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Performance Exit Topic 10 Part 1: Antibacterials Due Jul 14, 2024 by 11:59 pm Final Score 53% 17 out of 32 questions answered correctly Co...

Performance Exit Topic 10 Part 1: Antibacterials Due Jul 14, 2024 by 11:59 pm Final Score 53% 17 out of 32 questions answered correctly Completed on Jul 7, 2024 8:52 pm Incorrect (15) Report content error Which statement describes how superinfection can occur? “It can occur when the serum level of an antibiotic is too high.”  “It can occur when the patient has a gram-positive bacterial infection.” “It can occur when the patient has a gram-negative bacterial infection.” “It can occur when the antibiotic eliminates the normal bacterial flora.” Rationale The normal bacterial flora consists of certain bacteria and fungi that are needed to maintain normal function in various organs. Superinfection can occur when antibiotics completely eliminate the normal bacterial flora. When these bacteria or fungi are killed by antibiotics, then other bacteria or fungi cause infection, which is known as superinfection. When the serum level of the antibiotic is too high, it causes a toxic reaction. Gram-positive and gram-negative bacterial infections do not cause superinfection. Test-Taking Tip: Eat breakfast or lunch before an exam. Avoid greasy, heavy foods and overeating. This will help keep you calm and give you energy. p. 318 Report content error Which assessment is most important before administering the first dose of ampicillin to an 80-year-old patient? Renal function Hepatic function Cross-sensitivity Total body fluid Rationale The most important assessment before administering ampicillin to an older adult is that of renal function because older adults are more sensitive to medications. Ampicillin formulations contain large amounts of sodium and/or potassium. Doses must be adjusted for patients with renal dysfunction. If the patient is hypervolemic, assessment of renal function is even more important; however, the nurse would monitor intake and output and edema with the administration of ampicillin. In addition, older adults are likely to have declining organ function, including hepatic function, which can lead to impaired elimination of any medication. However, assessing renal function is a priority over assessing hepatic function. Ampicillin can be administered by way of several routes; if the patient’s veins are too poor for an infusion, it can be administered by means of injection into the muscle or by mouth. Cross-sensitivity to other antibiotics is not important until ampicillin fails to eliminate the bacteria after one course of treatment. Total body fluid is a reasonable assessment before the administration of ampicillin; however, eradication of the infection is the priority. p. 318  Report content error Which occurrence(s) would the nurse mention as causative of bacterial resistance when explaining antibiotic therapy to a patient? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Antibiotics are stopped after the patient feels better. Antibiotics are prescribed according to culture and sensitivity reports. Antibiotics are prescribed to treat a viral infection. Antibiotics are taken with water or juice. Antibiotics are taken with ascorbic acid (vitamin C). Doses of antibiotics are skipped. Rationale Not completing a full course of antibiotic therapy or skipping doses can allow bacteria that have not been killed but have been exposed to the antibiotic to adapt their physiology to become resistant to that antibiotic. The same thing can occur when bacteria are exposed to antibiotics in the environment or when antibiotics are erroneously used to treat viral infections. Thus the nurse would mention that stopping antibiotics before the end of a course, skipping antibiotic doses, and using antibiotics to treat viral infections can lead to bacterial resistance. Antibiotics prescribed according to culture and sensitivity reports do not affect bacterial resistance. Bacterial resistance to antibiotics does not occur with the use of water, juice, or ascorbic acid. p. 315 Report content error Which occurrence would the nurse identify as the cause of reported oral candidiasis in a patient who has been taking an antimicrobial drug for 2 weeks? Superinfection Cross-resistance Antibiotic resistance Nosocomial infection Rationale Superinfection is a secondary infection that occurs when normal gut flora are destroyed by antibiotic use, leading to an overgrowth of fungus. Thus the nurse would identify superinfection as the cause of the patient’s oral candidiasis. Cross-resistance occurs between antibacterial drugs that have similar actions. Antibiotic resistance occurs when bacteria reduce or eliminate the effectiveness of the antibacterial drug. A nosocomial infection is a hospital-acquired infection. p. 315  Report content error Which organ can be damaged by antibacterial drugs? Select all that apply. One, some, or all responses may be correct. Eyes Liver Brain Spleen Kidneys Rationale Organs that can develop toxicities from antibacterial medications include the liver and kidneys. The eyes, brain, and spleen are not damaged by antibiotics. p. 315 Report content error The nurse is reviewing a patient’s medical history before administering azithromycin. Which patient factor would most likely contribute to hepatotoxicity? Drinks fruit juice with the medication Takes acetaminophen at maximum dosing Uses antacids after taking the medication Prescribed theophylline twice a day Rationale Hepatotoxicity (liver toxicity) can occur if azithromycin is taken with other hepatotoxic drugs, such as high doses of acetaminophen. Fruit juice taken with azithromycin can alter the absorption of the medication. Antacids can alter the absorption of azithromycin. Theophylline levels are increased if taken with azithromycin. Test-Taking Tip: Start by reading each of the answer options carefully. Usually at least one of them will be clearly wrong. Eliminate this one from consideration. Now you have reduced the number of response choices by one and improved the odds. Continue to analyze the options. If you can eliminate one more choice in a four-option question, you have improved the odds to 50/50. While you are eliminating the wrong choices, recall often occurs. One of the options may serve as a trigger that causes you to remember what a few seconds ago had seemed completely forgotten. p. 326  Report content error The nurse reviews the medication list for a patient who is receiving treatment for Clostridium difficile. Which drug interaction is most likely to contribute to vancomycin nephrotoxicity? Current Medications Vancomycin 125 mg orally 4 times a day Furosemide 40 mg orally daily Metoprolol 25 mg extended-release tablets twice a day Atorvastatin 10 mg orally daily Acetaminophen 650 mg orally every 4 hours as needed for pain, up to 4 doses a day Furosemide Metoprolol Atorvastatin Acetaminophen Rationale Nephrotoxicity is potentiated when vancomycin is taken with furosemide. Metoprolol does not pose a drug interaction that increases the risk for nephrotoxicity. Atorvastatin may contribute to rhabdomyolysis with lipopeptides. Acetaminophen may increase the risk for liver toxicity; however, the patient’s dose is low and as-needed. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Example: If you are being asked to identify a diet that is specific to a certain condition, your knowledge about that condition would help you choose the correct response (e.g., cholecystectomy = low-fat, high-protein, low-calorie diet). p. 328 Report content error Which action by the nurse is inappropriate in caring for a patient receiving levofloxacin for a urinary tract infection (UTI)? Encouraging the patient to have caffeinated products Instructing the patient to take the drug along with food Instructing the patient to drink 8 glasses of water per day Informing the primary health care provider if the pH of the urine is 5 Rationale Levofloxacin can increase the effects of caffeine. This can lead to adverse effects from too much caffeine. Thus encouraging the patient to have caffeinated products is inappropriate. Levofloxacin may cause gastrointestinal distress, so it should be taken along with food. Drinking 6 to 8 glasses of water per day may reduce the burning sensation associated with a UTI. The pH of urine should be less than 6.7 to prevent crystalluria. Because the pH is 5, informing the primary health care provider is not necessary. Test-Taking Tip:A burning sensation while passing urine is the clinical sign of a UTI. Identify the option that may aggravate the condition of the patient. p. 337 Report content error Which complication would the nurse monitor for in a patient who is on nonsteroidal antiinflammatory drug (NSAID) therapy and has been prescribed levofloxacin to treat a lower respiratory tract infection? Seizures Ototoxicity Nephrotoxicity Encephalopathy Rationale Levofloxacin is the drug of choice for severe lower respiratory tract infections. Levofloxacin should not be administered with NSAIDs because it may cause central nervous system reactions, such as seizures. Thus the nurse would monitor this patient for seizures. Ototoxicity is an adverse effect of vancomycin. Nephrotoxicity may be seen with high doses of amphotericin B. Encephalopathy is an adverse effect of streptomycin and is not seen when levofloxacin is administered along with NSAIDs. Test-Taking Tip:You have at least a 25% chance of selecting the correct response in a multiple-choice item with four options. If you are uncertain about a question, eliminate the choices that you believe are wrong, then call on your knowledge, skills, and abilities to choose from the remaining responses. p. 337 Report content error Which assessment will the nurse include when planning care for a patient who is receiving daily gentamicin infusions? Deep tendon reflexes Range of motion Vision Hearing Rationale Aminoglycosides can cause ototoxicity. The nurse should plan to assess for hearing loss and report the findings to the health care provider. Assessing deep tendon reflexes, range of motion, and vision are not priorities for the nurse when caring for patients taking aminoglycosides. Test-Taking Tip: Answer the question that is asked. Read the situation and the question carefully, looking for key words or phrases. Do not read anything into the question or apply what you did in a similar situation during one of your clinical experiences. Think of each question as being an ideal, yet realistic, situation. p. 335 Report content error Which laboratory test is used to monitor for antibiotic toxicity? Trough Aspartate aminotransferase (AST) Peak Alanine aminotransferase (ALT) Rationale A peak measures the highest concentration of antibiotic levels in the blood. The test is used to monitor for antibiotic toxicity. The lowest concentration of antibiotic blood levels is measured with the trough; the test is important to maintain a therapeutic drug level but is not helpful for monitoring for toxicity. AST and ALT measure liver enzymes, which can be used to monitor for liver damage. Test-Taking Tip: Have confidence in your initial response to an item because it more than likely is the correct answer. pp. 334,336 Report content error Which statement correctly describes fluoroquinolones? