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NR293 Final Exam Review & Practice Questions
1.Ethambutol adverse reaction: Antitubercular med
adverse reaction:
- optic neuritis (decrease in visual acuity and color perception)
2.Isoniazid adverse reactions: antitubercular med
adverse reactions:
- Hepato and neuro toxicity (peripheral neuropathy)
- jaundice, can cause pyridoxine (B6 deficiency)
3.Isoniazid food interactions: interacts with foods containing tyramine
(aged cheese, caffeinated beverages, yogurt, chocolate, red wine, beer, and pep- peroni)
4.Pyrazinamide adverse reaction: antitubercular med
adverse reaction:
5.Rifampin adverse reactions: antitubercular med
adverse reaction:
- reddish-orange discoloration of body fluids
6.Tuberculosis treatment: - Total treatment is approximately 9 months
- reinforce medication regime and importance of compliance
7.What should be used while on TB therapy?: barrier contraceptives
8.How long is TB therapy?: may last for up to 24 months
9.The nurse is discussing adverse effects of antitubercular drugs with a patient who
2 / has active tuberculosis. Which potential adverse effect of antitu- bercular drug therapy should the patient report to the prescriber? a. Gastrointestinal upset b. Headache and nervousness c. Reddish-orange urine and stool d. Numbness and tingling of extremities: ANS: D Patients on antitubercular therapy should report experiencing numbness and tingling of extremities, which may indicate peripheral neuropathy. Some drugs may color the urine, stool, and other body secretions reddish-orange, but this is not an effect that needs to be reported. Patients need to be informed of this expected effect.
10.A patient who has been taking isoniazid (INH) has a new prescription for
pyridoxine. She is wondering why she needs this medication. The nurse explains that pyridoxine is often given concurrently with the isoniazid to prevent which condition?
a. Hair loss
b. Renal failure
c. Peripheral neuropathy
d. Heart failure: ANS: C
Pyridoxine (vitamin B6) may be beneficial for isoniazid-induced peripheral neuropa- thy. The other options are incorrect.
11.The nurse will assess the patient for which potential contraindication to
antitubercular therapy?
a. Glaucoma
b. Anemia
c. Heart failure
4 / results of laboratory studies (culture and sensitivity tests) and the chest radiographic findings will be used to confirm the clinical findings of resolution of the infection.
14.The nurse is counseling a woman who will be starting rifampin (Rifadin) as part of
antitubercular therapy. The patient is currently taking oral contracep- tives. Which statement is true regarding rifampin therapy for this patient?
a. Women have a high risk for thrombophlebitis while on this drug.
b. A higher dose of rifampin will be necessary because of the contraceptive.
c. Oral contraceptives are less effective while the patient is taking rifampin.
d. The incidence of adverse effects is greater if the two drugs are taken together.
x: ANS: C Women taking oral contraceptives and rifampin need to be counseled about other forms of birth control because of the impaired effectiveness of the oral contracep- tives during concurrent use of rifampin.
15.A patient newly diagnosed with tuberculosis (TB) has been taking anti- tubercular
drugs for 1 week calls the clinic and is very upset. He says, "My urine is dark orange! What's wrong with me?" Which response by the nurse is correct?
a. "You will need to stop the medication, and it will go away."
b. "It's possible that the TB is worse. Please come in to the clinic to be
checked."
c. "This is not what we usually see with these drugs. Please come in to the clinic to
be checked."
d. "This is an expected side effect of the medicine. Let's review what to expect.":
ANS: D
Rifampin, one of the first-line drugs for TB, causes a red-orange-brown discoloration of urine, tears, sweat, and sputum. Patients need to be warned about
5 / this side effect. The other options are incorrect.
16.The nurse is reviewing the medication administration record of a patient who is
taking isoniazid (INH). Which drug or drug class has a significant drug interaction with isoniazid?
a. Pyridoxine (vitamin B6)
b. Penicillins
c. Phenytoin (Dilantin)
7 / drug resistant."
c. "Using more than one drug can help to reduce side effects."
d. "Using multiple drugs enhances the effect of each drug.": ANS: B The use of
multiple medications reduces the possibility that the organism will become drug resistant.
