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NR293 Final Exam Review & Practice Questions
Typology: Exams
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1 /
adverse reaction:
adverse reactions:
(aged cheese, caffeinated beverages, yogurt, chocolate, red wine, beer, and pep- peroni)
adverse reaction:
adverse reaction:
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.
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?
Pyridoxine (vitamin B6) may be beneficial for isoniazid-induced peripheral neuropa- thy. The other options are incorrect.
antitubercular therapy?
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.
antitubercular therapy. The patient is currently taking oral contracep- tives. Which statement is true regarding rifampin therapy for this patient?
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.
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?
checked."
be checked."
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.
taking isoniazid (INH). Which drug or drug class has a significant drug interaction with isoniazid?
7 / drug resistant."
multiple medications reduces the possibility that the organism will become drug resistant.
drug therapy. Which of these statements should be included? (Select all that apply.)
precautions to avoid spreading the disease."
contact your doctor right away."
prescriber immediately."
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."
your prescriber immediately."
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.
Which drugs may cause interactions with oral contraceptives? (Select all that apply.)
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.
aminoglycoside therapy?
Patients on aminoglycoside therapy have an increased risk for injury caused by nephrotoxicity. The other options are incorrect.
gentamicin therapy. Which other medication or medication class, if ordered, would be a potential interaction concern?
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.
appropriate for the nurse to implement in order to reduce complica- tions that may occur with this drug's administration?
11 /
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
that contains multidrug-resistant Staphylococcus aureus (MRSA). Which drug would the nurse expect to be chosen for therapy?
Vancomycin is the drug of choice for the treatment of MRSA. The other drugs are not used for MRSA
vancomycin (Vancocin) and finds that the trough vancomycin level is 24 mcg/mL. What will the nurse do next?
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.
diarrhea
beginning antibiotic therapy.: ESSENTIAL; BEFORE
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
acidic fluids may nullify the drug's antibacterial action.
14 /
allergic to penicillin. Based on this finding, the nurse would question an order for which class of antibiotics?
Allergy to penicillin may also result in hypersensitivity to cephalosporins. The other options are incorrect.
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?
Administering penicillin reduces the vitamin K in the gut (intestines); therefore, enhanced anticoagulant effect of warfarin may occur.
16 /
Iodine compounds are contraindicated in patients with allergies to seafood.
intravenous penicillin. Which drug will the nurse expect to use to treat this condition?
Epinephrine is the drug of choice for the treatment of anaphylaxis. The other drugs listed are incorrect choices.
a hypersensitivity reaction. Which of these assessment findings may be an indication of a hypersensitivity reaction? (Select all that apply.)
17 / Hypersensitivity reactions may be manifested by wheezing; shortness of breath; swelling of the face, tongue, or hands; itching; or rash.
notes that the patient has a gram-positive infection. Which generation of cephalosporin is most appropriate for this type of infection?
First-generation cephalosporins provide excellent coverage against gram-positive bacteria but limited coverage against gram-negative bacteria.
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?
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.
fluid volume status
19 /
that a drug in which class is likely to be used initially?
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.
the nurse notes that which drug is most likely to cause a severe interaction with the diuretic?
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.
ticholinergic drug. Which nursing diagnosis would be appropriate for this patient?
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.
(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?
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.
and the nurse provides instructions to the patient about the med- ication. Which statement by the nurse is correct?