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Prescribed for gram-positive organisms Treat gram-negative organisms Are the first choice antibiotic for common infections Can be taken with all other medications Require increased fluid intake to 6 to 8 glasses a day while taking Rationale Fluoroquinolones are a broad spectrum antibiotic class that treat gram- negative and gram-positive organisms. The patient should be well hydrated to prevent crystalluria. Fluoroquinolones should be reserved for patients with uncomplicated infections who have no other options. The patient should not take antacids or iron products at the same time as fluoroquinolones, as it can affect absorption. p. 337 Report content error Which cue in a patient’s medical record would cause concern for a patient receiving gentamicin? A trough drawn 10 minutes before the next scheduled gentamicin dose A white blood cell count of 8.2 x 109/L Urinary output of 400 mL in the last 24 hours Culture results with sensitivity to gentamicin Rationale A patient’s urine output for a 24 hour day should be at least 600 mL. A urine output of 400 mL would alert the nurse to possible renal insufficiency. A white blood cell count of 8.2 x 109/L is within normal range. A trough should be drawn 10 minutes before a dose of gentamicin is received. A culture result with a sensitivity to gentamicin is appropriate because it would indicate that gentamicin will treat the particular cause of infection. Test-Taking Tip: If you are unable to answer a multiple-choice question immediately, eliminate the alternatives that you know are incorrect and proceed from that point. The same goes for a multiple-response question that requires you to possibly choose more of the given alternatives. If a fill-in-the-blank question poses a problem, read the situation and essential information carefully and then formulate your response. p. 335 Report content error Which action would the nurse suspect as the cause of shortness of breath, facial flushing, severe headache, vomiting, and confusion in a patient receiving metronidazole treatment? Drinking alcohol Taking vitamin B6 Taking echinacea Swishing the medication Rationale A patient receiving metronidazole treatment should avoid drinking alcohol to prevent a drug interaction that results in a disulfiram reaction. Disulfiram reactions are manifested by shortness of breath, facial flushing, severe headache, vomiting, and confusion. Thus the nurse would suspect that the patient has been drinking alcohol while taking metronidazole. Taking vitamin B6helps prevent peripheral neuropathy in patients who are receiving antitubercular treatment. Taking echinacea along with ketoconazole may lead to hepatotoxicity. Swishing the medication is advised for patients receiving any suspensions, such as nystatin, and this would not be a possible reason for the patient’s condition. p. 343 Report content error Which explanation will the nurse provide if a patient asks the nurse why a combination medication, trimethoprim- sulfamethoxazole (TMP-SMZ), is prescribed for a urinary tract infection? “The risk of allergic reaction is reduced with low doses of two medications.” “Combination medication reduces bacterial resistance to treatment.” “Sulfamethoxazole is faster acting when combined with trimethoprim.”  “Trimethoprim increases the absorption of sulfamethoxazole.” Rationale Trimethoprim is combined with sulfamethoxazole to prevent bacterial resistance to sulfonamide drugs used alone and to obtain a better bactericidal response. Allergic reactions may still occur with these medications. Sulfamethoxazole has intermediate action. Trimethoprim provides additional treatment of gram-negative bacteria. Trimethoprim does not change the absorption of sulfamethoxazole. p. 340 Correct (17) Report content error Which intervention(s) would be appropriate when caring for a patient who has been prescribed penicillin G potassium? Select all that apply. One, some, or all responses may be correct. Monitoring for superinfection Monitoring the patient for respiratory distress Obtaining a culture and sensitivity test after starting the therapy  Having availability of epinephrine to treat severe allergic reaction Advising the patient to take the medication on an empty stomach Rationale Taking penicillin for a prolonged period may cause superinfections. Therefore monitoring for stomatitis, which is a type of superinfection, would be appropriate and required. Respiratory distress is a severe allergic reaction that can occur after a first or second dose of penicillin. Thus monitoring the patient for signs of respiratory distress would also be appropriate. Epinephrine is used to treat a severe allergic reaction that may occur with the use of penicillin, so the nurse would have epinephrine on hand to treat a severe allergic reaction. For effective treatment, a culture and sensitivity test would be obtained before starting the therapy. Penicillins should be taken with food to avoid gastric irritation. Test-Taking Tip: Be alert for details. Details provided in the question stem, such as behavioral changes or clinical changes (or both) within a certain time period, can provide a clue to the most appropriate response or, in some cases, responses. p. 318 Report content error Which nursing action would be most important before administering an intravenous dose of penicillin? Locating the intravenous (IV) site Recording the daily urine output Obtaining serum creatinine levels Assessing the patient for any allergies Rationale The most important nursing action would be asking the patient whether the patient is allergic to penicillin before administering it. This would prevent allergic or hypersensitivity reactions caused by penicillin. Locating the intravenous site would be done if the patient has no known allergies to penicillin. After injecting the penicillin, the nurse would record the urine output and obtain the serum creatinine levels. Test-Taking Tip: If the question asks for an immediate action or response, all of the answers may be correct, so base your selection on identified priorities for action. p. 318 Report content error Which intervention is the most important when caring for a 22-year-old woman who has been prescribed amoxicillin? Obtain a baseline complete blood count (CBC). Assess if the patient is on oral contraceptives. Inform the patient about possible superinfections. Instruct the patient not to take the medication before meals. Rationale This medication may decrease the effectiveness of oral contraceptives. Thus the most important intervention is assessing whether the patient is on oral contraceptives and whether the patient is sexually active. Long-term use of antibiotics can cause blood dyscrasias, but a baseline assessment is not indicated. Obtaining a baseline CBC, informing the patient about possible superinfections, and instructing the patient not to take the medication before meals are not priorities. Test-Taking Tip: When using this program, be sure to note if you guess at an answer. This will permit you to identify areas that need further review. Also, it will help you to see how correct your guessing can be. p. 318 Report content error The nurse is assessing a patient who received the first dose of amoxicillin an hour ago. Which sign or symptom would require immediate intervention by the nurse? Nausea Candidiasis Angioedema Tongue discoloration Rationale Angioedema is a life-threatening reaction to a medication. The reaction can happen when a patient with an allergy is exposed to the first dose of a medication. Angioedema is a sign the airway may become compromised and requires immediate intervention. Nausea, candidiasis, and tongue discoloration are side effects of amoxicillin, but they are not life-threatening. Test-Taking Tip: If you are unable to answer a multiple-choice question immediately, eliminate the alternatives that you know are incorrect and proceed from that point. The same goes for a multiple-response question that requires you to choose one or more of the given alternatives. If a fill-in-the-blank question poses a problem, read the situation and essential information carefully and then formulate your response. p. 316 Report content error The nurse is reviewing the medication administration record of a patient who was newly prescribed ceftriaxone. Which patient parameter would lead the nurse to hold the dose and contact the health care provider (HCP)? Cefazolin allergy Diabetes mellitus White blood cell (WBC) count 8.2 cells/mm3 Creatinine 1.1 mg/dL Rationale A patient who has an allergy to one type of cephalosporin will most likely have an allergy to others. The allergy would necessitate the nurse holding the dose and contacting the HCP. The medication is not contraindicated in patients with diabetes mellitus. The patient has normal WBC and creatinine levels. p. 322 Report content error Which term is used to describe when an antibacterial drug is no longer effective due to repeated use? Potentiative effect  Antagonistic effect Inherent resistance Acquired resistance Rationale Acquired resistance occurs with repeated use of antibiotics. The bacteria mutate and become resistant to the drug. The potentiative effect occurs when one antibiotic increases the effectiveness of a second antibiotic. The antagonistic effect is when two antibiotics are used and the second antibiotic reduces the effectiveness of the first. Inherent resistance occurs without exposure to any antibiotic. An example is Pseudomonas aeruginosa, which will always naturally be resistant to penicillin G. p. 314 Report content error Which laboratory value would the nurse assess to ensure safe administration of vancomycin to a patient? Vitamin B12 Renal function Red blood cell count Blood glucose concentration Rationale Vancomycin is a tricyclic glycopeptide, which causes nephrotoxicity. Therefore the nurse would check the patient’s renal function before administering vancomycin. Renal impairment may lead to severe toxicity. The dosing frequency of vancomycin is dependent on renal function. Therefore it is important to check the patient’s renal function. Vancomycin does not affect vitamin B12, blood glucose concentration, or red blood cell counts; therefore the nurse need not check these in the patient. p. 328 Report content error Which action would the nurse take if the patient