are products that decrease the absorption of tetracyclines.
Incorrect Vitamin B-12 does not influence tetracycline absorption.

 

 

PTS:   1                    REF:   p. 201 | p. 202, Safe Nursing Practice 7-4

OBJ:   Cognitive Level: Application

 

  1. Clients taking urinary anti-infectives should receive instructions from the nurse to:
a. consume 3,000-4,000 of fluid per day.
b. discontinue medication when symptoms subside.
c. decrease oral fluid intake to prevent crystals from forming.
d. consume plenty of cranberry and orange juice.

 

 

ANS:  A, D

 

  Feedback
Correct a and d are correct. Clients with UTIs should consume 3L-4L of fluid a day and increase their consumption of juices that will increase the acidity of their urine.
Incorrect b and c are incorrect: As with all antimicrobials, urinary anti-infectives should be taken as long as the prescription lasts, and oral intake of fluids should be increased to prevent sulfonamide-induced urine crystals.

 

 

PTS:   1                    REF:   p. 204            OBJ:   Cognitive Level: Application

 

  1. A client receiving gentamicin IV should be monitored for:
a. tinnitus. c. loss of balance.
b. dizziness. d. nausea and vomiting.

 

 

ANS:  A, B, C, D

 

  Feedback
Correct All answers are correct and manifestations of eighth cranial nerve damage.
Incorrect

 

 

PTS:   1                    REF:   p. 203            OBJ:   Cognitive Level: Comprehension

 

  1. The client who is experiencing a viral infection may be prescribed which of the following antiviral agents?
a. amantadine c. interferon alfa-2a
b. acyclovir d. trimethoprim

 

 

ANS:  A, B, C

 

  Feedback
Correct a, b, and c are antiviral agents.
Incorrect Trimethoprim is a urinary anti-infective.

 

 

PTS:   1                    REF:   p. 187-189, Table 7-11

OBJ:   Cognitive Level: Comprehension