21.The nurse is providing patient teaching for a patient who is starting antitu- bercular
drug therapy. Which of these statements should be included? (Select all that apply.)
a. "Take the medications until the symptoms disappear."
b. "Take the medications at the same time every day."
c. "You will be considered contagious during most of the illness and must take
precautions to avoid spreading the disease."
d. "Stop taking the medications if you have severe adverse effects."
e. "Avoid alcoholic beverages while on this therapy."
f. "If you notice reddish-brown or reddish-orange urine, stop taking the drug and
contact your doctor right away."
g. "If you experience a burning or tingling in your fingers or toes, report it to your
prescriber immediately."
h. "Oral contraceptives may not work while you are taking these drugs, so you will
have to use another form of birth control.": B, E, G, H b. "Take the medications at the same time every day." e. "Avoid alcoholic beverages while on this therapy."
g."If you experience a burning or tingling in your fingers or toes, report it to
your prescriber immediately."
h."Oral contraceptives may not work while you are taking these drugs, so you
will have to use another form of birth control."
8 / Medications for tuberculosis must be taken on a consistent schedule to maintain blood levels. Medication therapy for tuberculosis may last up to 24 months, long after symptoms disappear, and patients are infectious during the early part of the treatment. Compliance with antitubercular drug therapy is key, so if symptoms become severe, the prescriber should be contacted for an adjustment of the drug therapy. The medication must not be stopped. Because of potential liver toxicity, patients on this drug therapy must not drink alcohol. Discoloration of the urine is an expected adverse effect, and patients need to be warned about it beforehand. Burning or tingling in the fingers or toes may indicate that peripheral neuropathy is developing, and the prescriber needs to be notified immediately. A second form of birth control must be used because antitubercular drug therapy makes oral contraceptives ineffective.
22.The nurse is providing patient education for a patient taking an oral contra- ceptive.
Which drugs may cause interactions with oral contraceptives? (Select all that apply.)
a. Cephalexin (Keflex)
b. Guaifenesin (Robitussin)
c. Warfarin (Coumadin)
d. Ibuprofen (Motrin)
e. Theophylline (Uniphyl): A, C, E
a. Cephalexin (Keflex)
c. Warfarin (Coumadin) e. Theophylline (Uniphyl) Patients must be educated about the need to use alternative birth control methods for at least 1 month during and after taking any of these drugs: antibiotics (es- pecially penicillins and cephalosporins); barbiturates; isoniazid; and rifampin. The effectiveness of other drugs, such as anticonvulsants, beta blockers, hypnotics, antidiabetic drugs, warfarin, theophylline, tricyclic antidepressants, and vitamins,
10 / rising blood urea nitrogen and creatinine levels. Fever may be indicative of the patient's infection; a white blood cell count of 7000 cells/mm3 is within the normal range of 5000 to 10,000 cells/mm.
32.Which nursing diagnosis is appropriate for a patient who has started
aminoglycoside therapy?
a. Constipation
b. Risk for injury (renal damage)
c. Disturbed body image related to gynecomastia
d. Imbalanced nutrition, less than body requirements, related to nausea: ANS: B
Patients on aminoglycoside therapy have an increased risk for injury caused by nephrotoxicity. The other options are incorrect.
33.The nurse is reviewing the medication orders for a patient who will be receiving
gentamicin therapy. Which other medication or medication class, if ordered, would be a potential interaction concern?
a. Calcium channel blockers
b. Phenytoin
c. Proton pump inhibitors
d. Loop diuretics: ANS: D
Concurrent use of aminoglycosides, such as gentamicin, with loop diuretics increas- es the risk for ototoxicity. The other drugs and drug classes do not cause interactions.
34.The nurse is administering a vancomycin (Vancocin) infusion. Which mea- sure is
appropriate for the nurse to implement in order to reduce complica- tions that may occur with this drug's administration?