develops excessive sweating and reports itching of the face and neck while vancomycin is being administered intravenously? Assess the patient’s blood pressure. Increase the rate of infusion. Decrease the rate of infusion. Stop the vancomycin infusion. Rationale Rapid infusion of vancomycin results in red man syndrome. This syndrome is characterized by flushing and itching of the head, face, neck, and upper trunk. It is most common when the drug is infused too rapidly. Thus the nurse would stop the vancomycin infusion in this situation. Checking the blood pressure is a secondary intervention and would be done once the patient is stabilized. Rapid infusion of vancomycin may also cause hypotension; this leads to excessive sweating. Rapid administration of the vancomycin infusion worsens the itching and hypotension. The symptoms of red man syndrome can usually be alleviated by slowing the rate of infusion of the dose to at least 1 hour, but in this situation, the syndrome is already underway, so it is best to stop the infusion. p. 328 Report content error Which teaching will the nurse provide to a patient who has been prescribed azithromycin for otitis media? “You can stop taking the medication once your symptoms improve.” “Take this medication on an empty stomach.” “Come back to have culture and sensitivity done when you finish the medication.” “You must complete the full course of the medication.” Rationale Completion of the full course of the medication is the most important patient teaching point for all antibacterial medications. Taking the full course is necessary to effectively kill the bacteria and prevent the growth of more bacteria. Patients should be informed that their symptoms might get better before they finish the full course of medication, but that they must continue to take the medication as prescribed until the full course is complete. The medication should be taken 1 hour before or 2 hours after eating. However, if gastrointestinal upset occurs, patients may take it with food. A culture and sensitivity specimen will be collected before the antibiotic is started. A repeat test might not be necessary after completion of the treatment. Test-Taking Tip: After you have eliminated one or more choices, you may discover that two of the options are very similar. This can be very helpful because it may mean that one of these look-alike answers is the best choice and the other is a very good distractor. Test both of these options against the stem. Ask yourself which one answers the question more fully and completely. The option that best completes or answers the stem is the one you should choose. Here, too, pause for a few seconds, and give your brain time to reflect; recall may occur. p. 327 Report content error Which cue indicates cranial nerve VIII toxicity in a patient receiving vancomycin?  Facial pain Vision blurring Hearing loss Facial asymmetry Rationale Vancomycin may cause ototoxicity. Ototoxicity results in damage to the auditory branch of cranial nerve VIII. A patient may report tinnitus and hearing loss. Cranial nerve V is related to facial sensation and movement. Cranial nerve VI is related to eye movement. Cranial nerve VII is related to facial movement. Test-Taking Tip: Once you have decided on an answer, look at the stem again. Does your choice answer the question that was asked? If the question stem asks “why,” be sure that the response you have chosen is a reason. Many times, checking to make sure that the choice makes sense in relation to the stem will reveal the correct answer. pp. 325,328 Report content error Which information would the nurse include when teaching a patient about the administration of an antacid and ciprofloxacin? “Take both drugs simultaneously.” “Take the antacid every alternate day.” “Take the drug on an empty stomach.” “Take ciprofloxacin 2 hours before or after the antacid.” Rationale The nurse would instruct the patient to take ciprofloxacin 2 hours before or after the antacid for the best absorption. The antacids should not be taken on alternate days because this may not help prevent gastrointestinal problems. Ciprofloxacin interacts with antacids, and this decreases the absorption of the ciprofloxacin. Ciprofloxacin causes gastric irritation when administered on an empty stomach. p. 337 Report content error For which patient would the nurse question the prescription of tetracycline? A 6-year-old patient with a Haemophilus influenzae infection A 45-year-old patient with a history of diabetes mellitus  A 60-year-old patient with a history of hypertension A 40-year-old patient diagnosed with rickettsiae Rationale Tetracycline is contraindicated in children younger than 8 years old because it can cause permanent discoloration of the teeth. Thus the nurse would question the prescription of tetracycline for a6-year-old patient with aHaemophilus influenzae infection.Tetracycline is not contraindicated for patients diagnosed with diabetes mellitus or hypertension. Tetracycline is used to treat rickettsiae. Test-Taking Tip: Become familiar with reading questions on a computer screen. Familiarity reduces anxiety and decreases errors. pp. 332-333 Report content error Which instruction would the nurse include in the discharge teaching for a patient receiving tetracycline? “Take the medication until you feel better.” “Use sunscreen and protective clothing when outdoors.” “Keep the remainder of the medication in case of recurrence.” “Take the medication with food or milk to minimize gastrointestinal upset.” Rationale Photosensitivity is a common side effect of tetracycline. Exposure to the sun can cause severe burns; therefore the nurse would instruct the patient to use sunscreen and wear protective clothing when outdoors. The medication should not be taken with milk and should be completely finished, not taken only up until the patient feels better and retained in case of recurrence. Test-Taking Tip: Pace yourself during the testing period and work as accurately as possible. Do not be pressured into finishing early. Do not rush! Students who achieve higher scores on examinations are typically those who use their time judiciously. pp. 332-333 Report content error After teaching a patient prescribed doxycycline for the treatment of a skin infection, which patient response reflects an understanding of doxycycline administration? Select all that apply. One, some, or all responses may be correct. “I will take this medication on an empty stomach.” “I will take all the doses that have been prescribed for me.” “I will let my health care provider know if my infection gets worse.”  “I will get medical attention if I have serious side effects.” “If I start to feel better, I can stop taking the medication.” Rationale The patient would be advised to take doxycycline with food to prevent gastrointestinal side effects. Patients should always take the complete course of antibiotics as prescribed. Worsening signs of infection indicate that the antibiotic therapy is not working; the patient should be advised to notify their health care provider if the infection does not improve. Patients should be made aware that adverse reactions such as hearing loss, nephrotoxicity, neurotoxicity, or anaphylaxis require medical attention. Doxycycline can cause gastrointestinal side effects such as nausea and vomiting and should not be taken on an empty stomach. Just because the patient feels better, does not mean the infection has been fully treated. The patient should never stop taking the medication until it is completed. pp. 331-333 Report content error Following education from the nurse for a new prescription of tetracycline, which patient statement reflects a need for clarification? “I should use sunblock and wear sunglasses when going outside.” “My oral contraceptive will be effective if I continue to take it daily as directed.” “I will avoid taking my medication with a glass of milk.” “I will complete my entire course of tetracycline, even if I start to feel better.” Rationale Tetracycline may decrease the effectiveness of oral contraceptives. The patient should plan to use an additional (back-up) method of birth control to prevent unwanted pregnancy while on the antibiotic. Tetracycline causes photosensitivity, and patients should be educated on wearing protective clothing, sunglasses, and sunblock when outdoors. Calcium-rich foods, like milk, may inhibit absorption of tetracycline and should not be taken with medication. The patient should complete the entire antibiotic regimen to ensure proper treatment, regardless of symptomology. p. 331 Report content error A patient is prescribed trimethoprim-sulfamethoxazole (TMP-SMZ) TMP 160 mg/SMZ 800 mg tablet orally every 12 hour for 10 days. Which statement indicates the patient requires further instruction? “I drink water frequently during the day.” “I avoid direct sunlight.” “I take the medication an hour before meals or snacks.” “I will take the medication until I feel better.” Rationale Trimethoprim-sulfamethoxazole (TMP-SMZ) is prescribed for 5 to 14 days. The prescription should be completed even if symptoms improve to avoid resistant bacteria growth. The patient requires more education about completing the full prescription. Drinking water is appropriate to prompt excretion through the kidneys. Avoiding direct sunlight reduces the risk for photosensitivity that is a side effect of the medication. Taking the medication on an empty stomach is preferred to support absorption of the medications. pp. 340,341 Report content error A patient prescribed trimethoprim-sulfamethoxazole (TMP- SMZ) reports feeling tired along with a painful and blistering rash. Which complication is likely occurring? Superinfection Hemolytic anemia Photosensitivity Stevens-Johnson syndrome Rationale Stevens-Johnson syndrome is a reaction to medications that results in flulike symptoms that include fatigue (tired feeling) and a painful rash that spreads and blisters. Superinfections include stomatitis, furry black tongue, itching, and anal or genital discharge. Hemolytic anemia is a disorder in which red blood cells are destroyed and the skin may be jaundiced. Photosensitivity is a redness from sunlight exposure, but it is less likely because the patient additionally reports feeling tired. pp. 340,341,342  Performance Exit Topic 10 Part 2: Anti-infectives Due Jul 14, 2024 by 11:59 pm Final Score 59% 13 out of 22 questions answered correctly Completed on Jul 8, 2024 6:14 pm Incorrect (9) Report content error By which method(s) of transmission is tuberculosis spread? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Talking Sneezing Coughing Sexual contact Sharing a toilet seat Rationale Tuberculosis is an infection caused by Mycobacterium tuberculosis. When a person inhales Mycobacterium tuberculosis, the infection spreads through their blood and lymphatic system. Mycobacterium tuberculosisis mostly transmitted when a healthy individual inhales droplets of saliva that are expelled by an infected person through talking, sneezing, or coughing. It is not transmitted through sexual contact or shared toilet seats. p. 345 Report content error Which side effect(s) may occur in a patient receiving isoniazid for tuberculosis? Select all that apply. One, some, or all responses may be correct. or all responses may be correct. Some correct answers were not selected Tremors Drowsiness Photosensitivity Changes in vision Changes in hearing Passing of red-orange urine Rationale Isoniazid is a first-line antitubercular drug. It may cause side effects such as tremors, drowsiness, photosensitivity, and changes in vision, including blurry vision. It is not expected to cause changes in hearing, as with capreomycin and streptomycin, or passing of red-orange urine, as with rifampin and rifapentine. p. 348 Report content error Which patient(s) would require cautious use, if at all, of fluconazole? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected  A patient who is in the first trimester of pregnancy A patient with candidiasis A patient with kidney failure A patient with hepatomegaly A patient with cryptococcal meningitis Rationale Cautious use, if at all, of fluconazole as an antifungal drug is warranted in patients who are pregnant (particularly in the third trimester), patients with kidney impairments (such as kidney failure), and patients with hepatic diseases (such as hepatomegaly). Fluconazole is indicated for candidiasis and cryptococcal meningitis and may be given in the absence of any contraindications. p. 353 Report content error Which microorganism is directly affected by acyclovir? Varicella-zoster virus Proteus vulgaris Pneumocystis jiroveci Staphylococcus aureus Rationale The varicella-zoster virus, which causes herpes zoster, is directly affected by acyclovir.Acyclovir in its oral form is used in the treatment of herpes zoster of immunocompetent patients. The intravenous formulation is used inimmunocompetent pediatric patients andimmunocompromised patients. Proteus vulgaris, Pneumocystis jiroveci, and Staphylococcus aureus are not affected by acyclovir; there are other antimicrobial remedies for these microorganisms.Proteus vulgaris is treated with antibiotics, such as sulfonamides. Pneumocystis jiroveci is treated with antiprotozoal drugs, such as atovaquone. Ciprofloxacin is used to treat Staphylococcus aureus. p. 357 Report content error Which herpesvirus is commonly known as chickenpox? Cytomegalovirus Epstein-Barr virus Varicella-zoster virus Herpes simplex virus type 2 Rationale The varicella-zoster virus is the herpes simplex virus type 3 that causes chickenpox. The cytomegalovirus, the Epstein-Barr virus, and the herpes simplex virus type 2 do not cause chickenpox. The cytomegalovirus can lead to pneumonia or blindness. The Epstein-Barr virus causes mononucleosis. The herpes simplex virus type 2 is responsible for genital herpes. p. 352 Report content error A patient is taking fluconazole with warfarin. Which laboratory finding describes the possible interaction with these two medications? Increased liver function tests Reduced potassium level Reduced blood glucose level Increased prothrombin time Rationale The patient is at risk for increased effectiveness of warfarin. Fluconazole can cause increased prothrombin time in patients who are taking warfarin. The patient would be educated on monitoring for signs and symptoms of bleeding. Fluconazole may increase liver function tests, but the combination with warfarin use does not cause this laboratory interaction. This combination is not expected to reduce potassium or blood glucose levels. Hypoglycemia is a concern when fluconazole is combined with oral sulfonylureas. p. 353 Report content error Which type of drug is used to destroy worms? Antivirals Antibiotics Antimalarials Anthelmintics Rationale Anthelmintics are drugs that destroy worms. Antivirals are drugs that are used to treat viral infections. Antibiotics are antimicrobial drugs used in the treatment and prevention of bacterial infections. Antimalarials provide treatment and prophylaxis of malaria caused by malarialPlasmodiumspecies. p. 364  Report content error Which drug classification includes antivirals, antimicrobials, antiparasitics, and antifungals? Antimalarials Anthelmintics Quinines Peptides Rationale The antimicrobial peptide classifications are broad spectrum and provide powerful defenses against parasites, fungus, and viruses. The class includes a wide variety of antivirals, antimicrobials, antifungals, and antiparasitics. Quinine is a type of antimalarial. Antimalarial drugs and anthelmintics do not include the entire variety of antivirals, antimicrobials, antifungals, and antiparasitics. p. 365 Report content error Which adverse reaction is common for ivermectin? Constipation  Nausea Anxiety Hypertension Rationale The most common side effects of anthelmintics are various gastrointestinal distress symptoms, such as nausea, vomiting, diarrhea, and anorexia. Anthelmintics are typically given over 1 to 3 days and do not usually have effects due to their short treatment range. Anxiety, hypertension, and constipation are not expected with anthelmintics. pp. 364,367,365 Correct (13) Report content error Which purpose does pyridoxine (vitamin B6) serve in a patient receiving isoniazid for tuberculosis? To prevent peripheral nerve damage To prevent cardiovascular complications To prevent gastrointestinal disturbances To prevent vision loss Rationale Isoniazid is used in the treatment of tuberculosis to inhibit tubercle cell- wall synthesis. In doing so, isoniazid causes a pyridoxine deficiency, which may cause peripheral neuropathy. Pyridoxine (vitamin B6) is administered to the patient to prevent this nerve damage. Pyridoxine does not prevent cardiovascular complications, gastrointestinal disturbances, or vision loss. pp. 349-350 Report content error Which intervention would the nurse expect to implement in the case of a patient newly diagnosed with oral candidiasis of the mouth and throat? Teach the patient to swish and gargle with nystatin. Instruct the patient to brush the teeth and gargle hourly. Start an intravenous (IV) line so that the patient does not have to eat by mouth. Administer valacyclovir, and monitor the lips, gums, mouth, and throat. Rationale Nystatin is an antifungal drug that is used to treat a variety of candidal infections. Thus the nurse would expect to teach the patient to swish and gargle with nystatin. The oral suspension is swished in the mouth for several minutes to ensure contact with the mucous membranes and is then either disposed of or swallowed. Because the throat area is involved, the patient should also gargle with nystatin before swishing and swallowing or spitting. There would be no need to start an IV or instruct the patient to brush the teeth and gargle hourly. Valacyclovir is an antiviral drug used to treat infections caused by the herpesviruses, which this patient does not have. Study Tip: When forming a study group, carefully select members for your group. Choose students who have abilities and motivation similar to your own. Look for students who have a different learning style than you. Exchange names, email addresses, and phone numbers. Plan a schedule for when and how often you will meet. Plan an agenda for each meeting. You may exchange lecture notes and discuss content for clarity or quiz one another on the material. You can also create your own practice tests or make flash cards that review key vocabulary terms. p. 350 Report content error Which is a first-line antitubercular drug? Isoniazid Amikacin Cycloserine  Capreomycin Rationale Isoniazid is a first-line and primary antitubercular drug. It is most widely used. It can be administered either as the sole drug in the prophylaxis of tuberculosis or in combination with other antitubercular drugs in the treatment of tuberculosis. Other first-line antitubercular drugs include rifampin, pyrazinamide, and ethambutol. Amikacin, cycloserine, and capreomycin are second-line antitubercular drugs. p. 346 Report content error Which laboratory value alteration may be observed in a patient receiving isoniazid? Increase in the neutrophil level Decrease in the blood glucose level Increase in the alanine aminotransferase serum level Decrease in the aspartate aminotransferase serum level Rationale Isoniazid is a bactericidal drug that increases the serum levels of liver enzymes, including alanine aminotransferase. Thus an increase in the alanine aminotransferase serum level may be observed in a patient receiving isoniazid. Isoniazid does not increase the neutrophil level and can, in fact, cause agranulocytosis, a severe lowering of the neutrophil count. Isoniazid does not decrease the blood glucose level, and it increases, not decreases, the serum level of aspartate aminotransferase. p. 348 Report content error Which drug is used to treat the majority of infections caused by the herpes simplex viruses and the varicella- zoster virus? Acyclovir Zanamivir Ganciclovir Amantadine Rationale Acyclovir, the drug of choice for the majority of infections caused by the herpes simplex viruses and the varicella-zoster virus, is used to suppress viral replication. Zanamivir is used to treat influenza in adults. Ganciclovir is the drug used most often in the treatment of cytomegalovirus infections. Amantadine is used to treat influenza A. p. 357 Report content error Which infection is a child at risk for developing as an adult if the child had chickenpox? Retinitis Shingles Gastroenteritis Kaposi sarcoma Rationale Shingles, or herpes zoster, is caused by reactivation of the varicella- zoster virus, which causes chickenpox. The virus that causes chickenpox may lie dormant in the nerve cells for many years, only to be reactivated by any trigger. When reactivated, it causes shingles. Gastroenteritis is unrelated to a history of chickenpox. Retinitis is usually caused by the cytomegalovirus, not the varicella-zoster virus. Kaposi sarcoma is a cancer associated with acquired immunodeficiency syndrome (AIDS), and it is caused by the Kaposi sarcoma herpesvirus, not the varicella- zoster virus. p. 353  Report content error Which patient would receive nystatin therapy? A patient with aspergillosis A patient with cryptococcosis A patient with histoplasmosis A patient with oral candidiasis Rationale Nystatin is administered orally or topically to treat Candida infections. Although it is poorly absorbed in the gastrointestinal tract, it is useful in the treatment of oral candidiasis. The suspension is swished in the mouth for several minutes to ensure contact with the mucous membranes and is then either disposed of or swallowed. If the throat area is involved, the