11 /
a. Monitoring blood pressure for hypertension during the infusion
b. Discontinuing the drug immediately if red man syndrome occurs
c. Restricting fluids during vancomycin therapy
d. Infusing the drug over at least 1 hour: ANS: D
Infuse the medication over at least 1 hour to reduce the occurrence of red man syndrome. Adequate hydration (at least 2 L of fluid in 24 hours) during vancomycin therapy is important for the prevention of nephrotoxicity. Hypotension may occur during the infusion, especially if it is given too rapidly
35.A patient who has been hospitalized for 2 weeks has developed a pressure ulcer
that contains multidrug-resistant Staphylococcus aureus (MRSA). Which drug would the nurse expect to be chosen for therapy?
a. Metronidazole (Flagyl)
b. Ciprofloxacin (Cipro)
c. Vancomycin (Vancocin)
d. Tobramycin (Nebcin): ANS: C
Vancomycin is the drug of choice for the treatment of MRSA. The other drugs are not used for MRSA
36.The nurse checks the patient's laboratory work prior to administering a dose of
vancomycin (Vancocin) and finds that the trough vancomycin level is 24 mcg/mL. What will the nurse do next?
a. Administer the vancomycin as ordered.
b. Hold the drug, and administer 4 hours later.
c. Hold the drug, and notify the prescriber.
d. Repeat the test to verify results.: ANS: C
13 / decrease in blood pressure. In addition, adequate hydration (at least 2 L of fluids every 24 hours unless contraindicated) is most important to prevent nephrotoxicity. Optimal trough blood levels of vancomycin are 10 to 20 mcg/mL; therefore, the drug should not be administered when there is a trough level of 24 mcg/mL.
38.The most common adverse effects of antibiotics are:: nausea, vomiting, and
diarrhea
39.It is to obtain cultures from appropriate sites
beginning antibiotic therapy.: ESSENTIAL; BEFORE
40.Antibiotics: Patient Teaching: -Instruct patient to take entire prescribed prod-
uct AROUND THE CLOCK even if they start to feel better -report any signs of allergic reaction or superinfection -teach that antibiotics CAN interfere with oral contraceptives (use another form of birth control) -avoid alcohol w/ cephalosporin -> alcohol intolerance -> abdominal cramping, N, V, headache, decreased BP, shortness of breath, cardiac palpitations, pulse rate greatly increases, sweating, and flushing. -use sunscreen with tetracycline -> avoid prolonged exposure to sun -> wear protective clothing/sunglasses (no tanning salon -dont take with milk or milk products or iron or magnesium containing laxatives and dont take antacids
41.Penicillin hypersensitivity reactions: Cross-sensitivity with cephalosporins
42.penicillin patient teaching: Take oral doses with water (not juices) because
acidic fluids may nullify the drug's antibacterial action.
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43.Cephalosporins adverse reactions: - Nephrotoxicity
- Antabuse effect/disulfiram-like reaction- occurs if alcohol is consumed within 72 hours and causes flushing, throbbing in head, respiratory distress, sweating, chest pain, and hypotension- can lead to arrhythmias and unconsciousness
44.Cephalosporins contraindications: allergy to penicillin
45.When reviewing the allergy history of a patient, the nurse notes that the patient is
allergic to penicillin. Based on this finding, the nurse would question an order for which class of antibiotics?
a. Tetracyclines
b. Sulfonamides
c. Cephalosporins
d. Quinolones: ANS: C
Allergy to penicillin may also result in hypersensitivity to cephalosporins. The other options are incorrect.
46.When reviewing the medication orders for a patient who is taking penicillin, the
nurse notes that the patient is also taking the oral anticoagulant warfarin (Coumadin). What possible effect may occur as the result of an interaction between these drugs?
a. The penicillin will cause an enhanced anticoagulant effect of the warfarin.
b.The penicillin will cause the anticoagulant effect of the warfarin to decrease.
c. The warfarin will reduce the anti-infective action of the penicillin.
d. The warfarin will increase the effectiveness of the penicillin.: ANS: A
Administering penicillin reduces the vitamin K in the gut (intestines); therefore, enhanced anticoagulant effect of warfarin may occur.
47.A patient is receiving his third intravenous dose of a penicillin drug. He calls the
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c. Povidone-iodine (Betadine)
d. Isopropyl alcohol: ANS: C
Iodine compounds are contraindicated in patients with allergies to seafood.
50.A hospitalized patient is experiencing a severe anaphylactic reaction to a dose of
intravenous penicillin. Which drug will the nurse expect to use to treat this condition?
a. Ephedra
b. Epinephrine
c. Phenylephrine
d. Pseudoephedrine: ANS: B
Epinephrine is the drug of choice for the treatment of anaphylaxis. The other drugs listed are incorrect choices.