patient should also gargle with nystatin before swishing and swallowing or spitting. Nystatin is not used to treat aspergillosis, cryptococcosis, or histoplasmosis. pp. 350,352 Report content error Which statement best describes how tuberculosis is spread? Which statement best describes how tuberculosis is spread? Encountering the infected person’s blood Touching an infected person Handling the infected person’s stool Inhaling droplets dispersed in the air Rationale A patient with an active tuberculosis infection would be placed on droplet precautions. Tuberculosis is transmitted from person to person by droplets that are dispersed in the air through coughing, sneezing, and speaking. These microorganisms are then inhaled into the lungs. Tuberculosis cannot be spread by coming in contact with the patient’s blood, by touching the patient, or by handling stool. While the patient may be on airborne precautions as well, the disease is spread by droplets in the air. Contact precautions would only account for the disease spread by touching something or someone. Standard precautions should be taken on all patients, regardless of their disease. Test-Taking Tip: Avoid taking a wild guess at an answer. However, should you feel insecure about a question, eliminate the alternatives that you believe are definitely incorrect, and reread the information given to make sure you understand the intent of the question. This approach increases your chances of randomly selecting the correct answer or getting a clearer understanding of what is being asked. Although there is no penalty for guessing, the subsequent question will be based, to an extent, on the response you give to the question at hand; that is, if you answer a question incorrectly, the computer will adapt the next question accordingly based on your knowledge and skill performance on the examination up to that point. p. 345 Report content error A patient with diabetes is being treated with isoniazid (INH) for tuberculosis. To prevent peripheral neuropathy, which drug or vitamin supplement would the nurse anticipate giving? Pregabalin Gabapentin Vitamin B6 Vitamin B12 Rationale A side effect of INH is peripheral neuropathy. Those at risk for this side effect are patients effected by malnutrition, alcohol use, and those with diabetes. This condition may be prevented if pyridoxine (vitamin B6) is administered. Pregabalin and gabapentin are both drugs that can treat diabetic neuropathy, but they are not recommended to prevent peripheral neuropathy while taking INH. Vitamin B6, not Vitamin B12, is prescribed. p. 346  Report content error The nurse has educated a patient on adverse reactions of antitubercular drugs. Which adverse reaction would be reported to the health care provider? Gastrointestinal (GI) upset Headache Orange urine Numbness and tingling of extremities Rationale Patients should report numbness or tingling in their extremities because this is indicative of peripheral neuropathy. Most antitubercular drugs can cause some type of GI upset. This should not be reported to the health care provider unless the patient has extreme GI complaints that interfere with intake and output. Headache is a minor symptom that does not require health care provider help unless it becomes persistent or severe. Rifampin is known to cause orange bodily fluids. pp. 349,350  Report content error Which physical finding may indicate a superinfection in a patient taking an antiinfective agent? Itchy skin Difficulty breathing White patches on tongue Decreased urinary output Rationale White patches on the tongue of a patient who is taking an antiinfective drug may indicate a superinfection. Itchy skin, difficulty breathing, and decreased urinary output may occur in a patient who is taking an antiinfective drug, but these do not indicate superinfection. p. 369 Report content error Which is the most common site for helminthiasis? Liver Intestine  Blood vessels Lymphatic system Rationale The most common site for helminthiasis (worm infection) is the intestine. Other sites for parasitic infection are the liver, blood vessels, and lymphatic system, but these sites are not as common. Test-Taking Tip:You have at least a 25% chance of selecting the correct response in a multiple-choice item with four options. If you are uncertain about a question, eliminate the choices that you believe are wrong, then call on your knowledge, skills, and abilities to choose from the remaining responses. p. 363 Report content error A patient is diagnosed with helminthiasis in the intestines and given a dose of ivermectin. The patient reveals to the nurse that she lives at home with her husband and two small children. Which statement would provide the best education to prevent the spread of the infection to the patient’s family? “Take daily showers.”  “Drowsiness may occur while taking ivermectin.” “A second dose of ivermectin may be needed if symptoms persist.” “Handwashing before meals and after toileting is important.” Rationale The parasite can be transferred to other members of the family if proper hygiene is not used. The patient would be educated on proper handwashing before preparing or eating meals and after toileting. Although taking daily showers versus tub baths is important for the patient's hygiene, handwashing is the best way to prevent spread. Drowsiness may occur while taking ivermectin but will not affect the spread of the infection. If the patient has not gotten better or signs of helminthiasis get worse, a second dose may be needed, but this has no bearing on spread prevention. p. 366  Performance Exit Topic 11: Anti-inflammatories and Analgesics Due Jul 21, 2024 by 11:59 pm Final Score 46% 16 out of 35 questions answered correctly Completed on Jul 21, 2024 1:15 pm Incorrect (19) Report content error Which is considered a cardinal sign of inflammation? Select Which is considered a cardinal sign of inflammation? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Pain Swelling Redness Numbness Increase in function Rationale Pain, swelling, and redness are three of the five cardinal signs of inflammation. In addition, the patient will experience a decrease in function, not an increase, and pain, not numbness. p. 279 Report content error Which serious illness would the nurse suspect in a 6-year- old patient with influenza if the nurse learns that the patient’s parents gave the child “baby aspirin” for fever and the patient is vomiting, delirious, extremely lethargic, and experiencing dermatologic symptoms? Petechiae  Rotavirus Reye syndrome Intracranial hemorrhage Rationale The nurse would suspect Reye syndrome in this case. Children should not be given aspirin, especially when febrile, because of the risk for Reye syndrome, which is characterized by vomiting, lethargy, delirium, and coma. Petechiae are a side effect of ibuprofen and are not a serious illness on their own. Rotavirus presents with vomiting but is not related to aspirin administration. Although vomiting and altered consciousness can be a sign of increased intracranial pressure related to intracranial hemorrhage, the question stem does not indicate that head trauma has occurred. p. 285 Report content error Which response would the nurse have if a family visits a patient in a long-term care facility and becomes alarmed after noticing several large bruises on the patient, who is on a moderate dose of aspirin daily? “We have already called 911.” “There is nothing to worry about.”  “This is common with people taking aspirin.” “The patient is very clumsy and always getting hurt.” Rationale Aspirin inhibits platelet aggregation, so bruising is common, even with small tissue injuries. Thus the nurse would respond by telling the family that bruising is common in people taking aspirin. Telling the family not to worry would be dismissive and would not answer the question. There would be no reason to call 911, unless there is active bleeding, a suspected head injury, or profound bruising. Calling the patient clumsy would be unprofessional and inappropriate. Test-Taking Tip: Do not select answers that contain exceptions to the general rule, controversial material, or degrading responses. p. 285 Report content error Which supporting evidence would the nurse provide to the patient regarding a proposed change in pain medication if the nurse encourages the patient to switch from over-the- counter aspirin to over-the-counter ibuprofen? Aspirin is associated with more gastric bleeding than ibuprofen. Aspirin may cause more damage to the kidneys than ibuprofen.  Aspirin causes more blood disorders compared with ibuprofen. Aspirin has a shorter duration of action compared with ibuprofen. Rationale The nurse would inform the patient that the risk for gastrointestinal bleeding increases with aspirin. Ibuprofen causes gastric irritation, but it is less severe than that caused by aspirin. Consumption of both aspirin and ibuprofen can lead to life-threatening conditions such as liver and kidney damage. Blood disorders can be caused by aspirin as well as ibuprofen, and both aspirin and ibuprofen have the same duration of action of 4 to 6 hours. p. 285 Report content error Which phrase describes the mechanism of action of allopurinol? Reduces uric acid biosynthesis Inhibits prostaglandin synthesis Reduces infiltration of inflammatory cells Inhibits the hypothalamic heat-regulating center Rationale Allopurinol effectively treats gout and hyperuricemia by reducing uric acid biosynthesis. Ibuprofen helps relieve pain by inhibiting prostaglandin synthesis. Infliximab helps treat rheumatoid arthritis by reducing the infiltration of inflammatory cells and delaying the inflammatory process. Aspirin inhibits the hypothalamic heat-regulating center, which helps in reducing pain and inflammatory symptoms. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation. p. 288 Report content error Which statement made by the female patient, who is at risk for stroke and on aspirin therapy, indicates an understanding of the nurse’s instructions regarding the correct use of aspirin? “I should take aspirin at mealtime.” “I should take aspirin with warfarin.” “I should discontinue aspirin for the first 2 days of my menstrual cycle.” “I should avoid large doses of vitamin C during aspirin therapy.” Rationale Aspirin is used to prevent blood clotting. It should be administered at mealtime or with plenty of fluids to avoid gastrointestinal disturbances. This is because aspirin inhibits cyclooxygenase-1 (COX-1), which protects the stomach lining. Thus the patient’s statement regarding taking aspirin at mealtime indicates an understanding of the nurse’s instructions. Administration of aspirin with warfarin should be strictly avoided because aspirin increases the effect of warfarin; this results in increased anticoagulant levels. Aspirin administration should be discontinued for 2 days before menstrual periods and for the first 2 days of menstrual periods because it can cause heavy menstrual bleeding. During this period, the patient can take acetaminophen. A large dose of vitamin C will not cause any effect during aspirin therapy; it should be avoided during the administration of allopurinol because it can cause kidney stones. p. 285 Report content error Which action performed by a patient could cause complications if the patient is on ibuprofen therapy for arthritis? Eating more ginger and garlic Increasing vitamin C in the diet Avoiding aspirin 2 days before menstruation  Taking acetaminophen in place of aspirin during the menstrual period Rationale Including more ginger and garlic in the diet while taking nonsteroidal antiinflammatory drugs (NSAIDs), such as ibuprofen,could cause bleeding. Increasing vitamin C in the diet during ibuprofen therapy would not cause any complications. Avoiding aspirin 2 days before menstruation would help prevent heavy bleeding. Taking acetaminophen in place of aspirin during menstruation would effectively prevent heavy bleeding, which could occur due to aspirin administration. p. 286 Report content error Which medication would the nurse anticipate the primary health care provider prescribing if a patient is determined to be at an increased risk for ischemic stroke? Aspirin Multivitamin Celecoxib Allopurinol Rationale Aspirin helps reduce the risk for stroke. It thins the blood and dissolves blood clots. Therefore the nurse would anticipate the primary health care provider prescribing a low dose of aspirin to the patient. Multivitamin tablets would not help reduce the risk for stroke; they provide nutritional support. Celecoxib therapy would not help reduce the risk for stroke either; instead it would lead to adverse drug reactions, such as peripheral edema. Allopurinol is an antigout drug and is not effective for preventing stroke. p. 284 Report content error Which assessment finding indicates that the nonsteroidal antiinflammatory drug (NSAID) has been effective? Partial thromboplastin time (PTT) is 100 seconds. Patient’s bleeding time is prolonged. Patient has increased circulation to the legs. Pain has decreased from a 6 to a 1 on a scale of 10. Rationale Prostaglandins are produced in response to the activation of the arachidonic acid pathway. NSAIDs work by blocking cyclooxygenase, the enzyme responsible for the conversion of arachidonic acid into prostaglandins. Decreasing the synthesis of prostaglandins results in decreased pain and inflammation. Thus an assessment finding of decreased pain indicates that the NSAID has been effective. The length of the PTT, the bleeding time, and the increased extremity circulation are not therapeutic effects of the medication. p. 280 Report content error A patient with Crohn’s disease presents to the outpatient infusion clinic to receive their first dose of infliximab. Which action will the nurse take first? Perform a pain assessment Draw baseline CBC, LFTs, and BUN/Creatinine Administer the dose of infliximab over 2 hours using a small filter Ensure the patient has a negative TB test Rationale Before starting infliximab, the nurse will conduct a thorough medical history and ensure that the patient has had a negative TB test. The nurse will assess the patient’s pain level within an hour of administration to confirm the treatment has decreased the patient's pain level. Before starting the infusion, the nurse would draw a complete blood count, liver function tests, and renal function tests. These levels will be monitored while the patient is treatment and will require that the patient has a current baseline on file. The medication should be administered over 2 hours using a 1.2 micron filter or smaller. pp. 288,291,290 Report content error Which patient(s) would be at high risk for respiratory depression with the use of intravenous morphine therapy? Select all that apply. One, some, or all responses may be correct. 57-year-old patient with thyroid cancer 65-year-old patient with myocardial infarction (MI) 77-year-old patient with chronic renal failure (CRF) 32-year-old patient with ruptured ectopic pregnancy 45-year-old patient with chronic obstructive pulmonary disease (COPD) Rationale Approximately 90% of morphine sulfate is excreted in the urine. Therefore patients with CRF would be at higher risk, as morphine is retained, resulting in suppression of the respiratory center of the brain. Morphine sulfate would be avoided in patients with COPD because it decreases the respiratory drive, causing retention of carbon dioxide and increased risk for respiratory arrest. Morphine is not a concern in patients with thyroid cancer. Morphine sulfate is a beneficial drug to help control MI pain because it lowers blood pressure, decreases the workload of the heart, and increases myocardial oxygenation. Morphine sulfate is appropriate for treating moderate to severe pain that a patient may experience with a ruptured ectopic pregnancy. p. 302 Report content error Which question is a priority for the nurse to ask a patient who has been prescribed sumatriptan for migraine headaches? “Do you have a history of diabetes?” “What other medications are you on?” “Have you ever taken sumatriptan before?” “Do you have a history of coronary artery disease?” Rationale Sumatriptan works to decrease migraine pain by constricting arteries in the brain. A history of coronary disease (CAD) is a contraindication for taking this medication because the medication could cause the patient to experience a myocardial infarction by constricting the coronary arteries. Thus the nurse’s priority question is asking the patient if the patient has a history of CAD. Diabetes mellitus is a condition that warrants proceeding cautiously in prescribing sumatriptan, but sumatriptan can still be taken by individuals with diabetes if they are closely monitored. Asking about other medications provides information about possible drug-drug interactions, but the priority is finding out if the patient has CAD. Asking the patient if the patient has ever taken sumatriptan before will provide information about results from taking the medication and allergic reactions to the medication, but this is not the priority question. pp. 309-310 Report content error Which type of pain originates from the skin and mucous membranes? Deep pain Somatic pain Visceral pain Superficial pain Rationale Pain is an unpleasant sensory and emotional experience that is associated with either actual or potential tissue damage. Superficial pain originates from the skin and mucous membranes. Deep pain occurs in tissues below the skin level. Somatic pain originates from skeletal muscles, ligaments, and joints. Visceral pain originates from organs and smooth muscles. p. 296 Report content error Which statement about somatic pain is accurate? “It originates from organs and smooth muscles.” “It originates from skin and mucous membranes.” “It originates from vascular or perivascular tissues.” “It originates from skeletal muscles, ligaments, and joints.” Rationale Somatic pain is pain that originates from skeletal muscles, ligaments, and joints. Somatic pain does not originate from organs and smooth muscles; skin and mucous membranes; or vascular or perivascular tissues. Pain that originates from organs and smooth muscles is called visceral pain. Pain that originates from skin and mucous membranes is called superficial pain. Pain that originates from vascular or perivascular tissues is called vascular pain. p. 296 Report content error Which assessment finding indicates that a patient has overdosed on morphine sulfate? Blood in urine Pinpoint pupils Increased peristalsis Increased urinary output Rationale Morphine sulfate is an opioid drug used for pain management. After administering morphine sulfate, the nurse should assess the patient’s pupillary reaction to light. Pinpoint pupils indicate an overdose of morphine sulfate. Overdose of morphine sulfate does not cause blood in the urine. Increased peristalsis is not a sign of morphine sulfate overdose. Constipation due to decreased peristalsis is an adverse effect associated with morphine sulfate. Administration of opioid drugs causes urinary retention; therefore increased urinary output would not be observed in the patient. p. 302  Report content error Which condition would the nurse expect to see in a patient who ingested 14 grams of acetaminophen? Renal failure Kidney stones Acute hepatotoxicity Metabolic alkalosis Rationale Acetaminophen in large doses is extremely hepatotoxic. Thus the nurse would expect to see acute hepatotoxicity in the patient. Renal failure does not occur because of an overdose of acetaminophen. Instead, renal failure increases the risk for toxicity in patients. Calcium antacids can cause kidney stones. Long-term use of sodium bicarbonate may cause metabolic alkalosis. p. 297 Report content error Which finding would the nurse expect when assessing a patient for adverse effects of morphine sulfate? Diarrhea Insomnia Drowsiness Increased bowel sounds Rationale The nurse would expect to find drowsiness, as morphine sulfate depresses the central nervous system. It also causes a decrease in gastrointestinal motility, leading to constipation, not diarrhea. Morphine sulfate does not cause insomnia; it is an opioid and causes drowsiness. Morphine sulfate can cause constipation, not increased bowel sounds. p. 304 Report content error Which condition is a contraindication for the administration of acetaminophen? Anemia Asthma  Joint pain Liver disease Rationale The administration of acetaminophen is contraindicated in patients who have liver disease. Hepatotoxicity is an adverse effect of acetaminophen. If it is administered to a patient with liver disease, it increases the risk for liver failure. Therefore acetaminophen should not be administered to a patient who has liver disease. Acetaminophen is safe for a patient who has anemia, asthma, or joint pain. pp. 297-298 Report content error Which opioid is used in mild to moderate pain and as an antitussive? Hydrocodone bitartrate Hydromorphone hydrochloride Oxycodone hydrochloride Codeine sulfate Rationale  Codeine sulfate is used in mild to moderate pain and as an antitussive. Hydrocodone bitartrate, hydromorphone hydrochloride, and oxycodone hydrochloride are used in moderate to severe pain and are not used as antitussives. Test-Taking Tip: If the question asks for an immediate action or response, all of the answers may be correct, so base your selection on identified priorities for action. pp. 303,298 Correct (16) Report content error Which substance do antiinflammatories inhibit? Prolactin Serotonin Prostaglandin Gamma-aminobutyric acid (GABA) Rationale Antiinflammatory drugs inhibit prostaglandin biosynthesis. GABA and serotonin are both neurotransmitters