51.During antibiotic therapy, the nurse will monitor closely for signs and symptoms of
a hypersensitivity reaction. Which of these assessment findings may be an indication of a hypersensitivity reaction? (Select all that apply.)
a. Wheezing
b. Diarrhea
c. Shortness of breath
d. Swelling of the tongue
e. Itching
f. Black, hairy tongue: ANS: A, C, D, E
a.Wheezing
c. Shortness of breath
d.Swelling of the tongue
e. Itching
17 / Hypersensitivity reactions may be manifested by wheezing; shortness of breath; swelling of the face, tongue, or hands; itching; or rash.
52. The nurse is reviewing the sputum culture results of a patient with pneumo- nia and
notes that the patient has a gram-positive infection. Which generation of cephalosporin is most appropriate for this type of infection?
a. First generation
b. Second generation
c. Third generation
d. Fourth generation: ANS: A
First-generation cephalosporins provide excellent coverage against gram-positive bacteria but limited coverage against gram-negative bacteria.
53.When administering morning medications for a newly admitted patient, the nurse
notes that the patient has an allergy to sulfa drugs. There is an order for the sulfonylurea glipizide (Glucotrol). Which action by the nurse is correct?
a. Give the drug as ordered 30 minutes before breakfast.
b. Hold the drug, and check the order with the prescriber.
c. Give a reduced dose of the drug with breakfast.
d. Give the drug, and monitor for adverse effects.: ANS: B
There is a potential for cross-allergy in patients who are allergic to sulfonamide an- tibiotics. Although such an allergy is listed as a contraindication by the manufacturer, most clinicians do prescribe sulfonylureas for such patients. The order needs to be clarified.
54.Diuretics patient teaching: • Teach clients to maintain proper nutritional and
fluid volume status
- Teach clients to eat more potassium-rich foods when taking any but the potassi- um-sparing drugs
19 /
- To reduce intracranial pressure
- Treatment of cerebral edema
- NOT indicated for peripheral edema
63.Osmotic Diuretics: Mannitol: - Intravenous infusion only
- May crystallize when exposed to low temperatures
- Use of a filter is required
64.What is the most commonly used loop diuretic?: Furosemide (Lasix)
65.A patient is started on a diuretic for antihypertensive therapy. The nurse expects
that a drug in which class is likely to be used initially?
a. Loop diuretics
b. Osmotic diuretics
c. Thiazide diuretics
d. Potassium-sparing diuretics: ANS: C
The Eighth Report of the Joint National Committee on Prevention, Detection, Evalu- ation, and Treatment of High Blood Pressure (JNC-8) guidelines reaffirmed the role of thiazide diuretics as one of the first-line treatment for hypertension. The other drug classes are not considered firstline treatments.
66.When monitoring a patient who is taking hydrochlorothiazide (HydroDI- URIL),
the nurse notes that which drug is most likely to cause a severe interaction with the diuretic?
a. Digitalis
b. Penicillin
c. Potassium supplements
d. Aspirin: ANS: A
There is an increased risk for digitalis toxicity in the presence of hypokalemia,
20 / which may develop with hydrochlorothiazide therapy. Potassium supplements are often prescribed with hydrochlorothiazide therapy to prevent hypokalemia. The other options do not have interactions with hydrochlorothiazide.
67.The nurse is developing a care plan for a patient who is taking an an-
ticholinergic drug. Which nursing diagnosis would be appropriate for this patient?
a. Diarrhea
b. Urinary retention
c. Risk for infection
d. Disturbed sleep pattern: ANS: B
Patients receiving anticholinergic drugs are at risk for urinary retention and constipa- tion, not diarrhea. The other nursing diagnoses are not applicable to anticholinergic drugs.
68.A patient is in the intensive care unit and receiving an infusion of milrinone
(Primacor) for severe heart failure. The prescriber has written an order for an intravenous dose of furosemide (Lasix). How will the nurse give this drug?
a. Infuse the drug into the same intravenous line as the milrinone.
b. Stop the milrinone, flush the line, and then administer the furosemide.
c. Administer the furosemide in a separate intravenous line.
d. Notify the prescriber that the furosemide cannot be given at this time.: ANS: C
Furosemide must not be injected into an intravenous line with milrinone because it will precipitate immediately. The infusion must not be stopped because of the patient's condition. A separate line will be needed.
69.Furosemide (Lasix) is prescribed for a patient who is about to be dis- charged,
and the nurse provides instructions to the patient about the med- ication. Which statement by the nurse is correct?