unaffected by antiinflammatories. Prolactin is a reproductive hormone not involved in inflammation. p. 280 Report content error Which drug is considered a cyclooxygenase-2 (COX-2) inhibitor? Etodolac Naproxen Celecoxib Meloxicam Rationale Celecoxib is a COX-2 inhibitor. Meloxicam is part of the oxicam class. Naproxen is a propionic acid derivative. Etodolac is a phenylacetic acid derivative. p. 283 Report content error Which response by the nurse would be most appropriate if Which response by the nurse would be most appropriate if a patient with rheumatoid arthritis who is considering treatment with infliximab expresses concern because a television ad mentions several infections as potential side effects? “Don’t worry; it is exaggerated.” “The medication suppresses your immune system.” “The government requires that information to be in ads.” “The only serious illness you can contract is tuberculosis.” Rationale Because rheumatoid arthritis is an autoimmune disorder, drugs that successfully treat its symptoms are immunosuppressants, which can lead to infections. Thus the nurse would respond by informing the patient that the medication suppresses the immune system. Although the nurse should try to calm the patient’s fears, it is dismissive to tell the patient not to worry and does not answer the question. A patient should be screened for tuberculosis before initiating immunosuppressive treatment, but tuberculosis is not the only serious illness that a patient can contract. The US Food and Drug Administration (FDA) requires the most prominent adverse reactions to be listed in television ads, but the full explanation can never be conveyed in the time it takes for a commercial to air. Test-Taking Tip: Because few things in life are absolute without exceptions, avoid selecting answers that include words such as always, never, all, every, and none. Answers containing these keywords are rarely correct. p. 288 Report content error Which drug is most appropriate for a patient with back pain caused by inflammation? Aspirin Ketorolac Ibuprofen Diclofenac sodium Rationale For a patient with back pain caused by inflammation, ibuprofen is the most appropriate drug. The effect of ibuprofen is stronger than that of aspirin, and it causes less gastric irritation. Aspirin is not preferred because it causes gastric irritation when used as an analgesic. Both ketorolac and diclofenac sodium are phenylacetic acid derivatives and are less preferred because of aspirin-like effects, such as gastric irritation. p. 286  Report content error Which instruction given by the nurse would ensure effective treatment if the nurse is teaching a patient with gout about dietary management during the administration of allopurinol? “Eat more meat.” “Eat more oranges.” “Take the medication with lots of fluids.” “Take the medication with coffee.” Rationale Antigout medications, such as allopurinol, should be taken with lots of fluids to avoid the development of kidney stones. Thus the nurse would instruct the patient to take the medication with lots of fluids. Meat should be avoided because it increases uric acid levels. Oranges should also be avoided because they are rich in vitamin C, and consuming large doses of vitamin C while taking allopurinol can lead to kidney stones. Allopurinol should not be taken with coffee, as coffee is rich in caffeine, which increases uric acid levels. p. 293  Report content error Which assessment finding in a patient taking nonsteroidal antiinflammatory drugs (NSAIDs) requires intervention? Headache Palpitations Black, tarry stools Nonproductive cough Rationale A major side effect of NSAID therapy is gastrointestinal (GI) distress with potential GI bleeding. Black, tarry stools are indicative of a GI bleed and require intervention. A headache, a nonproductive cough, and palpitations would not result from the use of NSAIDs. Test-Taking Tip:You have at least a 25% chance of selecting the correct response in a multiple-choice item with four options. If you are uncertain about a question, eliminate the choices that you believe are wrong, then call on your knowledge, skills, and abilities to choose from the remaining responses. p. 287  Report content error Which drug would the nurse expect to be added to a patient’s regimen if the nurse finds through review of laboratory reports that the patient, who has pain in multiple joints and has been prescribed indomethacin, has hyperuricemia and deposition of sodium urate crystals in the synovial fluid? Tolmetin Celecoxib Nabumetone Allopurinol Rationale Pain in multiple joints, hyperuricemia, and deposition of sodium urate crystals in the synovial fluids indicate that the patient has gouty arthritis. Allopurinol is prescribed for this condition; thus the nurse would expect allopurinol to be added to the patient’s medication regimen. It reduces uric acid levels and prevents the formation of kidney stones. Indomethacin is a nonsteroidal antiinflammatory drug (NSAID) that is more effective than other NSAIDs for pain relief. It also reduces inflammation in patients with gouty arthritis. Celecoxib, nabumetone, and tolmetin are NSAIDs; they are prescribed for pain relief and to reduce inflammation when a patient has rheumatoid arthritis or primary dysmenorrhea. Adding any of these drugs to the patient’s medication regimen along with indomethacin would not be as effective as adding allopurinol, which helps reduce uric acid levels in the serum. Test-Taking Tip: Do not select answers that contain exceptions to the general rule, controversial material, or degrading responses. p. 288 Report content error Which antiinflammatory agent inhibits cyclooxygenase-2 (COX-2) but not cyclooxygenase-1 (COX-1)? Etodolac Tolmetin Meloxicam Celecoxib Rationale Cyclooxygenase (COX) is the enzyme that helps convert arachidonic acid into prostaglandins and their products. These prostaglandins cause inflammation and pain at the tissue injury site. Celecoxib is a second- generation nonsteroidal antiinflammatory drug (NSAID) known as a selective COX-2 inhibitor. Celecoxib inhibits only COX-2. Usually, NSAIDs, such as etodolac, tolmetin, and meloxicam, inhibit both COX-1 and COX-2, but celecoxib is a selective COX-2 inhibitor. p. 288 Report content error Which food(s) or dietary supplement(s) would the nurse identify as potentially causing increased sedation with opioid therapy? Select all that apply. One, some, or all responses may be correct. Kava Valerian Bananas Grapefruit St. John’s wort Rationale The nurse would identify kava, valerian, and St. John’s wort as potentiallycausative of increased sedation when taken with opioid preparations. Bananas are high in potassium and should be avoided in the presence of renal failure or potassium-retaining conditions. Grapefruit should be avoided when taking certain drugs, such as statin drugs or Janus kinase 2 inhibitors. p. 301  Report content error Which test would the nurse anticipate the health care provider (HCP) ordering for a patient who has been chronically taking high doses of acetaminophen? Chest radiograph Kidney function test Liver function test Lung spirometry Rationale One major adverse effect associated with acetaminophen overdose is hepatotoxicity. Therefore the nurse would anticipate the HCP ordering a liver function test to determine whether the patient’s liver has been affected by the overdose. A chest radiograph need not be taken because acetaminophen overdose does not cause any complications in the lungs and heart that are visible on a radiograph. Renal dysfunction is not associated with acetaminophen overdose. Thus the nurse need not refer the patient for kidney function tests. Acetaminophen overdose does not alter lung functions. p. 297  Report content error Which action would the nurse take if a patient receiving 1 to 2 mg of morphine sulfate intravenously every 2 hours PRN has a respiratory rate of 8 breaths/min and a pain scale of 8 out of 10 an hour after the last 2-mg dose of morphine sulfate was given? Hold the drug, record the assessment, and recheck in 1 hour. Administer 2 mg of morphine and notify the primary health care provider. Administer another 1 mg of morphine and reevaluate the pain scale in 15 minutes. Consult the primary health care provider and obtain another drug prescription. Rationale The nurse would consult with the primary health care provider, who may prescribe another type of analgesic, such as a nonsteroidal antiinflammatory drug. The patient is in severe pain, so the patient needs to be given an analgesic. The drug should not simply be withheld and the patient rechecked in 1 hour. If respirations are depressed, it would be hazardous to give more morphine. p. 301  Report content error Which rationale describes why a nurse would record baseline vital signs before administering 5 mg of morphine sulfate intravenously to a patient who underwent surgery 30 minutes prior? Morphine sulfate causes the release of histamines. Morphine sulfate dilates vascular smooth muscle. Morphine sulfate depresses the respiratory center. Morphine sulfate reduces the level of consciousness. Rationale Respiratory depression is the most important reason why the nurse would record baseline vital signs before administeringmorphine intravenously. Opioid analgesics can cause respiratory depression when administered in standard dosages and can cause death when administered in overdoses. Because this patient is in the immediate postoperative period and is likely to be experiencing residual effects of anesthesia, including an inability to maintain an airway, the risk for respiratory depression is high. The patient is also at risk because the intravenous (IV) route of administration is being used. IV administration of an opioid means that the onset of action occurs quickly, the peak drug level occurs more quickly, and the risk for respiratory depression increases as a result of a generally high plasma drug concentration. The nurse would record baseline data for comparison with vital signs taken 15 minutes after IV administration of morphine to determine whether the patient is experiencing adverse effects of therapy. Morphine dilates vascular smooth muscle, releases histamines, and causes sedation; however, airway and breathing issues are more important. Death after overdose is almost always a result of respiratory arrest. p. 298 Report content error Which drug may cause tinnitus as a side effect? Aspirin Tramadol Indomethacin Acetaminophen Rationale Aspirin is associated with side effects such as tinnitus and vertigo. Tramadol causes nausea, vomiting, constipation, dizziness, and headache. Indomethacin causes gastric distress. Overdose of acetaminophen causes hepatotoxicity. pp. 299-300  Report content error Which medication is used to treat severe adverse effects of an opioid analgesic? Naloxone Flumazenil Acetylcysteine Methylprednisolone Rationale Naloxone is the opioid antagonist that will reverse the effects, both adverse and therapeutic, of opioid analgesics. Flumazenil, a benzodiazepine antidote, can be used to acutely reverse the sedative effects of benzodiazepines. Acetylcysteine is the antidote for acetaminophen overdose. Methylprednisolone is a glucocorticoid that is used as an antiinflammatory. p. 306 Report content error Which medication would the nurse anticipate incorporating into the plan of care for a postoperative patient who received fentanyl and subsequently developed respiratory depression? Morphine sulfate Polyethylene glycol Naloxone Meperidine hydrochloride Rationale The patient has respiratory depression caused by fentanyl, an opioid drug that can depress the respiratory center. Therefore the nurse would anticipate incorporatingnaloxoneinto the patient’s plan of care. Naloxone should be administered to reverse the action of fentanyl and improve the patient’s respiratory status. Morphine sulfate and meperidine hydrochloride are opioid drugs that would worsen respiratory depression. Polyethylene glycol is a laxative used to treat constipation. p. 306 Report content error Which symptom is an adverse effect associated with excessive doses of acetaminophen? Select all that apply. One, some, or all responses may be correct. Nausea  Vomiting Blurred vision Hepatotoxicity Polyuria Rationale Acetaminophen is a nonsteroidal antiinflammatory drug. Nausea, vomiting, and hepatotoxicity are the effects of an excess dose of acetaminophen. Acetaminophen does not affect vision. It causes oliguria, not polyuria.  Performance Exit Topic 12: GI and GU medications Due Jul 28, 2024 by 11:59 pm Final Score 28% 7 out of 25 questions answered correctly Completed on Jul 28, 2024 1:33 pm Incorrect (18) Report content error Which lifestyle factors would the nurse question if a patient presents with frequent constipation? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Water intake Sleep pattern Dietary habits Medication use Exercise regimen Rationale Insufficient water intake, poor dietary habits, lack of exercise, and certain medications, such as anticholinergics, narcotics, and antacids, are all contributing factors to constipation. Thus the nurse would question the patient’s water intake, dietary habits, medication use, and exercise regimen. Other factors to consider include fecal impaction, bowel obstruction, overuse of laxatives, certain neurologic disorders, and ignoring the urge to defecate. A patient’s sleep pattern does not directly play a role in constipation. p. 562 Report content error Which nonpharmacologic intervention is beneficial to a patient experiencing nausea and vomiting? Select all that patient experiencing nausea and vomiting? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Advise the patient to drink weak tea. Suggest that the patient drink flat soda. Suggest that the patient eat a high-fiber diet. Administer a polyethylene glycol solution to the patient. Suggest that the patient eat dry toast and crackers. Rationale Beverages such as weak tea and flat soda decrease gastric reflexes and alleviate the symptoms of nausea and vomiting. Dry toast and crackers maintain blood glucose levels in the body and also reduce nausea and vomiting. A high-fiber diet increases peristaltic movements of the gastrointestinal tract and alleviates constipation, but it has no effect in the treatment of nausea. Polyethylene glycol increases accumulation of fluid in the colon and alleviates constipation, but it has no effect in the treatment of nausea. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation or patient, but only one or some of the options may relate directly to the situation or patient. p. 555  Report content error Which instruction would a nurse give to a patient who has been prescribed bisacodyl? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected “Take the drug with milk.” “Take the drug at bedtime.” “Eat high-fiber foods consistently.” “Drink 8 oz of fluids when taking the drug.” “Chew the tablets thoroughly before swallowing.” Rationale Bisacodyl is a stimulant laxative that increases peristaltic movements in the colon, causing defecation. The nurse would give the patient appropriate instructions about the drug to increase effectiveness and prevent side effects. The nurse would advise the patient to eat high-fiber foods and drink 8 oz of fluids when taking the drug. This would help to ease defecation and prevent dry, hard stools. Milk may decrease bisacodyl’s effectiveness, so the drug should not be taken with milk. Bisacodyl has an onset of action of 6 to 8 hours after oral administration, and it may cause sleep disturbances. Therefore the nurse would not instruct the patient to take the drug at bedtime. Because bisacodyl is not a chewable tablet, its effectiveness decreases upon chewing. Therefore the nurse would not instruct the patient to chew the tablets before swallowing. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation or patient, but only one or some of the options may relate directly to the situation or patient. p. 564 Report content error Which mechanism of action describes how diphenoxylate with atropine treats diarrhea due to chemotherapeutic agents? Inhibits gastric motility Acts by coating the walls of the gastrointestinal (GI) tract Absorbs bacteria or toxins in the GI tract Soaks up water in the intestines Rationale Diphenoxylate with atropine is an opiate and opiate-related agent that is used to treat diarrhea. This drug inhibits gastric motility by exerting its effects on the smooth muscles of the GI tract. Absorbent drugs act by coating the walls of the GI tract while also absorbing any bacteria or toxins that are causing diarrhea. Bulk-forming laxatives soak up water in the intestines and are used to treat constipation, not diarrhea. p. 563 Report content error Which outcome assessment is essential to monitor for in a patient taking diphenoxylate with atropine? Decrease in urination Increase in bowel sounds Decrease in gastric motility Increase in number of bowel movements Rationale Diphenoxylate with atropine acts on the smooth muscles of the intestinal tract to inhibit gastrointestinal motility and excessive propulsion of the gastrointestinal tract (peristalsis). A decrease in gastric motility results in a decrease in the number of bowel movements, and it is essential to monitor for a decrease in gastric motility. There should be no change in urination or bowel sounds, and the number of bowel movements should decrease, not increase. p. 561  Report content error Which parameter would be monitored closely in a patient receiving narcotic analgesics for pain and diphenoxylate with atropine for diarrhea? Glucose levels Platelet count Respiratory rate Erythrocyte count Rationale Diphenoxylate with atropine is an opiate drug that is used to treat diarrhea. It potentiates the effects of other narcotic drugs, which may cause respiratory depression. Therefore the nurse would monitor the patient’s respiratory rate. Diphenoxylate with atropine does not affect glucose levels, platelet counts, or erythrocyte counts. p. 560 Report content error Which factor contributes to diarrhea? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Spicy foods Toxins Paraplegia Chronic narcotic use Malabsorption syndrome Rationale Causes of diarrhea include spicy foods, toxins, and malabsorption syndrome. Chronic narcotic use and paraplegia are known to slow gut peristalsis, thus leading to constipation, not diarrhea. p. 560 Report content error Which information would the nurse include in the teaching plan for a patient who has been prescribed sucralfate? “This medication will inhibit gastric acid.” “This medication will neutralize gastric acid.” “This medication will enhance gastric absorption of meals.”  “This medication will form a protective barrier over the gastric mucosa.” Rationale Sucralfate affects the gastric mucosa. It forms a paste-like substance in the stomach, which adheres to the gastric lining, protecting against adverse effects related to gastric acid. It also stimulates healing of any ulcerated areas of the gastric mucosa. Thus the nurse would include this information inthe teaching plan for a patient who has been prescribed sucralfate. This medication does not inhibit gastric acid, neutralize gastric acid, or enhance gastric absorption of meals. p. 578 Report content error Which statement by the patient indicates that the nurse’s teaching on the administration of a histamine-2 (H2) receptor antagonist was effective? “I should decrease bulk and fluids in my diet to prevent diarrhea.” “Because I am taking this medication, it is okay for me to eat spicy foods.” “Smoking decreases the effects of this medication, so I should look into cessation programs.”  “I should take this medication 1 hour after each meal in order to maximally decrease gastric acidity.” Rationale Patients taking H2 receptor–blocking drugs should avoid spicy foods, extremes in temperature, alcohol, and smoking. Thus the patient’s statement about looking into smoking cessation programs indicates that the nurse’s teaching was effective. Patients should increase bulk and fluids in the diet to prevent constipation. Cimetidine should be taken with meals, whereas famotidine can be taken without regard to meals. Test-Taking Tip: Avoid selecting answers that state hospital rules or regulations as a reason or rationale for action. p. 576 Report content error Which cells in the stomach secrete hydrochloric acid? Chief cells Parietal cells Mucous cells Endocrine cells Rationale Parietal cells in the stomach secrete hydrochloric acid. They are the primary site of action for many acid-controlling drugs. Chief cells are involved in the secretion of pepsinogen. Mucous cells secrete mucus, which protects the gastrointestinal layers. Endocrine cells secrete hormones used in the digestion of food. Test-Taking Tip: Get a good night’s sleep before an examination. Staying up all night to study before an examination rarely helps anyone. It usually interferes with the ability to concentrate. p. 576 Report content error Which adverse reaction would the nurse monitor for in a patient taking an aluminum-containing antacid? Diarrhea Constipation Gastrointestinal upset Fluid retention Rationale Aluminum- and calcium-containing antacids cause constipation. Thus the nurse would monitor the patient for constipation. Magnesium- containing antacids cause diarrhea and gastrointestinal upset. Sodium- containing antacids cause sodium retention and fluid retention. Test-Taking Tip: Study wisely, not hard. Use study strategies to save time and be able to get a good night’s sleep the night before your examination. Cramming is not smart, and it is hard work that increases stress while reducing learning. When you cram, your mind is more likely to